Medicaid & Medicare

Out of State Providers

Telehealth makes it possible for providers to deliver services across state lines if they are properly licensed in the state the patient is located in. Some Medicaid programs have placed restrictions on providers located out-of-state, requiring them to have some sort of an in-state presence, while other states have explicitly allowed out-of-state providers as long as they are licensed in the state and enroll with the Medicaid program.

Click the map to scroll down to the state

Federal

Last updated 09/01/2022

Doctors of Medicine and Osteopathy – The requirement that a …

Doctors of Medicine and Osteopathy – The requirement that a doctor of medicine be legally authorized to practice medicine and surgery by the State in which he/she performs his/her services means a physician is licensed to practice medicine and surgery. (Similar regulations exist for other types of practitioners, see manual).

SOURCE:  Medicare General Information, Eligibility and Entitlement, Chapter 5 – Definitions, Updated 11/2/2018, Sec. 70, p. 31-32.  (Accessed Sept. 2022).

Items and services furnished outside the United States are excluded from coverage (with exceptions for beneficiaries traveling in Canada and emergency situations).

Payment may not be made for a medical service (or a portion of it) that was subcontracted to another provider or supplier located outside the United States. For example, if a radiologist who practices in India analyzes imaging tests that were performed on a beneficiary in the United States, Medicare would not pay the radiologist or the U.S. facility that performed the imaging test for any of the services that were performed by the radiologist in India.

SOURCE:  Medicare Benefit Policy Manual, Chapter 16 – General Exclusions from Coverage, Revised 11/6/14, Sec. 60, p. 24.  (Accessed Sept. 2022).

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Alabama

Last updated 08/12/2022

Providers (in-state and out-of-state) who meet enrollment requirements are eligible …

Providers (in-state and out-of-state) who meet enrollment requirements are eligible to participate in the Alabama Medicaid Program.

Providers must have an Alabama license and be enrolled as a provider with the Alabama Medicaid Agency.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28-p. 3 & 17). Jul. 2022. (Accessed Aug. 2022).

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Alaska

Last updated 08/15/2022

No Reference Found

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Arizona

Last updated 07/12/2022

A provider who is not licensed within the State of …

A provider who is not licensed within the State of Arizona may provide Telehealth services to an AHCCCS member located in the state if the provider is an AHCCCS registered provider and complies with all requirements listed within A.R.S. § 36-3606.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019. (Accessed Jul. 2022)

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Arkansas

Last updated 07/04/2022

A healthcare provider treating patients in Arkansas through telemedicine shall …

A healthcare provider treating patients in Arkansas through telemedicine shall be fully licensed or certified to practice in Arkansas and is subject to the rules of the appropriate state licensing or certification board. This requirement does not apply to the acts of a healthcare provider located in another jurisdiction who provides only episodic consultation services.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. Updated Jan. 1, 2022, (Accessed Jul. 2022).

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California

Last updated 09/06/2022

Provider must be licensed in CA, enrolled as a Medi-Cal …

Provider must be licensed in CA, enrolled as a Medi-Cal rendering provider or non-physician medical practitioner (NMP) and affiliated with an enrolled Medi-Cal provider group. The enrolled Medi-Cal provider group for which the health care provider renders services via telehealth must meet all Medi-Cal program enrollment requirements and must be located in California or a border community.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Aug. 2020), Pg. 3.; Welfare and Institutions Code 14132.725, as amended by SB 184 (2022 Session). (Accessed Sept. 2022).

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Colorado

Last updated 07/27/2022

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Connecticut

Last updated 08/10/2022

Effective Now Until June 30, 2023

The following providers in …

Effective Now Until June 30, 2023

The following providers in another state or territory of the United States or the District of Columbia, that provide telehealth services pursuant to his or her authority under any relevant order issued by the Commissioner of Public Health, and maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers, are considered a telehealth provider:

  • Physician
  • Physician assistant
  • Physical therapist or physical therapist assistant
  • Chiropractor
  • Naturopath
  • Podiatrist
  • Occupational therapist or occupational therapy assistant
  • Optometrist
  • Registered nurse or advanced practice registered nurse
  • Psychologist
  • Marital and family therapist
  • Clinical social worker
  • Master social worker
  • Alcohol and drug counselor
  • Professional counselor
  • Dietitian-nutritionist
  • Speech and language pathologist
  • Respiratory care practitioner
  • Audiologist
  • Pharmacist
  • Paramedic
  • Nurse-midwife
  • Dentist
  • Behavior analyst
  • Genetic counselor
  • Music therapist
  • Art therapist
  • Athletic trainer

