Starting a virtual clinic in Virginia: 2026 telehealth requirements

Yes. CCHP summarizes Virginia's rule as the practice of medicine occurring where the patient is located, so a practitioner must be licensed in Virginia to treat a Virginia patient regardless of where the practitioner sits. The Board of Medicine's Telemedicine Guidance (Doc. 85-12, August 19, 2021) applies the same standard. CCHP lists Virginia's telehealth-specific license or registration process as No, and the dataset records Virginia as requiring a full license with a consultant exemption only.

Virginia is not in the Interstate Medical Licensure Compact. That is unusual for a state its size and it changes the launch math: a physician licensed in a compact state cannot use the IMLCC to add Virginia. CCHP does note that expedited licensure by reciprocity exists for certain out-of-state physicians, so the application route is faster for some applicants than a full initial license, but it still runs through the Board of Medicine. Virginia does participate in the Nurse Licensure Compact, the Physician Assistant Licensure Compact and PSYPACT, with implementation status to be confirmed on each compact's site.

The exemptions in Va. Code 54.1-2901 are narrow. Under subsection (A)(15), a qualified out-of-state practitioner may meet in consultation with Virginia-licensed practitioners, with regular communication between the consultant and the Virginia practitioner expected. A separate continuity-of-care provision lets an out-of-state physician, PA or APRN continue telemedicine care for a current patient where a practitioner-patient relationship already exists and an in-person exam took place within the previous 12 months; behavioral health services under this provision are limited to one year. CCHP also observes that audio-only calls, email, fax and online questionnaires for follow-up with an established Virginia patient may not require licensure, but a brand cannot build an onboarding funnel on follow-up exemptions.

For the roster, every provider who diagnoses or treats a Virginia patient should hold a Virginia license, and prescribers of Schedule II through V drugs must also maintain a Virginia practice location or be able to refer the patient to a Virginia-licensed practitioner for any required in-person exam under Va. Code 54.1-3303.

Both 50-state guides in our dataset classify Virginia as a state with no general corporate practice of medicine prohibition. One guide explains the statutory basis: Va. Code 54.1-2902 and 54.1-111(A)(1) extend the ban on unlicensed practice to any person, partnership, corporation or other entity, but Va. Code 54.1-111(D) states that nothing prevents a corporate entity that employs or contracts with a licensee from practicing through that licensee. The guide also cites a 1992 attorney general opinion confirming that nonprofit corporations, including hospitals, may employ physicians, and Board of Medicine Guidance Document 85-21 on the physician's duty to retain exclusive control over medical judgment even when employed by a non-physician-owned company.

So the Virginia question is less whether a lay-owned company can employ physicians and more how it must behave when it does. The licensee, not the employer, must control diagnosis, treatment decisions, referrals and prescribing. An employer that dictates clinical protocols for commercial reasons, or ties compensation to prescribing, invites both unlicensed-practice and unprofessional-conduct exposure even without a formal CPOM ban.

Most telehealth brands still use the two-entity structure in Virginia because it travels well to neighboring states with stricter rules and because it cleanly separates clinical governance. The brand owns a management services organization that supplies the platform, intake tooling, marketing, billing and administration under a management agreement priced at fair market value. A professional entity owned by a Virginia-licensed physician employs or contracts the clinicians and owns the clinical policies, records custody decisions and quality program. Because Virginia law expressly tolerates entity employment of licensees, some operators run a simpler single-entity model with employed physicians; weigh that against the guidance documents cited above and the anti-kickback and fee-splitting rules that apply regardless. Neither guide gives a Virginia fee-splitting statute, so confirm with counsel.

AANP's state practice environment map, with data dated May 2026, lists Virginia in the Restricted Practice category. Under AANP's definition, that means Virginia law restricts at least one element of NP practice and requires career-long supervision, delegation or team management by another health provider for the NP to provide patient care. In practical terms, a Virginia NP generally practices under a written or practice agreement with a patient care team physician unless the NP has met Virginia's conditions for autonomous practice, which our fetched sources did not detail; confirm the current hours threshold and process with the Virginia Board of Nursing and Board of Medicine, which jointly regulate NPs.

For an asynchronous telehealth program this matters at the staffing layer. An NP-led Virginia roster needs a Virginia-licensed physician in the practice agreement role, with the agreement on file before the first encounter, and the physician's availability and review obligations documented. Brands that want NP-only coverage should recruit NPs who already hold autonomous practice status in Virginia or plan for physician participation.