Per-State Licensure
A director licensed in each state you prescribe into — the point most virtual clinics get wrong.
Telehealth Prescribing
Find a Medical Director for Telehealth and Multi-State Clinics
Telehealth is a licensing question before it is a technology question: you generally need a physician licensed where the patient sits, a defensible exam policy behind every prescription, and mid-level supervision that holds up in whichever state the visit landed in. We cover direction per state and keep the structure straight as you expand.
Medical Director Oversight
What a Director Actually Signs Off for Telehealth Prescribing
Each of these is a decision your director owns, in writing, before it happens in your clinic.
Good Faith Exam
Whether a video visit or an asynchronous intake satisfies the exam requirement, answered state by state.
Prescribing & Supervision Limits
Category rules, controlled-substance requirements and mid-level supervision standards that change across state lines, written into your protocols.
Records
Documentation and retention standards that hold up across jurisdictions.
The Market
Demand Is Real, and the Data Backs It Up
Growth this fast means more competition and more regulatory attention at the same time — direction and protocols matter more as the category scales, not less.
$0B
U.S. telehealth market size, 2024
$0B
Projected U.S. market size by 2030
0%
Compound annual growth rate through 2030
Source: MarketsandMarkets, U.S. Telehealth & Telemedicine Market Report, 2025-2030
What We Set Up
Everything Behind a Compliant Telehealth Program
A virtual-first practice needs per-state direction, a good faith exam policy that holds up on both sync and async visits, and prescribing rules — including controlled substances — that differ by category and jurisdiction.
Physician coverage in each state you treat in
Good faith exam policy per state, covering both synchronous and asynchronous visits
Prescribing rules by category and jurisdiction, including controlled-substance and DEA requirements
Mid-level supervision standards that hold across the states you operate in
Identity verification and documentation standards
Platform, EHR and record-retention requirements
Escalation and in-person referral pathways
Supply
Where the Product Comes From
FAQ
Questions About Telehealth Prescribing
Still not sure? Twenty minutes on the phone answers what a page can't.
Do I Need a Director in Every State?
Generally you need a physician licensed in each state where patients are located. Group membership covers per-state placement.
Can I Prescribe GLP-1s by Telehealth?
In many states, yes, subject to exam and prescribing rules. Those rules are what your protocols encode.
What About Controlled Substances?
Stricter, and moving — DEA registration and state-specific rules both apply, and they do not always match. We map current requirements for your states and flag changes as they land.
Does a Video Visit Count as a Good Faith Exam?
In many states, yes, for many treatment categories — but not all, and asynchronous (questionnaire-only) intake is held to a stricter standard in some states. We set the exam policy per state and category rather than one blanket rule.
How Does Supervision Work for Mid-Level Providers Across States?
Supervision ratios, chart-review requirements and what a nurse practitioner or PA can prescribe without physician sign-off all vary by state. We set the standard per state so a provider licensed in more than one is not working under conflicting rules.
Who Is Allowed to Own a Telehealth Business?
Can a non-physician own a telehealth prescribing company? The platform and the brand, yes — the medical group behind it, generally no, and it has to be structured per state you prescribe into.
That is what the corporate practice of medicine doctrine decides — and it is the single rule that shapes how your business is built. Most states hold that medical judgment belongs to licensed clinicians, so a non-physician or a general corporation may not own or control an entity that practices medicine. The MSO model is the answer the industry settled on.
The Rule
CPOM — Corporate Practice of Medicine
A doctrine in state law, not a company or a service. The professional entity — the PC — must be owned by a licensed physician, and control counts as much as ownership: who hires the clinicians, who sets the fees, who decides what gets treated.
Only a licensed physician may own the professional entity in most states
Control counts too — hiring clinicians, setting fees, directing treatment
Fee-splitting rules limit how the MSO can be paid
Enforcement is by medical boards, attorneys general, insurers and acquirers
The Structure
MSO — Management Services Organization
The company that provides everything a Telehealth clinic needs that is not the practice of medicine, under a written management services agreement with the PC. You can own the MSO outright, whatever your license.
Owned by you, whatever your license — no physician equity required
Holds the brand, lease, staff, systems, supply and marketing
Paid a fair-market management fee, never a cut of clinical revenue
Takes no part in diagnosis, treatment or any clinical decision
How the two meet: a physician-owned PC employs the clinical team and holds the medical decisions; your MSO holds the brand, the lease, the staff, the systems and the supply; a fair-market management fee moves between them; and the line is drawn in writing where your state says it must be. Multi-state operations often need a PC in each state, or one PC with the right licensure footprint.
Watch
Where the Money Actually Goes
What This Covers
How money actually moves through a PC/MSO structure — patient revenue landing in the PC, the fixed management transfer to the MSO, MedGrid's retainer, and physician compensation — the same CPOM flow of funds covered on this page, walked through step by step.
This isn't just how we recommend running the accounts. In a state that enforces corporate practice of medicine, this exact flow is required to keep a PC structure compliant: revenue lands in the PC first, the MSO is paid a fixed, fair-market amount rather than a share of medical revenue, MedGrid is paid a fixed retainer by the MSO, and the accounts stay separate.
It's also why MedGrid only builds on a PC — never a PLLC — in every state we work in. A PLLC lets revenue flow straight into a member's account with no equivalent separation, which is exactly the structure this flow of funds is built to avoid. Why that distinction matters.
Getting It WrongMistake 01 Mistake 02 Mistake 03 Mistake 04
Four Ways Telehealth Clinics Get Structured Badly
These are the arrangements we most often find in place when a clinic comes to us, usually built in good faith, on advice from someone who had not read the state's rules.
An LLC That Should Be a PC
The clinical entity was formed as a plain LLC owned by a non-physician. In a strict state that is the whole problem, and it usually surfaces at diligence or renewal.
A Director on a Handshake
A physician agreed to "be the medical director" with no management agreement, no delegation document and no standing orders. There is nothing to show a board.
A Fee That Looks Like a Split
The MSO takes a percentage of clinical revenue. Many states read that as fee-splitting regardless of what the contract calls it.
Protocols From a Course
Treatment protocols copied from a training weekend, never adapted to this state or signed by the director who is supposed to own them.
General information about how these structures work, not legal advice for your clinic. Your director and your counsel confirm the specifics before you treat.
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Adding Telehealth to Your Menu?
Twenty minutes tells you what direction costs in your state, what has to be on file before the first patient, and how fast you can start.