Effective Now Until June 30, 2024

Ending on June 30, 2024, any Connecticut entity, institution or health care provider that engages or contracts with a telehealth provider that is licensed, certified or registered in another state or territory of the United States or the District of Columbia to provide health care or other health services shall verify the credentials of such provider in the state in which he or she is licensed, certified or registered, ensure that such a provider is in good standing in such state, and confirm that such provider maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers.

Ending on June 30, 2024, the Commissioner of Public Health may temporarily waive, modify or suspend any regulatory requirements adopted by the Commissioner of Public Health or any boards or commissions as the Commissioner of Public Health deems necessary to reduce the spread of COVID-19 and to protect the public health for the purpose of providing residents of this state with telehealth services from out-of-state practitioners.

SOURCE: HB 5596 (2021 Session)SB 2 (2022 Session). (Accessed Aug. 2022).

*See COVID-19 Licensing Section in regard to any effective temporary orders.

Effective July 1, 2022

The Commissioner of Public Health may issue an order authorizing telehealth providers who are not licensed, certified or registered to practice in this state to provide telehealth services to patients in this state. Such order may be of limited duration and limited to one or more types of providers described in subdivision (13) of subsection (a) of section 1 of public act 21-9, as amended by this act, or subdivision (12) of subsection (a) of section 19a906 of the general statutes, as amended by this act. The commissioner may impose conditions including, but not limited to, a requirement that any telehealth provider providing telehealth services to patients in this state pursuant to such order shall submit an application for licensure, certification or registration, as applicable. The commissioner may suspend or revoke any authorization provided pursuant to this section to a telehealth provider who violates any condition imposed by the commissioner or applicable requirements for the provision of telehealth services under the law. Any such order issued pursuant to this section shall not constitute a regulation, as defined in section 4-166 of the general statutes.

SOURCE: SB 2 (2022 Session), Sec. 33 & Practitioner Licensing CDPH (Accessed Aug. 2022).

Out-of-State Surgery

Physicians rendering inpatient surgical services for a CMAP member must ensure the hospital has submitted and obtained an approved prior authorization for the inpatient surgery. Once the hospital has an approved authorization on file for the CMAP member, the member is eligible to receive their pre- and/or post-surgical consultations via telemedicine. Any telemedicine service related to the surgery must be rendered by the Out-of-State (OOS) provider who will be performing the surgery. All telemedicine services must be clinically appropriate and medically necessary. Pre/Post surgery instructions are not eligible for reimbursement via telemedicine.

SOURCE: CT Medical Assistance Program, Provider Bulletin 2020-09 (March 2020), p. 4. (Accessed Aug. 2022).

The Commissioner of Public Health, in consultation with the Commissioner of Early Childhood, shall develop and implement a plan to establish licensure by reciprocity or endorsement of a person who (1) is (A) a speech and language pathologist licensed or certified to provide speech and language pathology services, or entitled to provide speech and language pathology services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, or (B) an occupational therapist licensed or certified to provide occupational therapy services, or entitled to provide occupational therapy services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, (2) has no disciplinary action or unresolved complaint pending against such person, and (3) intends to provide early intervention services under the employment of an early intervention service program participating in the birth-to-three program established pursuant to section 17a-248b of the general statutes.

When developing and implementing such plan, the Commissioner of Public Health shall consider eliminating barriers to the expedient licensure of such persons in order to immediately address the needs of children receiving early intervention services under the birthto-three program. The provisions of any interstate licensure compact regarding a speech and language pathologist or occupational therapist adopted by the state shall supersede any program of licensure by reciprocity or endorsement implemented under this section for such speech and language pathologist or occupational therapist.

On or before January 1, 2023, the Commissioner of Public Health shall (1) implement the plan to establish licensure by reciprocity or endorsement, and (2) report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and children regarding such plan and recommendations for any necessary legislative changes related to such plan.

