Delaware's Interstate Telehealth Registration

Delaware is small enough that most telehealth companies serve it as an add-on state, and it has one of the more usable out-of-state pathways for doing so. 24 Del. C. § 6002(c) lets a health care provider licensed in another state deliver telehealth to Delaware patients after obtaining an interstate telehealth registration from the Division of Professional Regulation (DPR). It is not limited to a patient count or a time window. Its catch is the eligibility test, and the relationship rules that come with it.

Who can use the registration?

Chapter 60 applies to providers in the professions regulated by twelve Delaware boards, including the Board of Medical Licensure and Discipline (physicians and PAs), the Board of Nursing (which covers APRNs), the Board of Pharmacy, and the psychology, mental health and social work boards (§ 6002(a)). The registration is for a provider "licensed in a state that has not adopted an interstate compact applicable to the health-care provider" (§ 6002(c)).

The provider must continuously meet four conditions (§ 6002(c)(1)-(4)):

1. A valid, active license issued by another state.
2. Good standing in every state where licensed.
3. No administrative complaint pending before another state's board.
4. No current investigation by another state's board or any Delaware authority.

DPR's own application pages phrase the compact condition as not being "actively licensed in a state that has enacted a compact in which Delaware participates." If your profession has a compact and both Delaware and your home state are in it, DPR expects you to use the compact route rather than the registration. Before filing, check whether Delaware participates in the compact for your profession and whether your home state does. DPR asks physicians and PAs for a National Practitioner Data Bank self-query, and nurses for license verification through Nursys or directly from the issuing state.

What does a registrant agree to?

Section 6002(d) makes the registrant subject to Delaware law for the profession, including Titles 11, 16 and 24; the personal jurisdiction of Delaware courts; the conduct rules of the practice act; and the Delaware board's complaint, investigation and hearing process. Discipline imposed in Delaware can be reported to the National Practitioner Data Bank and to every state where the provider holds a license. A complaint in Delaware therefore travels.

What does Delaware require to establish a relationship?

This is where Delaware is more specific than most states. Under § 6003(a), a provider-patient relationship may be established in person or by telehealth, but it must include all of the following:

• Verification and authentication of the patient's location and, to the extent possible, identity.
• Disclosure and validation of the provider's identity and credentials.
• Appropriate consent after disclosure of the delivery model and treatment limits, including informed consent to the use of telemedicine technologies.
• A diagnosis through acceptable medical practices, such as history, mental status exam, physical exam where warranted, and testing.
• Discussion of the diagnosis, the evidence for it and the risks and benefits of treatment options.
• A distant site provider or other coverage for follow-up care.
• A written visit summary provided to the patient.

Services may be synchronous or asynchronous store-and-forward, and telehealth may be used to establish the relationship only if the provider determines it can meet the in-person standard of care (§ 6003(b)). Without a proper relationship, prescriptions may not be issued "solely in response to an internet questionnaire, an internet consult, or a telephone consult" (§ 6003(c)).

Section 6004(a) adds that before diagnosis and treatment the provider must do at least one of four things: examine in person, have another Delaware-licensed provider present with the patient, diagnose using audio or visual communication, or meet the standard of applicable professional society telemedicine guidelines. Once a relationship is properly established, later treatment by the same provider need not repeat those steps (§ 6004(b)).

The written visit summary is the item operators most often miss. Build it into the visit template for every Delaware patient.

Does Delaware count audio-only as telemedicine?

Only conditionally. The definition of telemedicine in § 6001(6) includes audio-only conversations "if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection." Document why video was not possible when a Delaware visit is by phone. More in audio-only telehealth rules.

When is no relationship required?

Section 6005(a) lists four exceptions: informal, uncompensated, infrequent consultation; uncompensated emergency or disaster assistance; episodic consultation by an out-of-state specialist at the request of a licensed professional; and circumstances that make an in-person consultation before telemedicine impractical. Out-of-state mental health, behavioral health and social work providers have a separate path under § 6005(b), with a DPR form.

Can a registrant prescribe controlled substances?

A registrant who prescribes controlled substances to Delaware patients also needs a Delaware controlled substance registration from DPR's Office of Controlled Substances, plus a DEA registration for Delaware. The requirement covers interstate telehealth registrants and compact license holders as well as Delaware licensees, and the state registration is renewed every two years. Our sisters file these: White Glove APRN's state CSR list covers NPs, and White Glove IMLC covers state controlled substance registration for physicians. Federal telemedicine prescribing rules are on the DEA telemedicine rules hub.

Is Delaware a payment parity state?

Yes. Delaware requires insurers to reimburse telemedicine on the same basis and at least at the in-person rate (18 Del. C. §§ 3370, 3571R). See telehealth payment parity laws.

What should a practice adding Delaware do?

• Check each clinician's compact status first; it decides whether the registration is available at all.
• Add the written visit summary and location verification to the Delaware visit template.
• Line up Delaware controlled substance registrations before the first controlled substance patient.
• Set a monthly check that every registrant remains in good standing everywhere, because eligibility must be "continuously met."

Our Telehealth Registration Filing service ($395 per clinician, per state, plus state fees) prepares Delaware registrations for physicians, NPs and PAs. The Delaware page in the telehealth law index has the citations. This is research for your counsel, not legal advice.