Nurse Practitioners and Virtual Care: A 50-State Review of APRN Telehealth Law and Policy

METHODS

We performed an Internet search using Google, Firefox, and Chrome to locate telehealth information pertaining to healthcare providers. Various search terms were used in conjunction with each name of the 50 states: “telemedicine,” “telemedicine laws,” “telemedicine acts,” “nurse practice acts,” “telemedicine board of medicine,” “medical practice acts,” “telemedicine board of nursing,” “APRN telemedicine advisory opinions,” and “APRN telemedicine position statements” and the same utilizing the term “telehealth.” The most recent 50-state review by the Center for Connected Health Policy’s “State Telehealth Laws and Reimbursement Policies” was also used to identify legislation pertaining to APRNs and telehealth care.12

RESULTS

The findings summarized in Table 1 illustrate that most states have some telehealth guidelines, but the definition of telehealth varies, as well as the providers who can practice it. For example, the Alabama Board of Medical Examiners states that physicians can practice telemedicine within their scope of practice per Alabama Code §§ 34–24–290 and the Rules of the Alabama Board of Medical Examiners.13 This law also includes the scope of practice of telemedicine for nonphysician providers, such as physician assistants, certified registered nurse practitioners, and certified nurse midwives. The Alabama Nurse Practice Act also contains a definition of telehealth nursing [Code of Ala. 1975, §§ 34–21–2(c) (21)], and a description of the laws and regulations relating to telenursing practice [Code of Ala. 1975, §§ 34–21–2, 34–21–2 © (21)].14 Specifically mentioning telehealth in both the Rules of the Board of Medical Examiners and the Nurse Practice Act confirms that APRNs have the ability to practice telehealth within the state of Alabama.

https://doi.org/10.30953/tmt.v4.136
https://doi.org/10.30953/tmt.v4.136

DISCUSSION

The findings of the review reveal wide variations among states with regard to APRN practice and telehealth care. APRNs must review the telemedicine laws in the states where they practice with a critical eye to ensure that their practice falls within these regulations. Only nine states mention telehealth in their Nurse Practice Acts, while 39 have Telemedicine Acts. There are nine states with Advisory Opinions and 14 with Position Statements. Of those with Position Statements, two states address telenursing but do not specifically mention APRNs. When reviewing Telemedicine Acts, it is important to identify the prior legislation the telehealth act modifies, or whether telemedicine is a stand-alone statute. In some cases, these acts amend the physician practice act, while others amend health occupations or healing arts acts. It is important to focus specific attention on the language used within the act as well. Does the act refer to “physicians,” “providers,” or “practitioners,” or does it specifically address the APRN? Attention must also be paid to how telemedicine or telehealth is defined. For example, in a state where the definition refers to the “practice of medicine,” it is important to review the language in the Nurse Practice Act which defines the scope of practice for APRNs. If the language is not consistent with a state’s other telehealth guidelines, the content of the Telemedicine Act may not apply to the APRN.

https://doi.org/10.30953/tmt.v4.136

CONCLUSIONS

States have disproportionately addressed physician and physician assistant telehealth practice compared to the APRN. Ensuring that telehealth laws, regulations, and policies are inclusive of APRNs will encourage the successful implementation of telehealth programs and excellence in telehealth care that can be provided by APRNs. State licensing boards should provide clarity and promote inclusiveness of all healthcare providers when addressing virtual care regulations. With the current broad variations in telehealth laws by state, APRNs must become fully informed about the legislation and regulations affecting their practice prior to providing care virtually.

REFERENCES

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