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Care Across State Lines: Telehealth and the Traveling Patient
A member calls from a rented condo in Scottsdale. Another is spending January in Naples and wants her blood pressure medicine adjusted. For licensing purposes, both visits take place where the patient is sitting, not where your office is. This brief sets out the basic rule, the licensure routes that exist, where federal telehealth and prescribing rules stand in October 2026, and a scenario tool that turns a member’s travel into questions for your state board and your attorney.
New in October 2026. Federal dates checked October 7, 2026. A companion to Brief No. 33 (Medicare) and Brief No. 24 (technology in the membership practice).
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
State medical boards treat a telehealth visit as care delivered where the patient is located at that moment, so the license that matters is usually the one for the patient’s state, not yours. Some states carve out narrow exceptions. North Dakota, for example, lets an out-of-state physician keep treating an established patient who is there temporarily, and Florida offers a telehealth registration for out-of-state clinicians. For physicians who expect to follow members into the same states year after year, the Interstate Medical Licensure Compact (44 member states plus two territories as of September 30, 2026) speeds up getting separate state licenses. Federal rules run on their own clocks: Medicare’s telehealth flexibilities are extended through December 31, 2027, and the DEA’s flexibilities for prescribing controlled substances by telemedicine expire December 31, 2026, with a final special registration rule under White House review. None of this is legal advice. Confirm each state with its board and your counsel.
My member is out of state. Whose license do I need?
As a rule, the license of the state where the patient is physically located during the visit. The FSMB and HHS both say so. A handful of state exceptions exist, and they are narrow.
Go to the full answer ↓Is there a faster way to get licensed in more states?
The Interstate Medical Licensure Compact offers an expedited path to separate licenses in member states for physicians who meet its eligibility rules. It does not create a single multistate license.
Go to the full answer ↓Can I do a follow-up visit with a member who is traveling?
Sometimes. A few states allow follow-up care for established patients who are there temporarily; others require a license or a telehealth registration. Check the specific state’s rules before the visit.
Go to the full answer ↓Where do Medicare telehealth rules stand?
Most Medicare flexibilities, including telehealth at home anywhere in the U.S., run through December 31, 2027. They govern Medicare payment. They do not replace state licensure.
Go to the full answer ↓Can I prescribe a controlled substance by telehealth to a traveling member?
Federal flexibilities that waive the in-person exam requirement run through December 31, 2026. A final DEA special registration rule is under review and not yet public, and state law can be stricter. Treat this as an open question for 2027.
Go to the full answer ↓Does my malpractice policy follow the patient?
Not automatically. Ask your carrier in writing whether your policy covers telehealth to a patient located in each state your members visit.
Go to the full answer ↓The visit happens where the patient is sitting
State medical boards decide licensure by the patient’s location, not the physician’s. The Federation of State Medical Boards put it in one sentence in its 2022 telemedicine policy, and added that a physician “must be licensed, or appropriately authorized, by the medical board of the state where the patient is located.”1 Policy and Law
“The practice of medicine occurs where the patient is located at the time that telemedicine technologies are used.” Federation of State Medical Boards, 2022
Federal guidance agrees. HHS tells clinicians to be “licensed or legally permitted to practice in the state where the patient is located” and, as a practical habit, to verify the patient’s location and obtain consent before each appointment.2,
Concierge medicine sharpens the problem. Members pay for access, and many of them have second homes or grown children in other states. They reasonably expect the direct line to work from anywhere. The membership agreement can promise availability. It cannot carry a Georgia license into Arizona.
The clinical bar does not drop on a video call either. Under the same FSMB policy, telemedicine is held to the standard of an in-person encounter, and when that standard cannot be met virtually, telemedicine “is not appropriate.”1
Which of your members spend more than a few weeks a year in another state, and which states? A practice that can answer from its own records can plan licensure around real travel patterns. A practice that cannot ends up deciding on a Saturday phone call.
CMT survey data from concierge practices (reported separately from DPC) on the share of members who spend 30 or more days a year in another state, the most common destination states, whether physicians hold licenses there, and how practices handle visits with those members today. Report sample size, dates and recruitment method.
Editor: replace this box with CMT survey results (with sample size, dates and recruitment method) before publishing, or delete it.
Five routes, each with limits
A physician who wants to care for a member in another state has a short list of legal routes. Which ones exist depends entirely on the state the patient is in, and the details change often.
