New Hampshire Telemedicine Laws: Licensure, Opioids, Parity

New Hampshire regulates telehealth through cross-referenced statutes. RSA 310:7 sets the licensure rule and practice duties for every licensed health profession. The physician chapter, RSA 329, adds consent and controlled-substance terms. RSA 415-J and RSA 167:4-d then require commercial insurers and Medicaid to cover and pay for telehealth, including audio-only, on the same basis as in-person care. There is no telehealth registration.

Licensure: license or compact, with narrow exceptions

Under RSA 310:7, III, unless a statute provides otherwise, or the patient is in the custody of the New Hampshire Department of Corrections, an out-of-state health care professional providing telemedicine or telehealth "shall be required to be licensed, certified, or registered by the appropriate New Hampshire licensing body, or pursuant to a licensing compact or endorsement, if the patient is physically located in New Hampshire at the time of service." Out-of-state professionals treating Department of Corrections patients must instead be licensed and in good standing in their own state. RSA 329:1-d, II repeats the rule for physicians, and RSA 326-B:2, XII(b) does so for APRNs.

The exceptions include these:

• Consultation. RSA 329:21, II exempts physicians in other states "when called in consultation by" a New Hampshire licensee "who bears the responsibility for the patient's diagnosis and treatment." Regular or frequent consultation, as the board determines, is practice without a license.
• Prior patients. RSA 310:7, VI authorizes listed professions, including physicians, physician associates, APRNs, psychologists and mental health practitioners, to provide "consultation services or follow-up care via telehealth to a patient who previously received services from the provider in the state where the provider is licensed."
• Home-state relationships. RSA 329:21, IV-a exempts a physician licensed elsewhere who has a physician-patient relationship in the home state, with in-person examinations conducted by that physician at appropriate intervals, "but not less than annually."
• Other physician exceptions. RSA 329:21 also covers, among others, emergencies and a physician who resides on the border of a neighboring state, is authorized to practice there, and does not "open an office or appoint a place to meet patients or to receive calls" in New Hampshire.

New Hampshire Medicaid adds a participation condition: each participating telehealth provider must be licensed by New Hampshire and enrolled as a Medicaid provider (He-C 5004.03(c)).

New Hampshire is a full Interstate Medical Licensure Compact member under RSA 329-C, effective July 4, 2016. It has issued multistate nursing licenses since January 19, 2018, and is a full PSYPACT member effective July 1, 2020 (SB 232). It is a full Physical Therapy Compact member, and its Counseling Compact status is pending: enacted but not yet issuing privileges. See our cross-state licensing tracker.

Prescribing: Schedule II–IV allowed, with an annual exam

RSA 329:1-d, III lets a New Hampshire-licensed physician prescribe non-opioid and opioid Schedule II through IV drugs by telemedicine. A practitioner licensed to prescribe the drug must then conduct "a subsequent evaluation" at intervals appropriate for the patient, condition and drug, "but not less than annually." Parallel 2025 text gives physician associates (RSA 328-D:3-b, XIII) and APRNs (RSA 326-B:11, III-a) the same authority. The Controlled Drug Act makes Schedule II–IV telemedicine prescribing unlawful except under RSA 318-B:2, XVI (RSA 318-B:2, XII-f). That paragraph, last amended in 2022, limits telemedicine prescribers to those defined in RSA 329:1-d, I (physicians) and RSA 326-B:2, XII(a) (APRNs); it does not name physician associates. It still requires "subsequent in-person exams" by a practitioner licensed to prescribe the drug, at least annually, and compliance with all federal laws, "including the United States Drug Enforcement Agency registration or waiver when required" (a reference that predates the 2023 elimination of the federal buprenorphine waiver). RSA 326-B:2, XII(c) likewise still requires an APRN to establish an APRN-patient relationship first and to arrange a "subsequent in-person exam" at least annually. Because the Controlled Drug Act is the criminal statute, the conservative reading until the texts are reconciled is an in-person exam at least annually. Physician associates should confirm with the Board of Medicine that RSA 318-B:2, XVI does not bar their telemedicine prescribing.

Under RSA 329:1-c, a telemedicine exam counts if the physician verifies the patient's identity, discloses name, contact information and license type, obtains consent, and meets the standard of care. The physician must also complete or review a history, diagnosis and treatment plan and document all prescription drugs. Prescribing without that relationship is unprofessional conduct, subject to listed exceptions such as on-call coverage.

