Telehealth From Florida to a Michigan Patient
An OT licensed in Michigan lives in Michigan but spends January–March in Florida. She provides telehealth to a 16-year-old patient with autism who lives in Michigan. The patient's parent consents to telehealth by text. During a session, the OT realizes the patient has new self-injurious behavior and a possible medication change; the parent asks the OT to 'adjust the meds' because the psychiatrist is unavailable. The OT is also asked by a Florida neighbor to evaluate the neighbor's child while she is in Florida. The OT's Michigan license is active; she does not hold a Florida license. She documents the session in the Michigan clinic's EHR and plans to bill Michigan Medicaid. The parent has not signed a telehealth consent form.
1. May the OT provide telehealth to the Michigan patient while she is physically in Florida? What licensure principle applies?
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The patient is located in Michigan, so Michigan's licensure requirement applies to the service; her active Michigan license is necessary. But because the OT is physically practicing from Florida, Florida may also require a Florida license or telehealth registration. The general principle is that the provider must satisfy the licensure requirements of the state where the patient is located and may also need authorization where the provider is located. She should not assume Michigan licensure alone covers her Florida location. Before the next session she should verify Florida's telehealth rules for OT, obtain any required Florida license or registration, and check the Michigan telehealth requirements. If Florida does not authorize her, she should arrange coverage by a properly licensed provider or pause telehealth while in Florida.
2. What should she do about consent and the parent's request to adjust medication?
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She must obtain and document informed consent for telehealth using the required elements: patient identity, provider identity, location of both parties, modality, risks, privacy, emergency procedures, and right to withdraw. A text from the parent may not satisfy the clinic's or state's consent standard; she should use the approved consent form and document it. She must not adjust psychiatric medication; that is outside OT scope. She should explain that limitation, contact the psychiatrist or advise the parent to do so, and document the referral and safety plan. If the self-injury is new and urgent, she should follow the emergency plan rather than continue routine treatment.
3. Can she evaluate the Florida neighbor's child while staying in Florida?
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No, not unless she holds the required Florida authorization. The child is located in Florida; providing an OT evaluation there would be practice in Florida. Her Michigan license does not authorize services to a patient located in Florida. She should decline and refer the neighbor to a Florida-licensed OT. If she plans to practice in Florida regularly, she should apply for Florida licensure and comply with Florida telehealth and supervision rules. Providing the evaluation anyway could be unlicensed practice and could jeopardize her Michigan license.