The Center for Connected Health Policy counts are from its Fall 2025 survey of state law and will drift as legislatures act.5 Treat them as a sense of scale. The state board is the source of record.
| Route | What it allows | Main limits | Where to verify | Evidence type |
|---|---|---|---|---|
| Full license in the patient’s state | Full practice in that state, by telehealth or in person | Application time and fees in every state; renewals and continuing education add up | That state’s medical board3 | Policy and Law |
| Interstate Medical Licensure Compact | An expedited path to separate licenses in member states; one application, then a license from each state you choose | Strict eligibility (board certification, a clean disciplinary record, exam attempt limits, accredited training); $700 compact fee plus each state’s license fee; not every state is a member | imlcc.com and the state board6 | Policy and Law |
| Telehealth registration | Telehealth to patients in that state without a full license. Florida is one example | Florida registrants may not open an office in the state or see patients there in person, and must meet a liability coverage requirement | The state’s statute and health department7 | Policy and Law |
| Follow-up or temporary-presence exception | Continued care for an established patient in a few states, such as North Dakota and Alaska | Narrow conditions: an existing relationship, sometimes a prior in-person exam, time limits, and usually established problems only | The board’s rule text, not a summary8, | Policy and Law |
| Physician-to-physician consultation | Advising a physician licensed in the patient’s state who keeps responsibility for care | You are not the treating physician; the local clinician must request and direct care | State exception language1, | Policy and Law |
How the compact works
The IMLC is often misunderstood. Physicians “do not receive a ‘Compact license’ or a nationally recognized medical license.” The compact verifies eligibility once through a State of Principal License, issues a Letter of Qualification valid for 365 days, and each member state then issues its own license.6 Policy and Law The State of Principal License must be a member state where the physician holds a full, unrestricted license and either lives, does at least 25% of his or her practice, is employed, or files federal taxes as a resident. Adding a state later costs a $100 request fee plus that state’s fee.6
Membership is still moving. The commission’s October 2026 snapshot lists four states (Alaska, Arkansas, New Mexico and Rhode Island) as having passed the compact with implementation still in process, and New York with legislation introduced.4 Check the map for your members’ destination states before assuming the compact reaches them.
What state exceptions look like in the text
North Dakota’s rule, effective January 1, 2025, is one of the clearest. A physician licensed elsewhere may continue care for a North Dakota resident when the relationship was established in a state where the physician is licensed, for up to one year before another in-person encounter is required. A separate exception covers an established patient who is in North Dakota temporarily for business, work, education or vacation. New conditions, or care that requires an in-person exam, send the patient back to the licensing state or to a North Dakota physician.8 Policy and Law
Alaska allows telehealth without an Alaska license where the physician has an established relationship with the patient and has examined the patient in person before, with separate provisions for referrals and follow-up involving a life-threatening condition.9 Florida takes a different approach. Its statute offers registration, and the only exemptions CMT found in it are for emergencies and for consultation with a Florida-licensed clinician who keeps authority over the patient’s care.7 CMT did not find a visiting-patient exception in the Florida text; that is CMT’s reading, and counsel should confirm it.
These exceptions track the FSMB’s recommendation of “episodic follow-up care” for established patients who are temporarily away, limited to established problems, with a backup plan for local care and a transition plan if the stay stops being temporary.1
Exceptions are written for continuity of care. They tend to cover the hypertension follow-up with a long-time patient who is away for a month. They rarely cover a new complaint or a member who now lives in the other state most of the year. Where members return to the same state every winter, a license there is often simpler than a fresh exception analysis each season. That is editorial reasoning, not legal advice.
Two federal clocks, and neither one is a license
Federal telehealth rules decide what Medicare will pay for and when a controlled substance may be prescribed without an in-person exam. They do not decide which state’s license you need. Both sets of rules have changed several times since 2025.
DEA proposes a special registration for telemedicine. As proposed, a clinician would need a DEA registration in the state where the patient is located, plus a new DEA-issued state telemedicine registration for each state where he or she prescribes.10 Policy and Law
Medicare telehealth flexibilities lapse during the federal shutdown. CMS later said claims would be paid as if the lapse never happened.11 Policy and Law
DEA and HHS publish a fourth temporary extension: registered practitioners may prescribe Schedule II to V controlled substances by telemedicine without a prior in-person evaluation, if listed conditions are met, through December 31, 2026.12 Policy and Law
Congress passes the Consolidated Appropriations Act, 2026, extending most Medicare telehealth flexibilities through December 31, 2027.13,
DEA sends its final special registration rule to the White House Office of Information and Regulatory Affairs for review. The text is not public.15
Current DEA telemedicine prescribing flexibilities are scheduled to end.12 Policy and Law
Under current law, Medicare telehealth generally returns to rural facility originating sites outside behavioral health, and the in-person requirement for mental health telehealth takes effect.11 Policy and Law
Medicare: the patient can be anywhere, the license still matters
Through December 31, 2027, CMS says Medicare beneficiaries can receive telehealth “anywhere in the United States and territories,” including at home, and audio-only care at home is permitted.11 Policy and Law HHS lists several behavioral health provisions as permanent.14 None of these provisions speaks to state licensure. A Medicare patient in a Florida condo is still a patient in Florida for the Florida board.
