South Carolina’s Telehealth Laws Receive an F Grade

Our friends at the Cicero Institute annually publish an analysis of telehealth laws across the 50 states. Earlier this year, Palmetto Promise released an analysis of improvements needed in South Carolina’s telehealth laws, relying on previous editions of Cicero’s grading system that did not account for the Telehealth and Telemedicine Modernization Act, which was signed into law in early 2024.

This month, Cicero’s policy experts released an updated report for 2025, which we have confirmed takes into account South Carolina’s recent strides to advance telehealth access. This is the first year that Cicero has given states letter grades for their performance in telehealth innovation, and we were excited to see how the Palmetto State measured up against others.

But unfortunately….the grade doesn’t look too good for the Palmetto State.

Even with the important updates from the Telehealth and Telemedicine Modernization Act, South Carolina has still received an F grade for telehealth innovation compared to the rest of the nation.

We join 9 other states in receiving this low grade. What in the world has gone wrong in our telehealth policy?

Luckily, Cicero accompanies their grades with recommendations across four key areas that South Carolina lawmakers should tackle:

• Modality Neutral: Add definitions for remote patient monitoring and store-and-forward in the provider code.
• Start Telehealth by Any Mode: Make it clear that a patient-provider relationship can start over any mode.
• No Barriers to Across-State-Line Telehealth: Pass an easy registration or reciprocity law for all providers. Don’t require providers living out of the state still to obtain a South Carolina full license.
• Independent Practice: Remove the written protocol requirement.

Our team discussed each of these areas in greater detail in our January 2025 report, and we commend that to readers who wish to know more.

The latter two categories (no barriers to across-state-line telehealth and independent practice) were ranked by Cicero as being particularly prohibitive to innovation and most in need of reform.

The across-state-line issue in current law can be best illustrated by example from one of our current Palmetto Promise interns, whose childhood friend is attending college in Savannah, Georgia. She had a preexisting relationship with a mental health counselor from back home in Charleston and wished to continue receiving those services via telehealth while in college. Seems pretty simple, right? Yet, to comply with regulations on telehealth practice for mental health services, this student is forced to, for every weekly appointment, get in her car and drive from Savannah back across the South Carolina state line. She ends up conducting her telehealth appointments from a highway rest stop parking lot 25 minutes up the road, because it is illegal for her South Carolina licensed counselor to offer counseling to a South Carolina resident who happens to be in Georgia at the time of her appointment.

We know that this is just one anecdotal instance (and Georgia laws also come into play there),  but it really embodies the hoops that across-state-line telehealth practitioners must jump through and the burdens that it places on patients. Clearly, the current laws are broken.

We hope that South Carolina lawmakers will heed the recommendations that Cicero proposes and take action to make virtual healthcare more accessible for South Carolinians. Legislators may also be interested in reading some of the South Carolina specific resources on Cicero’s website. This is a test that we should not be flunking, and it’s one that the General Assembly can rectify with thoughtful legislation.