SOURCE: SB 2 (2022 Session), Sec. 26. (Accessed Aug. 2022).

Effective July 1, 2024

A telehealth provider also is to include an appropriately licensed, certified or registered provider as listed below in another state or territory of the United States or the District of Columbia, who (i) provides telehealth services under any relevant order issued pursuant to section 33 of this act, (ii) provides mental or behavioral health care through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession, and (iii) maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut mental or behavioral health care providers:

  • physician
  • naturopath
  • registered nurse
  • advanced practice registered nurse
  • physician assistant
  • psychologist
  • marital and family therapist
  • clinical social worker
  • master social worker
  • alcohol and drug counselor
  • professional counselor
  • dietitian-nutritionist
  • nurse-midwife
  • behavior analyst
  • music therapist
  • art therapist

SOURCE: SB 2 (2022 Session), Sec. 30. (Accessed Aug. 2022).

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Delaware

Last updated 08/24/2022

The Distant site provider must be located within the continental …

The Distant site provider must be located within the continental US and enrolled in the DE Medicaid program or in a DE Medicaid Managed Care Organization to be reimbursed for services.

SOURCE:  DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.4.1 & 16.5.7 Telemedicine pg. 72 & 75 & DE Adult Behavioral Health Service Certification and Reimbursement Provider Policy Manual (Dec. 14, 2016), p. 11.  (Accessed Aug. 2022).

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District of Columbia

Last updated 09/03/2022

Providers must be enrolled in the Program and licensed, by

Providers must be enrolled in the Program and licensed, by the applicable Board, to practice in the jurisdiction where services are rendered. For services rendered outside of the District, providers shall meet any licensure requirements of the jurisdiction where he/she is physically located and the jurisdiction where the patient is physically located.

When the provider and patient receiving healthcare services are located in the District of Columbia, all individual practitioners shall be licensed in the state. For healthcare services rendered outside of the District, the provider of the services shall meet any licensure requirements of the jurisdiction in which the patient is physically located.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.9. (Accessed Sept. 2022).

Providers whose practice address is located outside of the geographic boundaries of the District of Columbia are eligible to request consideration for participation in the DC Medicaid program if licensed in the state of the practice address.

SOURCE: FQHC Billing Manual. DC Medicaid. (Aug. 24, 2022) Sec. 5.3.2. P. 15, Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 5.3.2. P. 17, & Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 5.3.2, P. 17. (Accessed Sept. 2022).

 

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Florida

Last updated 08/04/2022

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Georgia

Last updated 08/05/2022

Physicians with licenses in other states may be licensed under …

Physicians with licenses in other states may be licensed under the Interstate Medical Licensure Compact.  Providers should see the Georgia Composite Medical Board for additional information.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 7 (July 2022). (Accessed Aug. 2022).

 

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Hawaii

Last updated 08/14/2022

No reference found.

No reference found.

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Idaho

Last updated 08/22/2022

Medicaid Providers are required to be licensed, certified, or registered …

Medicaid Providers are required to be licensed, certified, or registered with the appropriate state authority. The claims processing system verifies the effective dates of the provider’s license against the date of service. Provider licensure must be up to date in their provider file or claims will be denied at the header level. Providers are required to split claims for covered and non-covered dates of service, or update their license with Gainwell Technologies and resubmit the claim.

Providers of telehealth services must be licensed by the Idaho Board of Medicine, Board of Nursing, or in the case of therapeutic consultation and crisis intervention for children’s developmental disabilities services, providers must meet staff qualifications. Providers at the distant site, who regularly provide telehealth services to Idaho Medicaid participants are required to maintain current Idaho licensure.

Please refer to Idaho Administrative Code for additional information.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  July 20, 2022 Sections 6.4 & 10.9.1 p. 39 & 129 & IDAPA 16.03.09 Sec.855., p. 106 (Accessed Aug. 2022).

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Illinois

Last updated 08/15/2022

For medical services, the provider rendering the service at the …

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

For psychiatric services, the provider rendering the service at the distant site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program.

SOURCE: IL Handbook for Practitioners Rendering Medical Services, Chapter 200, 220.5.7 p. 26, (June 2021); Handbook for Podiatric Services, Chapter F-200 Policy & Procedures, p. 28 (Oct. 2016), & Handbook for Encounter Clinic Services 210.2.2 pg. 17-18 (Aug. 2016). (Accessed Aug. 2022).

