Tessic Health

TX · STATE RULES

Telehealth rules in Texas

Texas lets a first telemedicine visit run on store-and-forward photos or clinical records instead of live video, under Occupations Code chapter 111. The state then adds duties its neighbours do not: electronic health records of Texas patients must stay on US soil from January 1, 2026, clinicians must tell patients when AI helps diagnose or treat them, and the Texas Medical Board requires live video for chronic-pain prescriptions. Each rule below carries its citation and how Tessic Health's providers meet it.

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First visit
Async with conditions
Physician license
IMLC member via HB 1616
Controlled drugs
Video required for chronic pain
Nurse practitioners
Restricted practice

Rules checked September 2026 · 30 sources cited

ONLY IN TEXAS

What is different about Texas

Each rule here is true of Texas and of none of the states that border it. Beside each one: what the neighbours do instead.

  1. 01 · Practice

    Records stay in the US

    From January 1, 2026, Health & Safety Code 183.002, added by SB 1188, requires every covered entity to keep electronic health records holding Texas patient information physically in the United States or a US territory. The rule reaches records held by third-party and cloud vendors, whenever the record was created.

    Source: Tex. Health & Safety Code 183.002 (SB 1188)

    Across the border

    • New Mexico

      New Mexico's telehealth rule, 16.10.8 NMAC, requires the prescriber to generate and keep a record of the video visit but sets no rule on the country where that record is stored.

      Source: 16.10.8 NMAC

    • Oklahoma

      Oklahoma's 59 O.S. 478.1(B) requires telemedicine records to be HIPAA-compliant, secure and confidential, with no requirement about where the servers holding them are located.

      Source: 59 O.S. 478.1

    • Arkansas

      Arkansas State Medical Board Rule 38 requires a documented record and copies for the patient and the regular treating provider, but says nothing about where the record is hosted.

      Source: Ark. State Medical Board Rule 38

    • Louisiana

      LAC 46:XLV.7509 holds Louisiana telemedicine records to in-person documentation standards and requires them to state the visit was remote; it imposes no storage-location rule.

      Source: LAC 46:XLV.7509

  2. 02 · Advertising

    Tell patients about AI

    A Texas practitioner who uses AI for diagnosis must disclose that use to patients under Health & Safety Code 183.005. Since January 1, 2026, TRAIGA also requires a provider using any AI system in a health-care service or treatment to give a clear, plain-language notice no later than the date that service is first provided (Bus. & Com. Code 552.051).

    Source: Tex. Bus. & Com. Code 552.051 (HB 149, TRAIGA)

    Across the border

    • New Mexico

      New Mexico has no AI-disclosure duty for clinicians; HB 60, an Artificial Intelligence Act that carried notice-of-use duties, was postponed indefinitely and died without passing.

      Source: N.M. HB 60 bill history

    • Oklahoma

      Oklahoma has no patient AI-disclosure statute; HB 1915, which would have regulated AI devices in health care, stalled in the Rules committee and is recorded as dead.

      Source: Okla. HB 1915 status

    • Arkansas

      Arkansas has no clinician AI-disclosure law; HB 1816, which would have limited AI in patient care and medical records, was withdrawn by its author before a committee vote.

      Source: Ark. HB 1816 bill history

    • Louisiana

      Louisiana's R.S. 37:22.1 (Act 649, from August 1, 2026) requires only a spoken notice before a visit is recorded for AI transcription; it does not reach AI used to diagnose or treat.

      Source: La. R.S. 37:22.1 (Act 649)

  3. 03 · Prescribing

    Live video for pain drugs

    The Texas Medical Board requires two-way audio and video to prescribe for chronic pain by telemedicine (22 TAC 175.3(b)). The only exception covers an established pain patient who receives the same prescription as at the last visit and was seen in person or by video within the past 90 days.

    Source: 22 TAC 175.3

    Across the border

    • New Mexico

      New Mexico has no telemedicine-specific pain rule; 16.10.14 NMAC applies the same chronic-opioid duties in every setting, including urine drug testing at the start and at least every six months.

      Source: 16.10.14 NMAC

    • Oklahoma

      Oklahoma's 59 O.S. 478.1(C) bars forming a relationship by telemedicine to prescribe opiates, benzodiazepines or carisoprodol, with exceptions only for addiction-treatment drugs and opioid antagonists.

      Source: 59 O.S. 478.1

    • Arkansas

      Arkansas Rule 38 bars any Schedule II–V prescription by telemedicine unless the provider has examined the patient in person or the relationship came through referral, call coverage or an ongoing relationship.

