The landscape of telehealth practice across state boundaries has never been more complex. As healthcare continues its digital transformation, understanding where you can legally provide or receive telehealth services has become crucial for providers and patients alike. With rising demand for remote care and an evolving patchwork of state regulations, navigating cross-state telehealth requires careful attention to legal requirements that vary dramatically from state to state.
Legal Mechanisms Enabling Cross-State Telehealth
Full Licensing vs. Temporary Practice Laws
The traditional approach requires healthcare providers to hold full licensure in every state where they practice telehealth. This remains the standard in many jurisdictions, where telehealth is considered to occur at the patient’s physical location. However, three main alternatives have emerged to address the burden this places on providers and the barriers it creates for patient access.
Interstate Licensure Compacts (IMLC, PSYPACT, Nursing Compact)
Interstate licensure compacts represent the most streamlined approach to cross-state practice. These agreements between participating states allow licensed professionals to practice across member states without obtaining additional licenses. Currently operational compacts include:
- Interstate Medical Licensure Compact (IMLC): Facilitates physician practice across 29+ member states by expediting the licensure verification process
- Psychology Interjurisdictional Compact (PSYPACT): Active in 41 states, with 39 already implementing the compact for licensed psychologists
- Nursing Licensure Compact: Covers registered nurses and licensed practical nurses in 41 participating states and territories
- Physical Therapy Compact, Audiology and Speech-Language Pathology Interstate Compact, and Emergency Medical Services Personnel Licensure Interstate Compact: Additional specialty compacts expanding provider mobility
Telehealth-Only Registration Processes
Twenty states have established specialized telehealth registration systems that provide a middle ground between full licensure and limited exceptions. Florida serves as the prime example of this model.
Florida’s telehealth registration system requires out-of-state practitioners to register with the Florida Department of Health, maintain active out-of-state licensure, designate a registered agent for legal service, and carry appropriate liability coverage. Importantly, registered providers cannot open physical offices in Florida or provide in-person services.
State Examples: What’s Allowed in 2025
California – AB 232 Temporary Practice Expansion
California historically maintained some of the strictest cross-state telehealth restrictions, but recent legislation has created new opportunities. AB 232, effective in 2024, authorizes a 30-day temporary practice allowance for out-of-state therapists to continue treating existing clients who are visiting or relocating to California. This addresses critical continuity of care issues, particularly for college students and individuals in transition.
The state also provides exceptions for providers treating patients with life-threatening diseases and maintains traditional peer-to-peer consultation exemptions.
Alabama – Infrequent Services Exception
Alabama offers one of the clearer examples of limited licensure exceptions. The state allows out-of-state providers to deliver telehealth services without Alabama licensure if services are “irregular or infrequent”—defined as occurring fewer than 10 days per calendar year or involving fewer than 10 patients annually.
Additional Alabama exceptions include services provided in consultation with an Alabama-licensed physician (limited to 10 days per year) and necessary medical care for patients being transported into the state.
Florida – Formal Telehealth Registration System
Florida’s comprehensive registration model has become a template for other states. The system requires out-of-state providers to complete formal registration, maintain active out-of-state licensure without pending investigations or discipline, and comply with specific operational restrictions.
Key Florida requirements include:
- Designation of a registered agent for service of process
- Maintenance of liability coverage equal to Florida requirements
- Prohibition on opening Florida offices or providing in-person services
- Use of Florida-licensed pharmacies for medication dispensing
Overview: Current State Distribution
Recent analysis shows that 36 states currently have limited licensure exceptions, though these vary widely in scope and applicability. Meanwhile, 20 states have established telehealth registration processes that provide alternative pathways for cross-state practice. Only a handful of states maintain absolute restrictions without any cross-state allowances.
Medication Rules & ADHD-Specific Considerations
Variations in Telehealth Prescribing Laws for Controlled Substances
The prescribing of controlled substances via telehealth has been significantly influenced by pandemic-era flexibilities. The Drug Enforcement Administration and Department of Health and Human Services have extended telehealth prescribing flexibilities for controlled substances, including ADHD medications like Adderall, through December 31, 2025.
These flexibilities allow practitioners to prescribe Schedule II-V controlled medications via telehealth without the typically required in-person evaluation, provided they meet patients through legitimate telehealth encounters. This has particular importance for ADHD treatment, where stimulant medications are frequently prescribed and continuity of care is essential.
State-Specific Examples and Texas Telehealth Policies
Individual states maintain their own additional requirements for controlled substance prescribing. For example, Alabama requires prescribers to have had at least one in-person encounter with patients within the preceding 12 months before prescribing controlled substances via telehealth. The online ADHD treatment in Texas landscape operates under both federal flexibilities and state-specific regulations that providers must carefully navigate.
How to Find Your State’s Rules
CCHP Policy Finder and Fall 2025 Report
The Center for Connected Health Policy (CCHP) Policy Finder remains the most comprehensive resource for current state telehealth regulations. CCHP’s Fall 2024 Summary Report, covering policy updates through September 2024, provides detailed state-by-state analysis of telehealth laws and Medicaid policies.
The Policy Finder allows users to export current information for individual states and tracks changes across multiple policy categories, including cross-state licensing, Medicaid reimbursement, and professional practice requirements.
State Medical Board Resources
Each state’s medical board and professional licensing agencies maintain their own guidance on telehealth requirements. Given the complexity and frequent changes in regulations, providers should regularly consult both CCHP resources and their relevant state boards for the most current requirements.
Quick Compliance Checklist for Providers
Confirm Patient’s Location
Always verify and document the patient’s physical location during telehealth encounters. This determines which state’s regulations apply and affects prescribing authority.
Check Licensing, Compacts, Registration, Exceptions
- Verify your home state licensure status and any compact participations
- Research the patient’s state for specific telehealth registration requirements
- Identify applicable limited licensure exceptions
- Confirm any consultation or referral requirements
Obtain Proper Consent
Most states require specific telehealth informed consent that goes beyond standard medical consent. This often includes disclosure of telehealth limitations, privacy considerations, and patients’ rights to decline remote services in favor of in-person care.
Track Renewal and Documentation Requirements
Interstate compacts, registrations, and exceptions often have specific renewal timelines and documentation requirements. For example, Connecticut requires annual renewal of telehealth informed consent.
Supporting access to care for conditions like ADHD often requires working with services that understand these complex regulatory environments. For individuals seeking emotional support animal documentation, qualified telehealth providers must navigate similar cross-state compliance requirements.
Companies like Receptive Health have developed expertise in managing telehealth service delivery across state lines while maintaining compliance with varying state regulations.
Conclusion
Telehealth’s expansion continues, but success requires vigilant compliance monitoring. The landscape of cross-state telehealth regulation is evolving rapidly, with states increasingly recognizing the need to balance patient access with regulatory oversight. While mechanisms like interstate compacts, registration systems, and limited exceptions are expanding opportunities for cross-state practice, the complexity of compliance requirements demands careful attention from both providers and healthcare organizations.
The current regulatory environment reflects a broader shift toward embracing telehealth as a permanent component of healthcare delivery rather than a temporary pandemic response. As states continue refining their approaches through 2025 and beyond, providers must stay informed about changing requirements while maintaining focus on delivering quality care across state boundaries.
For healthcare providers considering cross-state telehealth practice, the key to success lies in understanding that compliance is not a one-time checklist but an ongoing responsibility requiring regular monitoring of state regulations, compact developments, and federal policy changes. The investment in proper compliance infrastructure pays dividends in expanded patient access and reduced legal risk.
