Delaware

Last updated 11/18/2021

Consent Requirements

Informed consent must be obtained to establish a physician-patient relationship over telehealth.

SOURCE: Title 24, Ch. 60, Sec. 6003. As amended by HB 160 (2021 Session). Accessed Nov. 2021.

Applies to Physical Therapists:

Before services are provided through telehealth, the licensee shall obtain written, informed consent from the patient, or other appropriate person with authority to make health care treatment decisions for the patient. For the purpose of this subsection, written consent includes an electronic signature. At minimum, the informed consent shall inform the patient and document acknowledgement of the risk and limitations of:

• The use of electronic communications in the provision of care;
• The potential breach of confidentiality, or inadvertent access, of protected health information using electronic communication in the provision of care; and
• The potential disruption of electronic communication in the use of telehealth.

SOURCE: 24 DE Administrative Code 2600. (Accessed Nov. 2021).

Informed consent required by Boards (see regulation citations in Professional Board Standards tab).

Last updated 11/18/2021

Cross State Licensing

No Reference Found

Last updated 11/18/2021

Definitions

Applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Mental Health, Chemical Dependency Professionals, Psychology, Dietetic and Nutrition Therapy, and Clinical Social Workers

“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

“Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health-care.

SOURCE: Title 24, Ch. 60, Sec. 6001. As amended by HB 160 (2021 Session). Accessed Nov. 2021.

Applies to: Physical Therapy

“Telehealth, as set forth in the Board’s rules and regulations, means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including physical therapy and athletic training related information and services, over large and small distances.  Telehealth encompasses a variety of healthcare and health promotion activities, including education, advice, reminders, interventions, and monitoring of intervention.”

SOURCE: 24 DE Administrative Code 2600. (Accessed Nov. 2021).

NOTE: DE Professional Boards have different definitions of telehealth/telepractice/telemedicine.  See Miscellaneous section for references.

Last updated 11/18/2021

Licensure Compacts

Member of enhanced Nurse Licensure (NLC) Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status. (Accessed Nov. 2021). & NCBSN. Enhanced Nurse Licensure Compact (eNLC) Interstate Commission Sets Jan. 19, 2018, as Implementation Date for eNLC. (Accessed Nov. 2021).

Member of the Advanced Practice Registered Nurse (APRN) Compact.

SOURCE: APRN Compact Map and DE HB 21 (2021 Session) (Accessed Nov. 2021).

Member of Physical Therapy Licensure Compact.

SOURCE: PT Compact.  Member States.  (Accessed Nov. 2021). 

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT. PSYPACT Map.  (Accessed Nov. 2021).

Member of Interstate Medical Licensure Compact (IMLC) (Effective July 1, 2022)

SOURCE: HB 160 (2021 Session) (Accessed Nov. 2021) & IMLC Passed; Implementation Delayed (Accessed Nov. 2021)

Member of Emergency Medical Services Compact.

STATUS: Interstate Commission for EMS Personnel Practice, Member States, (Accessed Nov. 2021).

Last updated 11/18/2021

Miscellaneous

No Reference Found

Last updated 11/18/2021

Online Prescribing

Health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include the following:

• Thorough verification and authentication of the location and, to the extent possible, identity of the patient.
• Disclosure and validation of the provider’s identity and credentials.
• Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.
• Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contra-indications, or both, for treatment recommended or provided.
• Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.
• The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.
• A written visit summary provided to the patient.

Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.

Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

SOURCE: Title 24, Ch. 60, Sec. 6003. As amended by HB 160 (2021 Session) (Accessed Nov. 2021).

Pharmacists:

Pharmacists are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site.

SOURCE: DE Code, Title 16 Sec. 4744(d)(1)(a). (Accessed Nov. 2021)

Physicians:

A remote, audio-only examination is not an “appropriate in-person examination”.

No opioid prescribing is permitted via telemedicine with the exception of addiction treatment programs offering medication assisted treatment that have received a Division of Substance Abuse and Mental Health (DSAMH) waiver to use telemedicine through DSAMH’s licensure or renewal process. All other controlled substance prescribing utilizing telemedicine is held to the same standards of care and requisite practice as prescribing for in-person visits.

For formation of the physician-patient relationship using audio and visual communications, the audio and visual communications must be live, real-time communications.

SOURCE: DE Admin Code. Sec. 1700.  Sec. 19. (Accessed Nov. 2021)

Delaware Board of Medical Licensure has specific requirements for electronic prescribing.

SOURCE: DE Admin Code Sec. 1713(a)(12) (Accessed Nov. 2021)

Last updated 11/18/2021

Professional Board Standards

Health-care providers licensed by the following professional boards are authorized to deliver health-care services by telehealth and telemedicine:

• The Board of Podiatry created pursuant to Chapter 5 of this title.
• The Board of Chiropractic created pursuant to Chapter 7 of this title.
• The Board of Medical Practice created pursuant Chapter 17 of this title.
• The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.
• The Delaware Board of Nursing created pursuant to Chapter 19 of this title.
• The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.
• The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.
• The Board of Pharmacy created pursuant to Chapter 25 of this title.
• The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.
• The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.
• The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.
• The Board of Social Work Examiners created pursuant to Chapter 39 of this title.

A professional board may promulgate or revise regulations and establish or revise rules applicable to health-care providers under the professional Board’s jurisdiction in order to facilitate the provision of telehealth and telemedicine services.

Practice requirements:

A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least one of the following:

• Provide an appropriate examination in-person.
• Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.
• Make a diagnosis using audio or visual communication.
• Meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.

A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

Telehealth and telemedicine services shall include, if required by the applicable professional board listed, use of the Delaware Health Information Network (DHIN) in connection with the practice.

Nothing in this section shall be construed to limit the practice of radiology or pathology.

Exceptions:

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

• Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
• Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
• Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
• Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

SOURCE: DE Statute Title 24, Chap. 60, Sec. 6002 & 6004. As amended by HB 160 (2021 Session) (Accessed Nov. 2021)

Physical Therapists and Athletic Trainers

SOURCE: DE Statute Title 24, Sec. 2602 (Accessed Nov. 2021).

Board of Clinical Social Work Examiners

SOURCE: 24 DAC 3920. (Accessed Nov. 2021).

Board of Dentistry and Dental Hygiene

SOURCE: 24 DAC 1100 (Accessed Nov. 2021).

Pharmacy

SOURCE: 24 DAC 2500 (Accessed Nov. 2021).