      Source: Ark. State Medical Board Rule 38

    • Louisiana

      LAC 46:XLV.7513 bars Louisiana physicians from using telemedicine to treat non-cancer chronic or intractable pain at all, unless the state medical board grants a written exception.

      Source: LAC 46:XLV.7513

  4. 04 · First visit

    A 72-hour note to the PCP

    When a Texas relationship is formed by telemedicine, Occ. Code 111.005(b) requires the practitioner to give follow-up guidance and, if the patient consents, to send the primary care physician a record or report of the treatment and diagnosis within 72 hours.

    Source: Tex. Occ. Code 111.005

    Across the border

    • New Mexico

      New Mexico's 16.10.8 NMAC requires a video visit, informed consent and a record kept by the prescriber, with no duty to copy the patient's primary care provider and no deadline.

      Source: 16.10.8 NMAC

    • Oklahoma

      Oklahoma's 59 O.S. 478.1 conditions a telemedicine relationship on an Oklahoma license, identity confirmation and HIPAA security; it imposes no duty to send records to a primary care physician.

      Source: 59 O.S. 478.1

    • Arkansas

      Arkansas Rule 38 forwards the encounter record to the regular treating provider unless the patient declines, an opt-out duty that sets no hour limit for sending it.

      Source: Ark. State Medical Board Rule 38

    • Louisiana

      LAC 46:XLV.7509 only requires Louisiana telemedicine records to be available to the patient or a referral physician within a reasonable period; nothing is pushed to a primary care physician.

      Source: LAC 46:XLV.7509

PRACTICE RULES

How telehealth works in Texas

Occupations Code chapter 111 governs every telemedicine visit with a patient in Texas, and the Texas Medical Board applies it to physicians through 22 TAC chapter 175. SB 1188 and TRAIGA add record-storage and AI duties that reach a brand's software vendors as well.

  1. 01

    Get consent first

    Occ. Code 111.002 requires informed consent from the patient, or a person authorized to decide for the patient, before any Texas telemedicine service begins. HB 1700 directs Texas licensing boards to standardize how consent to treatment, data collection and data sharing is recorded, including consent given during an audio-only visit.

    Source: Tex. Occ. Code 111.002

  2. 02

    Same care as in person

    Occ. Code 111.007 holds Texas telemedicine to the standard of care for the same service in person and bars state agencies from adopting a higher telemedicine standard. The Texas Medical Board's 22 TAC 175.2 ties supervision, delegation and posting of the board's complaint notice to chapter 111.

    Source: 22 TAC 175.2

  3. 03

    Vendors count too

    SB 1188's storage rule covers records a Texas covered entity keeps through third-party and cloud vendors, so EHR, e-prescribing and messaging tools all fall inside it. The attorney general can seek $5,000 per negligent violation and $25,000 per knowing violation each year, and up to $250,000 where health information is used for financial gain.

    Source: SB 1188 (Health & Safety Code ch. 183)

  4. 04

    Doctors own the practice

    Occ. Code 164.052(a)(17) lets the Texas Medical Board discipline a physician who aids the practice of medicine by a corporation not licensed by the board, which is why a Texas MSO runs only the business side while a physician-owned practice employs clinicians. A nonprofit health organization certified under Occ. Code 162.001 is the other lawful route.

    Source: Tex. Occ. Code 164.052

FIRST VISIT

Can a first visit happen without a live call in Texas?

Yes, with conditions

Yes, with conditions. Occ. Code 111.005 lets store-and-forward review start a Texas relationship only when the practitioner works from clinically relevant photos or video or the patient's relevant clinical records; otherwise the first visit needs live audio-video.

Occ. Code 111.005(a) lists the ways a Texas practitioner-patient relationship can begin without an in-person exam. A self-reported web questionnaire is not among the listed sources.

  1. 01

    Three ways to start

    Under Occ. Code 111.005(a)(3), a Texas relationship may begin by live audiovisual interaction, by store-and-forward review (alone or paired with a live phone call) that uses clinically relevant images or the patient's relevant records, or by another audiovisual technology that meets the in-person standard of care.

    Source: Tex. Occ. Code 111.005

  2. 02

    What counts as records

    Occ. Code 111.001 defines store-and-forward as technology that stores and transmits a person's clinical information for review at another location. Qualifying Texas records under 111.005(a)(3)(B)(ii) include relevant medical history, laboratory and pathology results and prescription histories.

    Source: Tex. Occ. Code 111.001

  3. 03

    Follow-up and the PCP report

    After a first visit formed under 111.005(a)(3), the Texas practitioner owes the patient guidance on follow-up care. With consent, a report explaining the treatment and the practitioner's evaluation, analysis or diagnosis must reach the primary care physician within 72 hours under 111.005(b)(2).