For concierge physicians who stay enrolled in Medicare, there is a second issue. A covered telehealth visit is a covered service, and federal regulators warned in 2004 that charging Medicare patients a fee for covered services can violate the assignment agreement.16 Policy and Law CMT Research Brief No. 33 covers how membership fees and Medicare coverage fit together.
Controlled substances: plan for a change on January 1
Until December 31, 2026, the federal in-person exam requirement for telemedicine prescribing is waived, subject to the conditions in the rule.12 What replaces it is unknown as of October 7, 2026. A law firm alert from September 2026 reports that the final rule is under review and could be published before the flexibilities expire, and that the review period can run 90 days with a possible extension.15 If the final rule keeps the proposal’s state-by-state registration design, a physician prescribing to members in several states would need to plan for it. That is an inference from the proposed rule, not a reading of the final one.10
State law layers on top. Florida’s telehealth statute, for one, bars using telehealth to prescribe Schedule II controlled substances except in listed settings such as psychiatric disorders, hospital inpatients, hospice and nursing home residents.7 Policy and Law
CMT confirmed the Medicare dates on CMS and HHS pages updated in February 2026 and the DEA dates in the Federal Register. CMT could not confirm what the final DEA rule will contain or when it will appear. Check the Federal Register and the DEA Diversion Control Division before prescribing controlled substances by telemedicine after December 31, 2026.
Malpractice coverage, member agreements and the member who moves
Licensure is the first question. Close behind it are whether your insurance responds if something goes wrong and whether your membership agreement promises more than the law lets you deliver.
Ask your carrier in writing
Coverage for telehealth to patients in other states depends on the policy. One national carrier markets its coverage as following the patient wherever the physician is licensed, and in the same page notes that terms and availability vary by location and underwriting company.17 Industry Research
Send the carrier a list of the states your members visit and ask whether a claim arising from a telehealth visit with a patient in each one would be covered. Florida’s registration route makes liability coverage a condition of registering.7
Unlicensed practice has consequences
Practicing without authorization in the patient’s state is a board matter there, not only at home. Alaska’s licensing agency says its medical board can sanction unlicensed telehealth practice and recover its investigation and hearing costs.9 Policy and Law
North Dakota’s rule states that a physician using its exceptions consents to North Dakota law and the board’s disciplinary jurisdiction.8
Check what the agreement promises
CMT’s reading: a membership agreement or website that promises video visits “wherever you are” sets an expectation the practice may not be able to meet lawfully. Plainer language works better. Name the states where the physician is licensed, and say how the practice will help arrange local care when a member is elsewhere.
Brief No. 43 covers the contract side of membership fees, and Brief No. 36 covers privacy and security on the platforms used for remote visits.
When a season becomes a move
The FSMB policy says that when a patient’s location stops being temporary, the physician should develop a plan to transition care to a physician licensed where the patient now lives.1 Policy and Law
North Dakota builds a time limit into its rule: one year of continued telehealth before another in-person visit in the licensing state.8 A move is also a natural moment to talk about whether the membership still serves the member.
The traveling patient: what to verify before the visit
Choose a scenario to see the questions to verify before the visit. The tool does not decide whether a visit is permitted. It cannot know your licenses or the rules in force on the day of the visit. Use it to prepare for a call with the state board or your attorney.
Traveling-patient scenario check
Sources behind the tool: FSMB 2022 policy, Telehealth.HHS.gov, IMLCC, the North Dakota, Alaska and Florida texts cited in Part 2, CMS, and the DEA’s December 2025 extension. Rules change; verify on the official site on the day you rely on them.
Map your members
List where members spend real time each year. Most practices find the same few states again and again.
License for the pattern
Check those states’ exceptions and your IMLC eligibility, then write a short protocol your staff can follow when a member calls from away.
Tell members plainly
Explain in the agreement and at the start of travel season what you can do by video from where they are, and who will see them locally when you cannot.
How this brief was built
CMT started from the Federation of State Medical Boards’ 2022 telemedicine policy and the federal telehealth guidance at Telehealth.HHS.gov, then checked licensure options against primary sources: the Interstate Medical Licensure Compact Commission’s own statistics and FAQ, North Dakota’s administrative rule, Alaska’s licensing agency page and Florida’s telehealth statute. The state examples were chosen because their official text could be opened and read, not because they are typical. For the count of states with exceptions or registrations, CMT relied on the Center for Connected Health Policy’s Fall 2025 report, a federally supported compilation. Federal status was taken from Federal Register notices and from CMS and HHS pages, with a law firm alert and a trade news report used only to describe review status and the name of the 2026 appropriations law. All sources were opened in October 2026; dates were checked on October 7, 2026.
