Telehealth Platforms

Telehealth CPOM complexity stems from the state-by-state nature of CPOM law. Each state where a patient receives telehealth services is potentially a state where the telehealth company must comply with that state's CPOM rules. For a telehealth platform serving patients nationwide, this means managing CPOM compliance in up to 50 jurisdictions. In practice, the five to ten strictest-enforcement states are the most critical.

The most common structure for a multi-state telehealth platform is a network of state-specific PCs, all owned by the same physician (or a small network of physicians), each contracting with the platform's central MSO. This is sometimes called a "nominee PC" or "friendly PC" network. The MSO provides platform infrastructure, technology, and operational support to all PCs under a master MSA.

A single physician who is licensed in multiple states can own PCs in all of those states. This simplifies governance and documentation. However, in some states, multi-physician ownership of the PC is required for certain entity types. The tradeoffs between a single-physician network and a multi-physician structure should be evaluated with counsel for each state.

Telehealth platforms that focus primarily on prescribing (weight loss medications, GLP-1 agonists, mental health prescriptions) are under particular regulatory scrutiny. State medical boards have focused enforcement on platforms where the prescribing physician has no meaningful relationship with the patient — i.e., rubber-stamp prescribing. CPOM compliance is necessary but not sufficient; clinical compliance (adequate physician-patient relationship, appropriate scope of practice) is also required.

The COVID-19 public health emergency (PHE) prompted significant relaxation of telehealth rules, including some CPOM-adjacent flexibility. Post-PHE, many of those flexibilities have expired or are expiring. Telehealth companies that structured during the PHE period should audit their structures against current state law.