    Source: Tex. Occ. Code 111.005(b)

  4. 04

    No pregnancy-ending drugs

    Occ. Code 111.005(c) states that no valid practitioner-patient relationship exists in Texas if the practitioner prescribes an abortifacient or any other drug or device that terminates a pregnancy, so no Texas telemedicine visit can support that prescription.

    Source: Tex. Occ. Code 111.005(c)

PRESCRIBING

Prescriptions and controlled drugs in Texas

Texas has no separate state controlled-substance registration, so a Texas license and a DEA registration are the permits a prescriber needs. It pairs that with a mandatory Texas PMP lookup and an electronic-prescribing mandate for controlled substances. Federal DEA telemedicine flexibilities run through December 31, 2026.

  1. 01

    Check the PMP first

    Health & Safety Code 481.0764 requires a Texas prescriber to review the patient's history in the Texas Prescription Monitoring Program (the state's prescription-monitoring database, run by the Texas State Board of Pharmacy on PMP AWARxE) before prescribing opioids, benzodiazepines, barbiturates or carisoprodol. The board warns that an EHR-integrated risk score alone does not satisfy the lookup.

    Source: Texas State Board of Pharmacy, PMP

  2. 02

    Controlled drugs go electronic

    Health & Safety Code 481.0755 requires Texas controlled-substance prescriptions to be issued electronically, with listed exceptions such as a system outage or a waiver. Under 481.0756, the prescriber's licensing board may grant a one-year waiver for economic hardship or technology limits outside the prescriber's control.

    Source: Tex. Health & Safety Code 481.0755

  3. 03

    No state DEA twin

    SB 195 repealed the Department of Public Safety controlled-substance registration in Health & Safety Code chapter 481 and moved the Texas PMP to the State Board of Pharmacy. A prescriber treating Texas patients now relies on a DEA registration alone for controlled-substance authority.

    Source: SB 195 bill analysis (84th Legislature)

  4. 04

    Mail-order needs Class E

    A pharmacy outside Texas that mails prescriptions to Texas patients needs a Class E nonresident pharmacy license from the Texas State Board of Pharmacy under Occ. Code 560.051(f). Dispensed Schedule II–V prescriptions must be reported to the Texas PMP by the next business day.

    Source: Tex. Occ. Code 560.051

Federal rules apply on top of every state's. Prescribing controlled substances by telehealth without an in-person visit runs on DEA flexibilities currently extended through December 31, 2026, with a permanent rule still pending.

LICENSES

Who can treat patients in Texas

A physician treating a patient located in Texas by telemedicine needs a full Texas medical license under 22 TAC 175.1. HB 1616 made Texas a member of the Interstate Medical Licensure Compact, which shortens the route to that license for physicians licensed in another member state.

  1. 01

    Full license only

    22 TAC 175.1 bars telemedicine to Texas patients without a full Texas medical license. The Texas Medical Board's out-of-state telemedicine license is closed to new applicants; only physicians who already held one before the cutoff in that rule keep that path.

    Source: 22 TAC 175.1

  2. 02

    Compact route

    Through HB 1616, Texas takes part in the Interstate Medical Licensure Compact (IMLC, an expedited multi-state licensing route). A physician applies with a Letter of Qualification from the state of principal license, and the Texas Medical Board then issues the full Texas license.

    Source: Texas Medical Board, IMLC application

  3. 03

    NPs work under agreements

    AANP rates Texas a restricted state: nurse practitioners and physician assistants prescribe under a prescriptive authority agreement with a delegating physician. Occ. Code 157.0512 caps a physician at seven APRNs and PAs combined and requires monthly meetings plus chart review in the quality plan.

    Source: Tex. Occ. Code 157.0512

  4. 04

    Schedule II stays with doctors

    Occ. Code 157.0511 allows a Texas physician to delegate Schedule II prescribing only in a hospital facility-based practice or for hospice patients. Outside those settings, Schedule II prescriptions for Texas telehealth patients must come from the physician, while Schedule III–V can be delegated.

    Source: Tex. Occ. Code 157.0511

ADVERTISING

Marketing to patients in Texas

The Texas Medical Board polices physician advertising under 22 TAC chapter 164. The legislature adds a patient-solicitation crime, a telemarketing law that now covers marketing texts, and the Texas Data Privacy and Security Act.

  1. 01

    Label every testimonial

    22 TAC 164.3 treats a Texas physician ad as misleading if a testimonial lacks a disclaimer about the speaker's credentials and a disclosure of any compensation paid. The same rule bars 'board eligible' wording that implies board certification and 'free' claims when a third party is billed.

