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Telehealth Certification for Out-of-State Practitioners

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  • Current: Telehealth Certification for Out-of-State Practitioners

NOTICE: We do not confirm receipt of items as they are received.

Please allow 4-6 weeks for review of applications and documentation. Upon review of application and additional documentation, you will be notified by email of any missing items.

You may also log onto your MyLicense account to view updates as they are processed. Allow 4-6 weeks for processing of submitted items. Items are processed in the order they are received.

Applicants are responsible for reviewing the application information for a full list of requirements. Status updates for new applications will not be provided over the phone.

Announcements

  • August 22, 2022 - The Indiana Professional Licensing Agency recently updated State Form 56084 (Out-of-State Telehealth Practitioner Certification) and State Form 56085 (Out-of-State Telehealth Practitioner’s Employer or Contractor Certification), pursuant to changes made to Indiana Code § 25-1-9.5 under SEA 284-2022. The updated state forms are now available for download through the links provided below under "File State Forms," and are also available in the Indiana Archives and Records Administration's State Forms Online Catalog.

Overview

The Telehealth Certification for Out-of-State Practitioners is required by Indiana Code § 25-1-9.5-9. This certification is required to be completed by an Indiana-licensed practitioner who is physically located outside of Indiana and intends to establish a provider-patient relationship or issue a prescription for an individual located in in Indiana. The practitioner must file a copy of their individual certification and their employer's or contractor’s certification with the Indiana Professional Licensing Agency. These certifications must be completed before the practitioner may establish a provider-patient relationship or issue a prescription for an individual who is located in Indiana.

Practitioners who are physically located in the state of Indiana are not required to complete this certification.

How to File Certifications with the Indiana Professional Licensing Agency

File Online

Both the practitioner’s and the employer’s or contractor’s certifications may be filed online. For purposes of receipt and timely processing, the Indiana Professional Licensing Agency highly recommends filing these certifications online. To begin this process, please refer to the instructions provided below to either create or log in to your Indiana Licensing Enterprise account and click on "Get Started."

IMPORTANT NOTE: The Indiana Professional Licensing Agency does not manage nor administer the licenses, certifications, or credentials of the following practitioners:

  • A school psychologist licensed by the Indiana Department of Education
  • A developmental therapist enrolled by the Bureau of Child Development Services to provide special instruction, as defined in 34 CFR 303.13(b)(14), to infants and toddlers receiving early intervention services
  • A peer as defined in Indiana Code § 12-21-8-5 and certified by the Division of Mental Health and Addiction
  • A qualified behavioral health professional or other behavioral health professional within a community mental health center

These practitioners do not have the option of filing their certifications online with the Indiana Professional Licensing Agency. These practitioners should utilize State Form 56084 and State Form 56085, which are provided below, to file their certifications. The Indiana Professional Licensing Agency will provide these certifications to the appropriate state agencies that are responsible for managing and administering the licenses, certifications, or credentials of these practitioners.

Access Indiana & MyLicense Instructions

  • Go to MyLicense.IN.gov.
  • If you are a practitioner, please utilize the 'Personal Licensing' option. If you are an employer, please utilize the 'Business Licensing' option.
  • If you have an existing Access Indiana account, select login using your existing account.
  • If you do not have an existing Access Indiana account, click 'Register for an Access Indiana account' and then use the Person Search function.
  • You can enter your Date of Birth and SSN to search for an existing personal record.
    1. If a record is found, your information will be populated and then click Register.
    2. If no record is found, you can enter your information and click Register.
  • Click Initial Application on the left-hand menu.
  • Select Telehealth Certificate.
  • Follow the prompts to receive your certification.

Get Started

File State Forms

For purposes of physically filing these certifications with the Indiana Professional Licensing Agency, State Form 56084 (Out-of-State Telehealth Practitioner Certification) and State Form 56085 (Out-of-State Telehealth Practitioner’s Employer or Contractor Certification) are available to download through the links provided below.

Renewal of Practitioner's Certification

A practitioner is required to renew their individual certification with the Indiana Professional Licensing Agency at the time the practitioner renews the practitioner’s license. A practitioner should also file a new individual certification with the Indiana Professional Licensing Agency in the event that the practitioner changes their employer or contractor.

Employer or Contractor Certification; Change in Employer or Contractor

A practitioner’s employer or contractor is required to file the employer/contractor certification only at the time of initial certification. However, in the event that a practitioner changes their employer or contractor, a new employer/contractor certification must be filed with the Indiana Professional Licensing Agency.

Eligible Practitioners

The following meet the definition of a "practitioner" who is eligible to provide telehealth services in the state of Indiana:

An athletic trainer licensed under Indiana Code § 25-5.1
A chiropractor licensed under Indiana Code § 25-10
A dental hygienist licensed under Indiana Code § 25-13
A dentist licensed under Indiana Code § 25-14
An individual who holds a dental residency permit issued under Indiana Code § 25-14-1-5
An individual who holds a dental faculty license under Indiana Code § 25-14-1-5.5
A diabetes educator licensed under Indiana Code § 25-14.3
A dietitian licensed under Indiana Code § 25-14.5
A genetic counselor licensed under Indiana Code § 25-17.3
A physician licensed under Indiana Code § 25-22.5
An individual who holds a temporary permit (temporary medical permit) under Indiana Code § 25-22.5-5-4
A nurse licensed under Indiana Code § 25-23
An occupational therapist licensed under Indiana Code § 25-23.5
An occupational therapy assistant licensed under Indiana Code § 25-23.5
Any behavioral health and human services professional licensed under Indiana Code § 25-23.6
An optometrist licensed under Indiana Code § 25-24
A pharmacist licensed under Indiana Code § 25-26
A physical therapist licensed under Indiana Code § 25-27
A physical therapist assistant certified under Indiana Code § 25-27-1-6.3
A podiatrist licensed under Indiana Code § 25-29
A psychologist licensed under Indiana Code § 25-33
A respiratory care practitioner licensed under Indiana Code § 25-34.5
A speech-language pathologist or audiologist licensed under Indiana Code § 25-35.6
A clinical fellow in speech-language pathology
A veterinarian licensed under Indiana Code § 25-38.1
A behavior analyst licensed under Indiana Code § 25-8.5 Important Note: Per Indiana Code § 25-1-9.5-3.5(c), this includes a behavior analyst during the time in which the Indiana Professional Licensing Agency is preparing to implement licensure of behavior analysts under Indiana Code § 25-8.5. Indiana Code § 25-1-9.5-3.5(c) expires on January 1, 2025.
A student who is pursuing a course of study in, or is a graduate from, a program in a profession specified in Indiana Code § 25-1-9.5-3.5(a)(1) through Indiana Code § 25-1-9.5-3.5(a)(22); and is providing services directed by an individual who holds a license in Indiana for that profession
A school psychologist licensed by the Indiana Department of Education
A developmental therapist enrolled by the Bureau of Child Development Services to provide special instruction, as defined in 34 CFR 303.13(b)(14), to infants and toddlers receiving early intervention services
A peer as defined in Indiana Code § 12-21-8-5 and certified by the Division of Mental Health and Addiction
A qualified behavioral health professional or other behavioral health professional within a community mental health center

Telehealth Resources

The practice of providing telehealth services in the state of Indiana is regulated under the requirements of Indiana Code § 25-1-9.5. To access the latest version of the Indiana Code, please visit the Indiana General Assembly's website.

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