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Indiana

Last updated 08/21/2022

Prior Authorization for Out-of-State Services

All out-of-state services rendered to …

Prior Authorization for Out-of-State Services

All out-of-state services rendered to IHCP members require prior authorization (PA), with the following exceptions: …

  • Telemedicine services if providers have the subtype “telemedicine” attached to their enrollment – See the Telemedicine and Telehealth Services module for more information (IHCP has marked the Telemedicine and Telehealth Services module “obsolete.”)

SOURCE: IN Medicaid Out-of-State Providers Module, Jan. 1, 2021, p. 1, (Accessed Aug. 2022).

Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.

SOURCE: IN Code 12-15-5-11, Sec. 11, f (Accessed Aug. 2022)

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Iowa

Last updated 07/21/2022

No Reference Found

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Kansas

Last updated 08/18/2022

No reference found. See Cross-State Licensing Section under Professional Requirements.…

No reference found. See Cross-State Licensing Section under Professional Requirements.

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Kentucky

Last updated 08/12/2022

KY Medicaid program shall require a telehealth provider to be …

KY Medicaid program shall require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services.

SOURCE: KY Statute Sec. 205.5591. (Accessed Aug. 2022).

Telehealth Provided by an Out-of-State Telehealth Care Provider.
  • The department shall evaluate and monitor the healthcare quality and outcomes for recipients who are receiving healthcare services from out-of-state telehealth care providers.
  • The department shall implement any in-state or out-of-state participation restrictions established by a state licensing board for the impacted provider.

SOURCE: 907 KAR 003:170. (Accessed Aug. 2022).

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Louisiana

Last updated 08/02/2022

No Reference Found

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Maine

Last updated 07/28/2022

Healthcare Providers must be licensed or certified in the state …

Healthcare Providers must be licensed or certified in the state of Maine.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p. 1, (June 15, 2020). (Accessed Jul. 2022).

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Maryland

Last updated 08/02/2022

If you are rendering services via telehealth with a participant …

If you are rendering services via telehealth with a participant located in Maryland, then you are considered to be practicing in Maryland; therefore, you must be licensed in Maryland and are subject to your professional board’s licensure requirements.

It is your responsibility to ensure that you meet the Board licensure requirements. This includes consulting with the professional board in the state where the patient physically is located as well as where the provider is physically located. Failure to comply with licensure requirements involving services delivered via telehealth will likely have implications beyond Maryland Medicaid’s telehealth purview.

SOURCE: MD Medicaid Telehealth Program FAQs. p. 2, Updated April 2020. (Accessed Aug. 2022).

“Health care provider” means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program.

SOURCE: MD Health General Code Sec. 15-141.2(a)(4)(i). (Accessed Aug. 2022).

 

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Massachusetts

Last updated 08/26/2022

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Michigan

Last updated 09/03/2022

Telemedicine services must be provided by a health care professional …

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1889, Jul. 1, 2022 (Accessed Sept. 2022).  

Assertive Community Treatment Programs (ACT)

The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 351, Jul. 1, 2022 (Accessed Sept. 2022).

Behavioral Health Therapy

Providers of telepractice services must be currently certified by the Behavior Analyst Certification Board (BACB), be a QBHP, be fully licensed in MI as a fully licensed psychologist, or be a practitioner who holds a limited license and is under the direction of a licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 484-485, Jul. 1, 2022 (Accessed Sept. 2022).

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Minnesota

Last updated 08/03/2022

Out-of-state coverage policy applies to services provided via telehealth. See …

Mississippi

Last updated 08/24/2022

For teleradiology, consulting and referring provider is a licensed physician …

For teleradiology, consulting and referring provider is a licensed physician (or PA or NP for referring providers) who must be licensed in the state within the United States in which he/she practices.

SOURCE: MS Admin. Code 23, Part 225, Rule 3.1. (Accessed Aug. 2022).

