Effective July 1, 2022, Penn Medicine guidance on out-of-state telehealth has been updated to reflect changes for compliant telehealth in Pennsylvania and New Jersey. Clinicians must be licensed in the state where the patient is located at the time of the visit. See details below:
Overview
Clinicians with a Pennsylvania license only:
- May see patients located in Pennsylvania via telehealth.
- Patients may be new or established.
- Non-compliant telehealth visits held with patients located in New Jersey or other states will not be billed.
- Patients are permitted to travel to Pennsylvania for the telehealth visit, and this must be clearly documented in the appointment notes.
Clinicians with a New Jersey license only (e.g., practice out of a New Jersey location only):
- May see patients located in New Jersey via telehealth.
- Patients may be new or established.
- Non-compliant telehealth visits held with patients located in Pennsylvania or other states will not be billed.
- Patients are permitted to travel to New Jersey for the telehealth visit, and this must be clearly documented in the appointment notes.
Clinicians with a Pennsylvania license, New Jersey license, and leasing agreement with Clinical Health Care Associates of New Jersey (CHCA):
- May see patients located in Pennsylvania or New Jersey via telehealth.
- Both temporary and permanent New Jersey licenses qualify, as long as the temporary license remains valid. New Jersey temporary licenses are scheduled to expire on 08/31/22 unless a clinician has applied for a permanent license by this date. See more details here.
- CHCA lease is required for CPUP and CCA billing clinicians.
- Patients may be new or established.
- Non-compliant telehealth visits held with patients located in states where a clinician is not licensed will not be billed.
- Patients are permitted to travel to Pennsylvania or New Jersey for the telehealth visit, and this must be clearly documented in the appointment notes.
Clinicians with a Pennsylvania and New Jersey license (no CHCA lease):
- Same guidance as those with a Pennsylvania license only; CHCA lease required for CPUP/CCA providers to offer telehealth in New Jersey
Clinicians with a Delaware license, interstate telehealth registration, or participating in licensure compact that includes Delaware:
- May see patients located in Delaware via telehealth.
- Clinicians may receive an Interstate Telehealth Registration if licensed in a state other than Delaware and that license is in good standing.
- Patients may be new or established.
Clinicians with an additional license in another state:
- May see established patients located in the state via telehealth and must abide by all state laws and regulations. To see new patients via telehealth who are located in an additional state where a clinician is licensed or to address other questions, please contact the Connected Health team: PennConnectedHealth@pennmedicine.upenn.edu
Cross-state controlled substance prescribing
Additionally, please be advised that cross-state controlled substance prescribing as part of a telemedicine visit is discouraged due to complex and changing state and federal laws that increase risk of non-compliance, including in-person examination requirements and limiting controlled substance prescribing to patients at certain treatment facilities or with certain conditions. If you believe your clinical practice requires an exception to this guidance, please consult with the Office of General Counsel.
Frequently asked questions
What actions will Penn Medicine be taking?
New Jersey and Pennsylvania will now have the same cross-state telemedicine measures as all other states:
- A soft stop warning will appear when scheduling a telehealth appointment with a new or established patient in Pennsylvania or New Jersey or an established patient in any other state.
A hard stop will prevent the scheduling of a telehealth appointment with a new patient whose home address is outside of Pennsylvania or New Jersey. - A scheduling work queue supports practices in identifying future visits that may need to be rescheduled or converted to in-person visits due to a mismatch between patient location and clinician licensure.
- A billing work queue supports revenue cycle in identifying past visits that may need to be no-charged due to a mismatch between patient location and clinician licensure.
- A patient-facing communication template will be shared with practices to distribute on an as-needed basis.
Why is Penn Medicine no longer advising out-of-state return patient visits for telemedicine unless a clinician is licensed in the state?
- This action is being taken to protect clinicians’ licenses. Most states have now ended state licensure waivers associated with the Covid-19 public health emergency and have made it clear that offering telehealth across state lines without a license in the state where the patient is located constitutes unauthorized practice.
- Additionally, there is increasing attention from state medical boards on out-of-state telemedicine activity, including enforcement of laws requiring a clinician to be licensed in the state where the patient originates the telemedicine visit.
What strategies can I use moving forward for my out-of-state telemedicine patients?
- Convert upcoming visits to an in-person visit; direct patient to a local provider if appropriate; determine whether patient in question is located in a state with infrequent practice exceptions; obtain a permanent license – see Out-of-state Telemedicine Physician Licensing Guide.
Who does this impact?
- This change impacts any clinician who requires an out-of-state license including physicians, NPs, PAs, nurses, social workers, psychologists, genetic counselors, nutritionists, pharmacists, speech therapists, and PT/OT.
If I have a large volume of patients in a certain state, should I pursue obtaining a permanent license there?
- Work with your department and entity leadership to determine whether there is a strategic or financial benefit to expanding your practice within a given state by pursuing a permanent license.
- Additionally, work with Connected Health (PennConnectedHealth@pennmedicine.upenn.edu) and the Office of General Counsel to explore whether there are additional laws/regulations relating to employment, medical board supervision, and billing that may impact your ability to practice in a given state.