Delaware Telemedicine Laws: Registration, Opioids, Parity

Title 24, Chapter 60 decides who may treat a Delaware patient remotely, including through an interstate telehealth registration, and what a provider-patient relationship requires. Controlled substances follow a separate definition in the Uniform Controlled Substances Act, and the insurance code requires commercial plans to pay telemedicine at least at the in-person rate. The old physician telemedicine section, 24 Del. C. § 1769D, was repealed effective July 1, 2021.

Licensure: a registration for providers without a compact

Section 6001 defines the originating site as "a site in Delaware at which a patient is located," and the distant site as one where a provider "legally allowed to practice in Delaware" is located. Chapter 60's definition of telemedicine includes audio-only conversations only "if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection" (§ 6001(6)).

Under § 6002(c), a provider "licensed in a state that has not adopted an interstate compact applicable to the health-care provider may only provide telehealth under this chapter if the health-care provider obtains an interstate telehealth registration from the Division of Professional Regulation." Four conditions must be "continuously met": a valid, active license from another state; good standing in all states of licensure; no pending administrative complaint before another state's board; and no current investigation by another state's board or any Delaware authority. HB 334 (83 Del. Laws c. 484) created the registration, effective October 21, 2022. The Division's physician page covers MDs, DOs and physician assistants, among others, and excludes applicants actively licensed in a state that has enacted a compact Delaware participates in.

Section 6005(b) lets a mental health provider, behavioral health provider or social worker licensed elsewhere, who would be authorized if licensed in Delaware, treat Delaware residents by telehealth; the Division must require such providers to complete a Medical Request Form and meet any other registration requirements it sets. Section 1727 lets physicians authorized in another state or country consult with Delaware-certified physicians.

Delaware is a full Interstate Medical Licensure Compact member, statutory effective date July 1, 2022, under HB 160 (83 Del. Laws c. 52, approved June 23, 2021). It has issued multistate nursing licenses since January 19, 2018, is a full PSYPACT member effective July 1, 2020 (HB 172), and is a full Physical Therapy Compact member. Its Counseling Compact status is pending: enacted but not yet issuing privileges. See our cross-state licensing tracker.

Prescribing: an in-person path for controlled substances

Section 6003 bars telehealth care without a provider-patient relationship, except as the chapter provides. Formed in person or by telehealth, the relationship must include seven elements, among them verification of the patient's location and, to the extent possible, identity; appropriate consent; a diagnosis through acceptable medical practices; availability of the provider or other coverage for follow-up care; and a written visit summary. Telehealth may establish it "only if the provider determines" the in-person standard of care can be met. Without a proper relationship, providers may not prescribe "solely in response to an internet questionnaire, an internet consult, or a telephone consult."

Before diagnosis and treatment, § 6004 requires at least one of four steps: an in-person exam; another Delaware-licensed provider present with the patient; a diagnosis using audio or visual communication; or meeting professional-society telemedicine guidelines. Later treatment of the same patient by the same provider need not repeat it.

The Uniform Controlled Substances Act defines a "lawful prescription or order" as one issued under a "patient-practitioner relationship," and 16 Del. C. § 4701(34) lists seven qualifying situations. They include at least one in-person medical evaluation with a history and physical examination; consultation or referral from a practitioner with an existing relationship who agrees to supervise; and on-call or cross-coverage. Senate Substitute 1 for SB 101 (85 Del. Laws c. 92), effective July 21, 2025, added opioid use disorder treatment with FDA-approved Schedule III–V medications under a relationship established under § 6003; its synopsis said the Act had required an in-person examination to prescribe controlled substances for that treatment. Anyone who prescribes controlled substances to a patient in Delaware needs a Delaware controlled substance registration. Section 4732(a) extends that duty to practitioners who hold an interstate telehealth registration, an interstate compact license or a practice privilege, and § 4733(a) lets them register. The Division of Professional Regulation's application page accepts a medical interstate telehealth registration in place of a Delaware license, and says a practitioner needs both a Delaware controlled substance registration and a DEA registration for Delaware before prescribing controlled substances in Delaware. A prescription issued outside a § 4701(34) relationship is not a "lawful prescription" under § 4701(25). The Secretary may limit, suspend, fine or revoke a registration for violating the chapter (§ 4735(b)(6), (d)), separate from any licensing-board discipline.