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Missouri

Last updated 08/22/2022

Payment cannot be made to any financial institutions, telemedicine providers, …

Payment cannot be made to any financial institutions, telemedicine providers, pharmacies, or other entities outside of the US, and US territories.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 58 (Aug. 19, 2022)MO HealthNet, Physician Manual, Telehealth Services, p. 66 (Aug. 19, 2022) & MO HealthNet, Rural Health Clinic, p. 56 (Aug. 19, 2022). (Accessed Aug. 2022). (Language also appears in ALL Medicaid manuals).

In order to treat participants in this state through the use of telemedicine, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards. In addition, psychologists licensed in a Psychology Interjurisdictional Compact (PSYPACT) state may render telemedicine services under the Authority to Practice Interjurisdictional Telepsychology, according to the requirements in the PSYPACT.

A health care provider utilizing telemedicine at either a distant site or an originating site shall be enrolled as a MO HealthNet provider pursuant to 13 CSR 65-2.020 and be fully licensed for practice in the state of Missouri. A health care provider utilizing telemedicine must do so in a manner that is consistent with the provisions of all laws governing the practice of the provider’s profession and shall be held to the same standard of care as a provider employing in-person behavioral health or medical health care.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Aug. 2022). 

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Montana

Last updated 08/01/2022

Providers must be licensed in the state of Montana.

Any …

Providers must be licensed in the state of Montana.

Any out of state distance providers must be licensed in the State of Montana and enrolled in Montana Healthcare Programs in order to provide telemedicine services to Montana Healthcare Programs members. Providers must contact the Montana Department of Labor and Industry to find out details on licensing requirements for their applicable professional licensure.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Aug. 2022).

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Nebraska

Last updated 08/25/2022

Payment in fee-for-service and Managed Care may be approved for …

Payment in fee-for-service and Managed Care may be approved for services provided outside Nebraska in the following situations:

  • When an emergency arises from accident or sudden illness while a client is visiting in another state and the client’s health would be endangered if medical care is postponed until the client returns to Nebraska;
  • When a client customarily obtains a medically necessary service in another state because the service is more accessible; and
  • When the client requires a medically necessary service that is not available in Nebraska.

Prior authorization is required for out-of-state services.  See regulation for procedures.

Out-of-State telehealth services are covered if the telehealth services otherwise meet the regulatory requirements for payment for services provided outside Nebraska and:

  • When the distant site is located in another state and the originating site is located in Nebraska; or
  • When the Nebraska client is located at an originating site in another state, whether or not the provider’s distant site is located in or out of Nebraska.

SOURCE: NE Admin. Code Title 471, Ch. 1,  Sec. 1-002.02(E) & 1-004.11, (Accessed Aug. 2022).

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Nevada

Last updated 08/17/2022

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New Hampshire

Last updated 08/18/2022

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New Jersey

Last updated 09/06/2022

A psychiatrist or psychiatric APN may be off-site, but must …

A psychiatrist or psychiatric APN may be off-site, but must be licensed in the State of New Jersey.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Sept. 2022).

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New Mexico

Last updated 08/05/2022

For telemedicine services, when the originating-site is in New Mexico …

For telemedicine services, when the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and regulations or meet federal requirements for providing services to IHS facilities or tribal contract facilities. Provision of telemedicine services does not require that a certified medicaid healthcare provider be physically present with the MAP eligible recipient at the originating site unless the telemedicine consultant at the distant site deems it necessary.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Aug. 2022).

When the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and NMAC rules or meet federal requirements for providing services to IHS facilities or tribal contract facilities.

SOURCE: NM Administrative Code 8.310.3.9 (F). (Accessed Aug. 2022). 

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New York

Last updated 08/25/2022

“Distant site” means a site at which a telehealth provider …

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Aug. 2022).

A distant site must be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.

The originating site must be located within the fifty United States or United States’ territories.

Practitioners providing services via telehealth must be licensed or certified, currently registered in accordance with NYS Education Law or other applicable law, and enrolled in NYS Medicaid.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3 & 6. (Accessed Aug. 2022).

Telemental Health

The distant site must possess a current, valid license, permit, or limited permit to practice in New York State.

Psychiatrists and nurse practitioners in psychiatry may deliver services from a site located within the United States, including from a space in a place of residence approved by the Office of Mental Health; and

Mental health practitioners may deliver services from a site located within the State of New York, including from a space in a place of residence approved by the Office of Mental Health.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.6 , New York State Office of Mental Health, Telemental Health Guidance (Nov. 2019) p. 7. (Accessed Aug. 2022).