    Source: 22 TAC 164.3

  2. 02

    No paying for patients

    The Texas Patient Solicitation Act, Occ. Code 102.001, makes it a Class A misdemeanor to knowingly pay or accept remuneration for soliciting or securing patients. Occ. Code 102.003 exempts arrangements the federal anti-kickback statute permits, including its regulatory safe harbors.

    Source: Tex. Occ. Code 102.001

  3. 03

    Texts count as telemarketing

    SB 140 extended Bus. & Com. Code chapter 302 to marketing texts, so a seller soliciting Texas purchasers by call or text must hold a Secretary of State registration and post $10,000 security unless an exemption applies. Violations are actionable under the Texas Deceptive Trade Practices Act; counsel should confirm which exemption fits the brand.

    Source: Tex. Bus. & Com. Code 302.107

  4. 04

    Health data needs consent

    The Texas Data Privacy and Security Act lists a mental or physical health diagnosis as sensitive data a controller may process only with consent (Bus. & Com. Code 541.001(29), 541.101). HIPAA covered entities and business associates are exempt under 541.002, so the act bites on brand activity outside HIPAA, such as ad pixels on a marketing site.

    Source: Tex. Bus. & Com. Code 541.101

TESSIC HEALTH IN TEXAS

How Tessic Health's providers cover Texas

Tessic Health's providers hold full Texas licenses and run each Texas visit to Occupations Code chapter 111 and 22 TAC chapter 175. The brand keeps its name, patients, records and data, while the MSO and friendly-PC structure leaves clinical decisions with Texas-licensed clinicians.

  1. 01

    Async only with photos or records

    A first Texas visit handled asynchronously always draws on clinically relevant photos or the patient's relevant clinical records under 111.005(a)(3)(B); a questionnaire alone never starts the relationship. With the patient's consent, the visit report reaches the primary care physician within 72 hours.

  2. 02

    PMP and EPCS every time

    Tessic Health's providers open the full Texas PMP report, not an integrated score, before any opioid, benzodiazepine, barbiturate or carisoprodol prescription, and send every controlled-substance prescription for a Texas patient by EPCS. Chronic-pain prescriptions follow the live-video rule in 22 TAC 175.3(b).

  3. 03

    US-hosted records, AI notice

    Records of Texas patients sit on US-hosted systems to meet Health & Safety Code 183.002. Where AI supports a diagnosis or treatment decision for a Texas patient, the patient receives a plain-language notice by the date that service is first provided, as TRAIGA requires.

  4. 04

    Licensed Texas pharmacies

    Pharmacies that ship into Texas from out of state hold a Texas Class E nonresident pharmacy license. Fulfillment runs at 0% markup, with cold-chain shipping for Texas orders of drugs that need it, such as injectable GLP-1 medications.

  5. 05

    Physician-led delegation

    Texas nurse practitioners and physician assistants on the network prescribe under prescriptive authority agreements with delegating Texas physicians that meet the Occ. Code 157.0512 limits, and Schedule II prescriptions for Texas patients are written by physicians.

COMMON QUESTIONS

Questions about telehealth in Texas

  • Yes, if the provider works from photos, video or the patient's clinical records. Occ. Code 111.005(a)(3)(B) allows store-and-forward review, with or without a live phone call, when it draws on clinically relevant images or records such as labs and prescription history.

  • In the United States or a US territory. Since January 1, 2026, Health & Safety Code 183.002 requires covered entities, including their cloud vendors, to keep electronic health records of Texas patients physically on US soil, whenever the record was made.

  • Yes. A practitioner who uses AI for diagnosis must disclose it under Health & Safety Code 183.005, and TRAIGA (Bus. & Com. Code 552.051) requires a plain-language notice of any AI system used in a health-care service or treatment by the date that service is first provided.

  • Only by live video, with one refill exception. 22 TAC 175.3(b) requires two-way audio and video for chronic-pain prescribing unless an established pain patient gets an identical prescription after a visit in person or by video within 90 days, and the Texas PMP must be checked before any opioid.

  • Yes. HB 1616 made Texas a member of the Interstate Medical Licensure Compact, and the Texas Medical Board issues full Texas licenses to physicians who hold a Letter of Qualification from their state of principal license.

  • No. Texas nurse practitioners prescribe under a prescriptive authority agreement with a delegating physician (Occ. Code 157.0512), and Occ. Code 157.0511 limits Schedule II delegation to hospital facility-based practice and hospice care.

SOURCES

Rules checked September 2026 · 30 sources cited. A planning summary, not legal advice. Statutes, board rules and enforcement priorities change; a brand's own counsel should review its model and marketing before launch.

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Rules in other states

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