The brief applies to concierge practices; it contains no direct primary care data, and the licensure rules discussed apply to physicians regardless of payment model. The malpractice point draws on one insurer’s own web page, labeled Industry Research. The scenario tool in Part 5 produces questions to verify, never a verdict on whether a visit is permitted. Because this is a legal topic, CMT recommends review by a healthcare attorney licensed in the relevant states before relying on any part of it.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- What the DEA’s final special registration rule will say, and whether it will be published before the current flexibilities lapse on December 31, 2026.
- How many concierge members live part of the year in another state. No published dataset CMT found measures this for membership practices.
- How state boards enforce visiting-patient rules in practice. Published disciplinary data rarely separate telehealth licensure cases.
- How Congress will handle Medicare telehealth after December 31, 2027, when rural and facility requirements return under current law.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Federation of State Medical Boards. The Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Report of the FSMB Workgroup on Telemedicine, adopted by the FSMB House of Delegates, April 2022. www.fsmb.orgFunding: not stated (adopted and published by the Federation of State Medical Boards)
- U.S. Department of Health and Human Services. Getting started with licensure (telehealth). Telehealth.HHS.gov. Last updated February 21, 2024. www.telehealth.hhs.govFunding: federal (U.S. Department of Health and Human Services publication)
- U.S. Department of Health and Human Services. Licensing across state lines. Telehealth.HHS.gov. Last updated April 30, 2025. telehealth.hhs.govFunding: federal (U.S. Department of Health and Human Services publication)
- Interstate Medical Licensure Compact Commission. IMLCC snapshot statistics and participation map (updated October 5, 2026; information as of September 30, 2026) and release: Alaska finalizes legislation to join IMLCC, June 26, 2026. www.imlcc.comFunding: not stated (published by the Interstate Medical Licensure Compact Commission)
- Center for Connected Health Policy (Public Health Institute). State Telehealth Laws and Reimbursement Policies Report, Fall 2025. October 2025. www.cchpca.orgFunding: mixed: federal (HRSA Office for the Advancement of Telehealth grant to the National Telehealth Policy Resource Center) and other funders named in the report
- Interstate Medical Licensure Compact Commission. Frequently asked questions (eligibility, State of Principal License, fees, location of practice). Accessed October 2026. www.imlcc.comFunding: not stated (published by the Interstate Medical Licensure Compact Commission)
- Florida Statutes, section 456.47: Use of telehealth to provide services (registration of out-of-state telehealth providers; Schedule II limits). The Florida Senate, 2026 Florida Statutes. flsenate.govFunding: state government publication (Florida)
- North Dakota Administrative Code, Article 50-02, Chapter 50-02-15 (telemedicine), section 50-02-15-03: Exceptions. North Dakota Board of Medicine; effective January 1, 2025. ndlegis.govFunding: state government publication (North Dakota)
- Alaska Division of Corporations, Business and Professional Licensing. Telehealth information (physicians licensed in another state). Accessed October 2026. commerce.alaska.govFunding: state government publication (Alaska)
- Drug Enforcement Administration. Special Registrations for Telemedicine and Limited State Telemedicine Registrations (proposed rule). Federal Register 90 FR 6541. January 17, 2025. www.federalregister.govFunding: federal (Drug Enforcement Administration publication)
- Centers for Medicare & Medicaid Services. Telehealth FAQ, updated February 26, 2026. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration (HHS). Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Federal Register 90(247):61301 to 61306. December 31, 2025. Effective January 1, 2026 through December 31, 2026. www.govinfo.govFunding: federal (Drug Enforcement Administration and HHS publication)
- Ivanova J. Federal telehealth policy in 2026: what the Medicare extensions mean. Telehealth.org. February 11, 2026. telehealth.orgFunding: not stated (news report)
- U.S. Department of Health and Human Services. Telehealth policy updates (Medicare telehealth flexibilities extended through December 31, 2027). Telehealth.HHS.gov. Last updated February 5, 2026. telehealth.hhs.govFunding: federal (U.S. Department of Health and Human Services publication)
- Faget KY, Mazur L, Greco J, Dimick GI. DEA appears close to finalizing telemedicine special registration. McDermott Will & Schulte client alert (law firm commentary). September 18, 2026. www.mcdermottlaw.comFunding: not stated (law firm commentary)
- HHS Office of Inspector General. OIG Alert: charging Medicare beneficiaries for services that are covered (assignment violations). March 31, 2004. hhs.govFunding: federal (HHS Office of Inspector General publication)
- The Doctors Company. Telemedicine malpractice insurance coverage (company web page). Accessed October 2026. www.thedoctors.comFunding: industry (The Doctors Company, company website)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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