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North Carolina

Last updated 08/17/2022

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North Dakota

Last updated 04/05/2022

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Ohio

Last updated 09/07/2022

Mental Health Services Provided by Agencies

Provider must have a …

Mental Health Services Provided by Agencies

Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive in person services rather than telehealth services.

SOURCE: OAC 5122-29-31. (Accessed Sept. 2022).

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Oklahoma

Last updated 09/06/2022

The provider must be contracted with SoonerCare and appropriately licensed …

The provider must be contracted with SoonerCare and appropriately licensed or certified, in good standing.  Services that are provided must be within the scope of the practitioner’s license or certification. If the provider is outside of Oklahoma, the provider must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.

Providers and/or patients may provide or receive telehealth services outside of Oklahoma when medically necessary, however prior authorization may be required.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Sept. 2022).

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Oregon

Last updated 08/23/2022

The Authority may expand network capacity through remote care and …

The Authority may expand network capacity through remote care and telemedicine, or telehealth services provided across state lines.

SOURCE: OR OAR 410-120-1990 (Accessed Aug. 2022).

A provider located in a state other than Oregon whose services are rendered in that state shall be licensed and otherwise certified by the proper agencies in the state of residence as qualified to render the services. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services.  See rule for additional requirements.

SOURCE: OR OAR 410-120-1180 (Accessed Aug. 2022).

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Pennsylvania

Last updated 04/07/2022

Out-of-state licensed practitioners who provide treatment through telehealth to individuals

Out-of-state licensed practitioners who provide treatment through telehealth to individuals in Pennsylvania through the MA program must meet the licensing requirements established by the Pennsylvania Department of State. In order to receive payment for services to beneficiaries in the FFS delivery system, practitioners must be enrolled in the MA Program. Practitioners seeking to provide services to beneficiaries in the managed care delivery system should contact the appropriate Managed Care Organization for its enrollment processes. Practitioners are also advised to consult with their professional liability insurance carrier regarding provision of services in other jurisdictions.

SOURCE: PA Department of Human Services, Office of Mental Health and Substance Abuse Services Bulletin OMHSAS-22-02, p. 3, July 1, 2022, (Accessed Sept. 2022).

Out-of-state licensed practitioners who render services via telemedicine to individuals in Pennsylvania through the MA Program must meet the licensing requirements established by the Pennsylvania Department of State. In order to receive payment for services to beneficiaries in the FFS delivery system, practitioners must be enrolled in the MA Program.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-22-02, p. 5, May 6, 2022, (Accessed Sept. 2022).

See Miscellaneous section for residence temporarily out-of-state.

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Rhode Island

Last updated 07/20/2022

No Reference Found

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South Carolina

Last updated 08/12/2022

The health professional providing the medical care must be currently …

The health professional providing the medical care must be currently and appropriately licensed in South Carolina and located within the South Carolina Medical Service Area (SCMSA), which is defined as the State of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina State border.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30 (July 2022). (Accessed Aug. 2022).

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South Dakota

Last updated 08/19/2022

The out-of-state prior authorization requirement does not apply if the …

The out-of-state prior authorization requirement does not apply if the recipient is located in South Dakota at the time of the service and the provider is located outside of the State. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

The distant site provide does not need an out-of-state prior authorization for services delivered via telemedicine. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 & 12-13 (May. 2022), & Telemedicine and Telephonic Services Updates Bulletin July 2, 2021, (Accessed Aug. 2022).

Indian Health Service (IHS) Servicing Providers Licensure and Referrals

Per 42 CFR 431.110, servicing providers who practice at an Indian Health Service (IHS) facility may do so with a South Dakota license or an equivalent license from another state as long as the individual otherwise meets South Dakota Medicaid’s provider eligibility requirements.

Referrals made to non-IHS providers by IHS physicians and other licensed practitioners who are solely licensed out-of-state are considered valid referrals under federal regulation. Non-IHS providers should accept referrals by IHS providers on the same basis as they accept referrals from non-IHS providers.

Certain exceptions apply for Indian Health Service providers. See Medicaid Out of State section for details.

