Telehealth Needs National Standards To Serve Patients And Providers Better

Updated on June 11, 2024
Doctor talking with a senior patient. Telemedicine concept

Telehealth has significantly accelerated healthcare delivery, but at the same time, the conflicts between federal and state telehealth regulations are holding it back from reaching its full potential for patients and providers.

That’s not surprising when you consider that many medical board policies and regulations were created in the first half of the 20th century, before interstate travel and communication were widespread. As a result, many don’t exactly jibe with the way modern healthcare is practiced today, especially when it comes to telehealth. The issues particularly compound in terms of patient and provider location.

For instance, a clinician is allowed to meet with a patient from another state at their clinic if the patient crossed a state line to get there. However, when that same patient returns home, that clinician cannot provide care to them by telemedicine, or even deliver a home visit, unless they’re licensed to practice in that patient’s state. Case in point: 

When the state of Virginia rolled back Covid licensing exemptions, Johns Hopkins Medicine in Maryland had to quickly notify more than a thousand of their Virginia patients that their telehealth appointments were “no longer feasible” because their treating clinicians were not licensed to practice in Virginia.

In many cases telehealth has quickened and improved healthcare services, such as consultation, patient triage, treatment, and education. Nationwide, telehealth usage rates remain higher than pre-pandemic levels. In California, the use of telehealth  quadrupled between 2018 and 2022, according to a UCLA study. But different state telehealth regulations can add complexity, cause confusion for patients and providers, and limit patient choice and access to qualified care. Providers struggle to keep up with the nuances of each state’s laws, hindering their ability to offer telehealth services broadly. 

Therefore, given the patchwork regulations from state to state and the issues they create, we need uniform national telehealth standards to ensure the health and safety of patients and consistent, equitable telehealth services across all states. 

How different state rules affect telehealth

Once you’ve seen one medical board, you’ve seen one medical board; they’re all as unique as the states they represent, with their own personalities, interests, and priorities. Every state has different rules, and they change constantly. 

Federal laws set the basic safety standards, but states can then set their own limits. The differences in telehealth laws across various states can be quite significant, affecting how telehealth services are implemented, accessed, and reimbursed. Some state regulations are stricter than federal guidelines, such as with privacy protections and differing reimbursement structures and rates. 

Licensing requirements is another area where states can differ greatly. Some states require healthcare providers to be licensed in the state where the patient is located at the time of the telehealth service. Others participate in interstate compacts like the Interstate Medical Licensure Compact, which facilitates the licensing process across state lines but does not uniformly cover all states.

In terms of reimbursement policies, there is variability in how telehealth services are reimbursed by Medicaid and private insurers. Because Medicaid programs are state-specific, each state can determine what type of telehealth services are reimbursed, and for what amounts. Some states have parity laws that require insurers to reimburse telehealth services at the same rates as in-person services, while others may not mandate such parity.

Also, states differ in the types of telehealth services they cover. For example, some may allow a broad range of services, including mental health treatments, while others might restrict telehealth to certain types of medical consultations or follow-up visits.

Benefits of national telehealth standards

National uniformity in telehealth standards would help in streamlining regulations, simplifying the licensing process for providers, and ensuring that all patients receive the same standard of care regardless of their location. Streamlined national standards would remove unnecessary barriers for patients seeking telehealth services, which could be particularly beneficial for those in rural areas or with limited mobility.

With clear, consistent rules, providers would be more comfortable offering telehealth services across state lines. This would expand the pool of qualified healthcare professionals available to patients. Given the shortage of qualified professionals in many parts of the country, states would be wise to increase access to qualified healthcare professionals within their borders.

Another benefit: Standardizing nationally-recognized best practices for telehealth would raise the bar for quality of care across the board. Standardized telehealth regulations can lead to better patient outcomes by promoting wider access to qualified healthcare professionals and fostering a culture of quality and safety.

With national standards, telehealth can become a seamlessly integrated part of the healthcare ecosystem, benefiting patients, providers, and the overall healthcare system.

Brandon M. Welch
Brandon M. Welch, MD
Founder and CEO at

Brandon M. Welch, Ph.D., co-author of Telehealth Success: How to Thrive in the New Age of Remote Care, is the founder and CEO of, a telemedicine software company. Welch is also an associate professor at the Medical University of South Carolina, where his NIH-funded research develops new health technologies. Drawing from his experience as a researcher and business leader, Welch offers practical strategies and expert advice for aspiring innovators, entrepreneurs, and healthcare professionals alike. He holds a doctorate degree in biomedical informatics from the University of Utah School of Medicine, and a master’s degree in human genetics from the Tulane University School of Medicine. He lives in Charleston, South Carolina.