Other duties reach telehealth prescribing:

• Opioid rules (Med 502). These bind Board of Medicine licensees and apply to opioids for non-cancer, non-terminal pain; APRNs and other prescribers follow their own boards' opioid rules adopted under RSA 318-B:41. They exclude supervised administration in a health care setting. For acute pain, the prescriber must conduct and document a physical examination and history, complete a risk assessment tool and use written informed consent. In an emergency department, urgent care setting or walk-in clinic, the prescription may not exceed 7 days. If persistent acute pain lasts beyond 30 days, an in-office follow-up is required before a new opioid prescription. Chronic-pain prescribing requires, among other things, a written treatment agreement, reevaluation at least twice a year, and 24/7 clinical coverage.
• PDMP query (Med 502.06). Prescribers required to register with the program must query the program before an initial Schedule II–IV opioid prescription for pain, then at least twice a year. The exceptions are administration in a health care setting, a program outage, and an emergency department volume surge that would materially delay care. The prescriber must document the last two.
• E-prescribing. Since January 1, 2022, RSA 318:47-c, III has barred issuing a controlled-drug prescription unless it is transmitted electronically to a pharmacy. It lists eight exceptions, including technological failure, a pharmacy outside New Hampshire that complies with its own state's law, prescriber-dispensers, FDA-required elements, board waivers of up to one year, hospice compounding, and veterinarians. 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.
• Eyeglass and contact lens prescriptions (RSA 329:1-d, VI). These may not be determined solely by an online questionnaire, among other conditions.

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: oral or written for physicians, documented for Medicaid

RSA 329:1-c requires the physician to obtain "oral or written consent from the patient or from the patient's parent or guardian, if state law requires the consent of a parent or guardian for use of telemedicine services." RSA 310:7, IV sets duties for every profession. Clinicians must use the in-person standard of care and keep a record. Subject to the patient's consent, they must forward the record to the patient's primary care or treating provider "if appropriate." In a facility with federal or state language-access obligations, they must provide meaningful language access.

Under He-C 5004.02 and 5004.07, the patient must consent to telehealth, sessions may not be recorded without consent, and the record must show the patient was told of six rights. They include the right to refuse, referral to in-person emergency care, and how an emergency will be handled. For medication-assisted treatment delivered by telehealth under Medicaid, RSA 167:4-d, IV-a requires notice to the regional doorway, but only with the patient's written consent. The Med 502 opioid rules require written informed consent in any modality.

Medicaid: parity by statute, audio-only included

RSA 167:4-d, III requires Medicaid to cover and reimburse telemedicine "on the same basis" as in-person care. The combined distant-site and originating-site payment may not be less than the in-person amount. The statute bars site restrictions and requires reimbursement for "all modes of telehealth, including video and audio, audio-only, or other electronic media" for all medically necessary services.

Primary care and remote patient monitoring by telemedicine are covered only after the patient has "already established care at an originating site via face-to-face in-person service." Five exceptions apply: the provider is a VA or VA-contracted practitioner not required to obtain a special registration under 21 U.S.C. 831(h), or the patient is being treated by, and is physically located in, a state or county correctional facility, a doorway, a state-designated community mental health center, or a hospital or clinic registered consistent with 21 U.S.C. 823(f). Prior authorization and service limits match in-person care, and no claim may be submitted when a transmission fails. Store-and-forward and remote monitoring are paid only "as funding and resources within the current state fiscal year are available." A March 25, 2022 provider bulletin added the informational FQ modifier for audio-only services and place of service 10 for the home, both effective April 1, 2022.

Private insurance: coverage and payment parity

RSA 415-J:3, II bars insurers from denying coverage solely because a service that would be covered in person was delivered by telemedicine. Under paragraph III, insurers must "provide coverage and reimbursement" for telemedicine "on the same basis" as for in-person care. Paragraph V requires that the combined payment to the distant and originating sites "be the same as the total amount allowed" for in-person care.

Paragraph VIII bars deductibles, copayments, coinsurance, benefit limits or dollar maximums not equally imposed on similar in-person services. Paragraph XI requires reimbursement for all modes, including audio-only, for medically necessary services. The chapter covers remote patient monitoring and store-and-forward, and it sets no sunset. The limits run both ways:

• Insurers may cover only medically necessary services, subject to the policy's terms and conditions (XIII).
• A service excluded in person is not reimbursable by telemedicine (VII).
• Insurers may not pay more for telemedicine than in person (IX).
• An originating site operated by a provider or facility authorized to bill directly receives "reasonable compensation." The insurance commissioner resolves disputes over that amount (IV).

What to watch

First, whether the legislature conforms RSA 318-B:2, XVI and RSA 326-B:2, XII(c) to the 2025 "subsequent evaluation" language and adds physician associates to RSA 318-B:2, XVI. Second, when the Counseling Compact begins issuing privileges. Third, the federal DEA rule's December 31, 2026 end date. For background, see how state telemedicine laws work.