Locum Law | NJ Telehealth Ruling, NC Fees Rise, & More (Oct 2026)

By Locumpedia Editorial

2026-10-05

Locum Law is Locumpedia’s monthly column on the rules that govern locum tenens: licensure, the compacts, telehealth, and Medicare. Every claim links to its source and we describe them rather than advise.

The biggest licensure development of the month didn’t come from a medical board. On August 31, a federal appeals court issued a precedential decision holding that New Jersey can require a state license before a physician treats a patient located there by video. Meanwhile, North Carolina’s license fees went up on October 1, marking the first increase in physician fees there since 2016.

Here’s what changed, what’s still only proposed, and what’s on the calendar.

What Did the Court Actually Decide?

That the patient’s location sets the license, not the physician’s.

The case is MacDonald v. President of the New Jersey State Board of Medical Examiners, No. 25-2090, decided August 31, 2026, in the US Court of Appeals for the Third Circuit. Physicians licensed elsewhere argued that New Jersey’s telemedicine licensure requirement violated the First Amendment, the dormant Commerce Clause, and the Privileges and Immunities Clause. The court rejected all three.

On the speech question, the panel wrote that “New Jersey’s requirement that one obtain a New Jersey medical license before providing medical advice by telemedicine to persons in New Jersey does not violate Plaintiffs’ First Amendment rights” (Third Circuit, precedential opinion).

It was more direct on the commerce question: “The telemedicine law applies equally to in-state and out-of-state doctors; all who wish to practice medicine (virtually or in person) with a patient in New Jersey must be licensed, regardless of the doctor’s location.”

The patient’s location sets the license, not the physician’s.

The decision is precedential within the Third Circuit, which includes New Jersey, Pennsylvania, Delaware, and the US Virgin Islands. It isn’t a national holding. The opinion does, however, affirm New Jersey’s authority to require physicians treating patients situated in the state by telemedicine to hold a New Jersey medical license.

What Does a North Carolina License Cost Now?

More, as of October 1. The North Carolina Medical Board raised application and renewal fees for both physicians and physician assistants, and the notice is specific about the trigger: “The new fees apply to all license applications submitted on or after October 1, 2026" (fee notice).

The board, which is self-funded, points to a 40% increase in its licensee population and a 79% increase in complaints since 2016. Physician fees were last increased in 2016, while PA fees had been unchanged since 2019.

The new fees are based on the application submission date, which is a detail worth reading twice if you’re mid-application.

Which States Still Aren’t in the Compact?

California, New York, and Virginia, same as last month. Between them, they hold 608 of the locum tenens opportunities currently posted to Locumpedia, and none of the three is an Interstate Medical Licensure Compact member.

These are the ten states Locum Law tracks each month, not a national ranking. Counts are active, approved postings aggregated across competing agencies on Locumpedia as of October 2, 2026. They’re a snapshot of where agencies are posting opportunities right now and they move with posting and expiry cycles, so month-to-month totals aren’t a demand index. Postings older than 90 days were retired in September 2026, so these counts reflect a tighter freshness window than the ones we published last month and the two aren’t directly comparable. Compact membership is based on the Interstate Medical Licensure Compact Commission’s member-state map, which is current as of March 2026.

California is still the single largest source of locum tenens work posted to Locumpedia, and the IMLC isn’t an option for licensure there. New York and Virginia sit outside the physician compact too, which the commission’s own member-state map shows by omission.

The August 31 ruling puts a sharper focus on that distinction. If the patient’s location sets the license, physicians seeking licensure in states outside the compact don’t have access to the IMLC’s expedited pathway.

What Changed for Physician Assistants?

Virginia’s Prescription Rule Reached the Final Stage

The regulation that would stop requiring a PA to name the patient-care-team physician or podiatrist on a Schedule II through V prescription has moved from the proposed stage to final, with its comment period closed on May 8, 2026. It now shows “Governor’s office review in progress” (Virginia Regulatory Town Hall, action 6294).

The PA Licensure Compact Still Issues Nothing

No change since August. The compact’s own newsletter put membership at 29 states and said “No states are actively issuing privileges yet,” with a working database projected for early 2027 (PA Licensure Compact, August newsletter). The commission met on September 18 and hadn’t posted a summary as of this writing.

North Carolina’s August Rule Is Now Nine Weeks Old

A reminder rather than news: since August 1, 2026, a PA with 4,000 total clinical hours, including 1,000 in a specialty, can work in a North Carolina team-based practice setting without physician supervision, under 21 NCAC 32S .0227 (North Carolina Medical Board, rule change tracker).

What’s Still Only Proposed?

Georgia’s protocol-ratio change, for the second month running. Proposed Chapter 410-11 would let eight advanced practice registered nurses enter a nurse protocol agreement with one physician instead of four. It hasn’t taken effect. We re-read the live rule on October 2, and it still says “Only four (4) advanced practice registered nurses may enter into a nurse protocol agreement with a delegating physician at any one time” (Georgia Rules and Regulations, Chapter 410-11). Four is still the number.

Virginia opened a new rulemaking on its PA regulations, 18VAC85-50, which reached the Governor’s office at the notice stage on September 10, 2026. What it would change hasn’t been published yet, so the details aren’t clear.

Texas proposed standards for parenteral ketamine therapy in office-based settings, amending Chapter 173, published in the Texas Register on July 10, 2026, with no hearing date set (Texas Medical Board, rule changes).

What’s Happening With Medicare Telehealth?

The waiting part. The comment period on the CY2027 Medicare Physician Fee Schedule closed on September 14, 2026, and the final rule hadn’t been published as of October 2. It’s normally out in November or December, and it’s the document that sets next year’s telehealth payment rules.

The proposed rule remains the best available guidance. CMS proposed “conforming regulatory changes to implement the Consolidated Appropriations Act, 2026 Section 6209(c) to require that in-person visit requirements for mental health visits not apply to any services furnished through December 31, 2027,” and noted that the same statute “extended the authority for CMS to pay RHCs and FQHCs for non-behavioral health visits furnished via telecommunication technology through December 31, 2027" (CMS, CY2027 PFS fact sheet).

New Mexico remains the next compact state to watch. Its board says the November meeting is where the proposed rules get their hearing, with an “anticipated launch of the Interstate Medical Licensure Compact in New Mexico, pending completion of the rulemaking process and final approvals” in December 2026 or January 2027 (New Mexico Medical Board, IMLC update).

Locum Law describes what state boards, compacts, courts, and federal agencies have published. It isn’t legal advice. Every item here was reviewed using its primary source on the date shown. Where a rule is proposed rather than enacted, we say so.