SOURCE: SD Department of Social Services, Indian Health Service (IHS) Servicing Providers Licensure and Referrals, May 25, 2022, (Accessed Aug. 2022).

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Tennessee

Last updated 09/05/2022

No Reference Found

No Reference Found

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Texas

Last updated 09/07/2022

Distant site providers must be licensed in Texas.

An out-of-state …

Distant site providers must be licensed in Texas.

An out-of-state physician who is a distant site provider may provide episodic telemedicine without a Texas medical license as outlined in Texas Occupations Code §151.056 and Title 22 Texas Administrative Code (TAC) §172.2(g)(4) and 172.12(f).

Distant site providers that provide mental health services must be appropriately licensed or certified in Texas, or be a qualified mental health professional-community services (QMHP-CS), as defined in 26 TAC §301.303(48).

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 8 (Sept. 2022). (Accessed Sept. 2022).

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Utah

Last updated 08/23/2022

No Reference Found

No Reference Found

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Vermont

Last updated 08/11/2022

No Reference Found

No Reference Found

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Virginia

Last updated 09/01/2022

Providers must maintain a practice at a physical location in …

Providers must maintain a practice at a physical location in the Commonwealth or be able to make appropriate referral of patients to a Provider located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Providers must meet state licensure, registration or certification requirements per their regulatory board with the Virginia Department of Health Professions to provide services to Virginia residents via telemedicine. Providers shall contact DMAS Provider Enrollment (888-829-5373) or the Medicaid MCOs for more information.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), (Apr. 2022) (Accessed Sept. 2022).

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Washington

Last updated 08/26/2022

No Reference Found

No Reference Found

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West Virginia

Last updated 09/02/2022

All interstate telehealth practitioners must be registered with the appropriate …

All interstate telehealth practitioners must be registered with the appropriate board in West Virginia.

Interstate: The provision of telehealth services to a patient located in West Virginia by a healthcare practitioner located in any other state or commonwealth of the United States. The practitioner must be licensed and in good standing in the state they reside and not currently under investigation or subject to an administrative complaint. The provider must register as an interstate telehealth practitioner with the appropriate board in West Virginia and will be subject to the laws and requirements set forth by the registering board. The practitioner must also enroll with the current Medicaid fiscal agent(s) as an Interstate Provider. A practitioner currently licensed to practice in West Virginia is not subject to registration.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 3, 5 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

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Wisconsin

Last updated 09/02/2022

ForwardHealth policy for services provided via telehealth by out-of-state providers …

ForwardHealth policy for services provided via telehealth by out-of-state providers is the same as ForwardHealth policy for services provided face to face by out-of-state providers. Out-of-state providers who do not have border status enrollment with Wisconsin Medicaid are required to obtain PA before providing services via telehealth to BadgerCare Plus or Medicaid members.

Note: Wisconsin Medicaid is prohibited from paying providers located outside of the United States and its territories, including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Sept. 2022).

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Wyoming

Last updated 07/19/2022

The billing Provider must comply with all licensing and regulatory …

The billing Provider must comply with all licensing and regulatory laws applicable to the Providers’ practice or business in Wyoming and must not currently be excluded from participating in Medicaid by state or federal sanctions.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 123 (Jul. 1, 2022), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pg. 133 & Ch. 7 CMS-1500 Common Billing Information, pg.  208  (Jul. 1, 2022) & Institutional Provider Manual pg. 133.  (Jul. 1, 2022). (Accessed Jul. 2022).

If the provider is an out-of-state, non-enrolled provider and renders services to a Medicaid client, the provider may choose to enroll in the Medicaid Program and submit the claim according to Medicaid billing instructions, or bill the client.  Out-of-state providers furnishing services within the state on a routine or extended basis must meet all of the certification requirements of the State of Wyoming. The provider must enroll in Medicaid prior to furnishing services.

Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers).

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pgs 36 & 122 (Jul. 1, 2022), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 3 Provider Responsibilities, pg. 44, Ch. 6 Institutional/UB Common Billing Information, pg. 132 & Ch. 7 CMS-1500 Common Billing Information, pg. 206 (Jul. 1, 2022) & Institutional Provider Manual pgs. 43 & 132.  (Jul. 1, 2022). (Accessed Jul. 2022).

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Medicaid & Medicare

Out of State Providers

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