For nutrition professionals, offering virtual services can be a cost-effective way to expand your practice reach, retain clients and generate additional income for your business. However, understanding telehealth laws and regulations can be difficult for dietitians. Here’s the facts about practicing telehealth for nutrition professionals:

• Telehealth laws and regulations are set by each state, which means that to be compliant with telehealth laws, you must be aware of each state’s statutes
• For dietitians, licensure and title protection is also established by each state (or country). If there is licensure for the state, it essentially means that only nutrition professionals who hold a license in the state are qualified to provide medical nutrition therapy
• When you counsel a client virtually, you must adhere to the telehealth regulations AND licensure laws established by the state (or country) that your client resides in. Providing medical nutrition therapy across state lines
• Parity laws set by each state make an effort to establish telehealth services as equal, reimbursable services as in-person services.
• Insurance companies have been slow to adopt telehealth as a reimbursable service. Doctors are seeing more reimbursement through telehealth, but the trickle down to dietitians and other wellness professionals has been slow.

Despite these challenges to telehealth, research and data continues to show the benefits that virtual care brings. With improved patient outcomes, cost-savings and technology advances, telehealth nutrition services continue to advance within healthcare. With that, dietitians are at the forefront of delivering virtual care.

Today, we’re answering some of the most common telehealth questions asked by nutrition professionals. Learn the basics about telehealth technology and compliance so you can confidently offer virtual services in your nutrition practice.

What is telehealth?

Telehealth is an umbrella term for the application of telecommunications and technology in healthcare. Telehealth includes any digital communication between a client and practitioner. Most commonly, telehealth is the term used to describe providing client care virtually, opposed to in-person. For dietitians, telenutrition means providing telehealth nutrition services to clients digitally.

Why is telehealth becoming increasingly popular?

Both clients and practitioners recognize, more than ever, that virtual care is an effective and flexible means to receive and provide high quality nutrition and wellness services.

But did you know that telehealth has actually been around for nearly a century? Since the 1920s, organizations like NASA and AT & T have been experimenting with telemedicine. In recent years, telehealth has become so popular because of advancements in technology. The widespread use of apps and smartphones have made integrating telehealth and technology a reality for practitioners and patients.

Telehealth was first used broadly by primary care physicians, dermatologists, radiologists, and psychiatrists, but is now rapidly expanding throughout healthcare. With advances in technology, and easily affordably telehealth platforms, many nutrition professionals are evolving their private practices to include virtual services.

What are the benefits of telehealth for nutrition professionals?

• Flexibility and convenience: work from home or wherever you’d like! Save your clients the time of traveling to and from appointments
• Savings on time and money: reduce the need for an office, cut down on travel time between office and home, and lessen rent expenses
• Closer relationships with clients: the beauty of technology is that it makes it easier to connect with clients – in addition to videoconferencing sessions, message with patients, share documents, and more, to build longer-term, effective relationships
• Increased access to care for clients: clients in remote locations now have the ability to receive quality care, thanks to telehealth! Telehealth even helps treat patients during disaster relief.
• Expanded educational reach: practitioners can now access more individuals at one time, with webinars and group counseling sessions.

I’m a new nutrition professional, just starting out in private practice. Am I ready to provide virtual services?

Yes, absolutely. You are actually more ready to provide telehealth services because you can structure and build your practice around the fact that you’d like to provide virtual care. This has incredible implications for the amount of office space you need (if any) and the way you develop your website, intake forms, billing processes, client packages, and more!

Are there any challenges to getting started with telehealth in nutritional care?

When getting started with telehealth, it’s important to choosing the right technology. Keeping your client’s private health information secure is always a priority, and compliance is especially important in virtual care. It’s important to choose a telehealth platform that is HIPAA-compliant. You also want to be sure to choose a technology platform that will provide quality telehealth services to help showcase your nutrition services in a professional way.

Apart from your technology, knowing state regulations, especially when providing care across state lines can also be challenging. Stay up-to-date on your local state regulations and policies requires you to be proactive and vigilant.

What are the regulations surrounding telehealth for nutrition professionals?

Each state determines telehealth laws and also establishes licensure law (or professional guidelines) for dietitians. The Academy of Nutrition and Dietetics has a free state-by-state licensure and statutes map available online. This map serves as a great starting point to understanding the licensure laws where your client resides.

How to read the AND licensure and statutes map:

• Red states: have practice exclusivity for licensed nutrition professionals. If your client resides in a red state, and you do not have licensure in that state, then you do not meet the requirements to provide medical nutrition therapy to that client.
• Green states: do not have practice exclusivity and do not have strict licensure laws for dietitians, however there may be exclusions or certifications requires for nutrition professionals. When providing care across state lines to a green state, we suggest you check with the state office (the links to each board/agency are included in the AND licensure map)
• Yellow or gray states: there is no strict licensure or regulations that allow dietitians to practice exclusively in these states.

Note: this information is meant to serve as general guidance for licensure laws and telehealth regulations. Please consult with each individual state board to confirm their latest regulations, and if you are qualified to provide nutritional care virtually to a client residing in their state.

HINT: each state board/agency has information on their website regarding the requirements for obtaining a license or certification as a dietitian in their state. Generally, the information is not complicated to acquire (ie proof of CDR examination, proof of ACEND accredited coursework and a licensure fee). You can obtain licenses or certifications in as many states as you’d like, but many do require a renewal fee to be paid every 2 or 3 years. Make a list of states that may be profitable for you to practice in, and consider becoming licensed in those states. Keep track of renewal fees and dates.

Is telehealth for nutrition professionals reimbursable by insurance?

The short answer is, sometimes, and it depends on a few factors:

• Where do you live? 32 states have passed parity laws, which means that services that are reimbursable in-person are reimbursable through telehealth. Although insurance companies are slow to adopt this law, many states are seeing improved reimbursement rates for virtual services, even for nutritional care. At the moment, the best practice is to call the insurance provider for each client and ask about benefits eligibility. During this call, you can ask if your client is covered for telehealth services and if there are any stipulations. Some common requirements from insurance companies:
• Initial sessions may need to be conducted in-person
• A client may require a physician’s referral for nutrition counseling
• Clients may need to sign a telehealth consent form and/or their dietitian should document in their chart note that the client consented to a telehealth session.
• What liability insurance do you have? Make sure your personal coverage includes Telehealth, and check out our blog post for an overview of RD insurance liability plans that cover Telehealth
• Are you using a HIPAA-compliant platform to conduct care? For insurance companies to reimburse your services, you must be using a HIPAA-compliant platform. Unfortunately, Skype is not HIPAA-compliant; that’s where tools like Healthie help dietitians provide nutritional care virtually, and get billing processed along the way (plus a lot more too)
• Are you licensed in the state where care is being received? If your state has licensure, make sure you follow local guidelines.

All in all, the advent of telehealth is a great benefit for nutrition professionals. It means that care can be provided remotely, nutrition providers can build closer relationships with clients, and it makes practices run more efficiently. Sounds like a triple win!

We hope this was a helpful overview as you begin to think about telehealth and nutrition technology. We genuinely believe (and have seen) that integrating telehealth into your practice can be game-changing.

Healthie’s telehealth platform is accessible in all 50 states, and internationally. We at Healthie encourage you to state with your state nutrition academies, insurance providers, and governing bodies to understand specific rules regarding seeing clients across state lines.