Are You Licensed Where Your Patient is Located? By Jeanne E. Varner Powell, JD Senior Legal Risk Management Consultant, Mutual Insurance Company of Arizona (MICA) Physicians and advanced practice professionals have over a year of clinical telemedicine experience under their belts but still have questions about the maze of legal, regulatory, and reimbursement requirements. Federal and state regulators have relaxed, waived, or modified telemedicine requirements during the pandemic, especially during shut-downs. As enforcement of these regulations resumes, practices and clinicians should review their telemedicine processes to ensure compliance. Variations on a Theme One of the most frequent telemedicine questions has many variations but can be summarized as whether a physician or advanced health care practitioner licensed and located in one state can provide telemedical care to a patient in another state at the time of the encounter. Illustrating Questions about the Patient’s Location • Dr. Acton (licensed and practicing in Utah) has an established patient, Jenny, who resides in Utah and is on a 3-day business trip in New Hampshire. Jenny wants a telemedicine appointment while she is away. • Dr. Bonet ’s (licensed and practicing in Utah) long-time pediatric patient, Jimmy, resides with his mother in Utah. Jimmy is visiting his father in North Dakota for the summer. Jimmy’s mother requests a telemedicine appointment while Jimmy is in North Dakota and his mother is in Utah. • Dr. Camara’s (licensed and practicing in Arizona) established patient, Ann, lives in Michigan but spends winters in Arizona. Ann wants Dr. Camara to continue treating her via telemedicine during the months she is in Michigan. • Nevada-based nurse practitioner Divata has taken care of a pediatric patient for many years. The patient and her family are in California for a week-long vacation. The mom asked for a video visit to assess and treat a rash on the patient ’s arm. Location and Licensure Answers When the patient is out of state, even temporarily, the answer is always the same. Physicians, advanced health care practitioners, and other licensed health care professionals have always had to comply with federal and state laws as well as state licensing requirements where the care is received – known as the originating site. In the examples above, the clinicians are not located or licensed in the state where the patient is located. Each state licensing agency oversees and disciplines the professionals it regulates. A physician providing care to a patient in Nebraska is subject to the rules and regulations of the Nebraska medical board. If the physician is not properly licensed in Nebraska, the physician may be practicing medicine in Nebraska without a license and subject to discipline. A Utah-licensed and -located clinician treating a Utah resident visiting Nebraska could also be subject to other Nebraska laws and court rules. Should the patient file a medical professional liability lawsuit in Nebraska, the Utah physician may be required to defend a lawsuit there. Located| Continued on page 34 33 |
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