Other duties reach telehealth prescribing:

• Opioid analgesics (UCSA Regulation 9.0). Regulation 9.2 requires a Delaware license and DEA registration to prescribe opioid analgesics in Delaware, and says out-of-state practitioners prescribing controlled substances to Delaware patients must hold active licensure and registration in their home states. That home-state requirement is in addition to, not instead of, the Delaware controlled substance registration described above. A first outpatient opioid prescription for an adult's acute pain episode, and any prescription to a minor, is capped at a seven-day supply unless the prescriber documents the reason, queries the Prescription Monitoring Program and meets other conditions. A subsequent acute-pain prescription requires, among other steps, a program query for the first prescription beyond the initial seven days, a physical examination with a documented discussion, and a signed informed consent form. Chronic pain adds, among other duties, program queries and drug screens at least every six months and a treatment agreement. Hospice, cancer, palliative care and hospital patients are exempt; for hospital patients the exemption covers the stay and discharge prescriptions of seven days' supply or less.
• Prescription Monitoring Program (16 Del. C. § 4798(f)). A prescriber must obtain a 12-month report before prescribing a Schedule II–V drug when the prescriber reasonably believes the patient may be seeking it other than to treat an existing condition.
• E-prescribing (24 Del. C. § 1764A(b)). Since January 1, 2021, a person licensed under Chapter 17 of Title 24 must prescribe electronically, for any drug, subject to ten exceptions, including temporary technological or electrical failure, which Board Regulation 19.0 limits to one lasting no more than a week through no fault of the licensee, certain out-of-state pharmacies, prescriber-dispensers, and Board waivers of up to one year. Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our guide to federal telehealth laws.

Consent: built into the relationship

Section 6003(a)(3) requires "receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies." The statute names no form. Delaware Medicaid adds that the patient must be told of, and given an opportunity to request, an in-person assessment before a telehealth assessment, with consent documented and the record showing telehealth delivery. For a member involuntarily detained or committed, consent may be impracticable; that exception ends on discharge.

Medicaid: in-person rates, telephone as a fallback

Section 16.0 of the Delaware Medical Assistance Program's Practitioner Provider Specific Policy Manual (the text quoted here matches the December 2024 and March 17, 2026 versions), added January 1, 2024, covers medically necessary telehealth for State Plan services at the same procedure codes and rates as in-person care. The home may be an originating site but earns no originating-site fee. Store-and-forward and remote patient monitoring are covered under stated conditions.

Under this manual, telephones are an acceptable mode if two conditions are met: "Interactive Telehealth Services are unavailable," and telephonic services are "medically appropriate for the underlying covered service." Calls not meeting the full requirements of an E/M code are billed under the CPT telephone services codes.

Private insurance: payment parity by statute

Sections 3370 (individual) and 3571R (group) require insurers, health service corporations and HMOs to cover telemedicine, and telehealth as Department of Insurance regulations direct. They may not exclude a service solely because it is delivered by telemedicine, "for services appropriately provided through telemedicine services." Subsection (e) requires reimbursement "on the same basis and at least at the rate" of the same in-person service, plus "reasonable compensation" to the originating or distant site for transmission costs. Cost-sharing and durational limits must apply equally to all covered services. The sections apply to policies issued or renewed on or after January 1, 2016, and exclude short-term travel, accident-only, limited or specified disease and individual conversion policies. Self-funded employer plans fall under federal ERISA law instead.

Regulation 1409 bars limits imposed "solely because the health care service is being provided through telehealth," including "preauthorization, medical necessity, homebound requirements, or requiring the use of technology permitting visual communication." It does not on its face bar medical-necessity review or preauthorization applied equally to in-person care, and coverage requires that the underlying service be covered and the provider licensed. See our reimbursement guide.

What to watch

No pending 2026 bill in the 153rd General Assembly amends Chapter 60 or the insurance telehealth sections. Watch whether lawmakers extend § 4701(34)'s telehealth path beyond opioid use disorder medications, when the Counseling Compact begins issuing privileges, and the federal rule's December 31, 2026 end date. For background, see how state telemedicine laws work.