North Dakota’s landmark telemedicine legislation: A new era for optometric care

North Dakota has enacted a landmark law that brings clarity and accountability to the delivery of optometric care via telemedicine. House Bill 1267 (HB 1267), signed into law by Governor Kelly Armstrong on March 24, 2025, introduces essential updates to the state’s optometry statutes, specifically focusing on modern telemedicine regulations.

The law amends multiple sections of the North Dakota Century Code and was developed in partnership with the North Dakota Optometric Association (NDOA), the North Dakota State Board of Optometry, and national advocacy bodies. Its passage marks a shift toward more structured and safe remote healthcare practices in the state.

A long-awaited legislative update

For over two decades, North Dakota’s optometry laws had remained unchanged. As telemedicine began to take hold across various healthcare sectors, especially during and after the COVID-19 pandemic, the need for a comprehensive framework for remote eye care became evident. HB 1267 responds directly to this demand by establishing clear and enforceable guidelines for delivering optometric care via digital platforms.

This bill marks a pivotal shift in how the state regulates telemedicine in eye care, ensuring that both patients and providers have a clear understanding of the rules surrounding remote consultations, diagnoses, and treatments.

Importantly, while the law addresses telemedicine within optometry, it does not alter the scope of practice for optometrists in North Dakota. Rather, it sets up the necessary regulations and structure to ensure that telemedicine services are provided responsibly and ethically. This development is particularly important given the rapid expansion of telemedicine across healthcare fields, and the increasing role of telemedicine regulations in maintaining high-quality care.

Addressing the remote care gap

Before the enactment of HB 1267, North Dakota lacked specific legal provisions addressing telemedicine in optometry. This created a regulatory gray area, leaving both providers and patients uncertain about how to navigate remote eye care. With the passage of HB 1267, these uncertainties have been cleared up, and a legal framework has been established to govern telemedicine in optometry.

The new law outlines exactly when and how telemedicine can be utilized, identifies who is qualified to provide telemedicine services, and establishes the standards to be upheld to ensure patient safety and the quality of care.

One of the major concerns addressed by HB 1267 is the formation of the provider-patient relationship in a telemedicine setting. In traditional in-person care, this relationship is established through direct physical interaction between the patient and the optometrist.

However, in telemedicine, this relationship can be more ambiguous. The new law clarifies that a valid telemedicine provider-patient relationship is established when a patient actively seeks services, and a licensed optometrist agrees to provide them. This ensures that telemedicine services are only offered when both parties are appropriately engaged in the care process.

Furthermore, HB 1267 specifies that telemedicine cannot be used as a substitute for in-person care in all situations. Instead, it is to be used primarily for follow-up consultations, non-urgent care, and in situations where physical exams are not immediately necessary. In emergencies, however, telemedicine may be used for immediate care, as long as the situation allows for appropriate remote consultation.

Informed consent and verification

The new law underscores the necessity of informed consent as a foundation of ethical and legal telemedicine practice. Prior to delivering any remote optometric services, the provider is required to obtain the patient’s informed consent. This consent must include a detailed explanation of the technologies used for care delivery and protocols for resolving potential issues like service interruptions or disconnections.

In addition to informed consent, providers must present verification of their professional credentials. Licensed optometrists offering telemedicine services must confirm their identity, current licensure, and updated contact information before engaging in any form of diagnosis or treatment. These verification steps help ensure that patients are being served by legitimate professionals governed by the standards set by the State Board of Optometry in North Dakota.

The law empowers the board to establish additional rules for remote consultations, diagnoses, and treatments for ocular conditions. These protocols are aimed at making sure that the same standards applied to in-person care are extended to telemedicine interactions.

Behind the bill: A unified legislative push

The path to HB 1267’s passage was paved by two years of dedicated work from optometric professionals, policymakers, and national advocates. The North Dakota Optometric Association and the State Board of Optometry led the charge, identifying key areas of concern and crafting legislation that could withstand both political and professional scrutiny.

National collaboration and regional guidance: The American Optometric Association (AOA), especially through its State Government Relations Committee (SGRC), played a critical advisory role during the bill’s drafting and revision phases.

Representatives from neighboring state optometric affiliates also lent their insights. Notably, North Dakota stakeholders participated in the SGRC Regional Advocacy Meeting in Dallas, Texas in October 2024, where they received support and strategic guidance that helped refine the bill’s language and strengthen its objectives.

Kim Hacker, the executive director of the NDOA, emphasized the importance of collaboration, noting that the success of the bill went beyond enhancing safety and accountability in optometric telemedicine. She expressed deep gratitude for the significant support received from the SGRC and fellow affiliates throughout the process.

Legislative timeline: HB 1267 was introduced to the North Dakota House of Representatives on January 13, 2025, and quickly gained traction. It passed the Senate on February 17, 2025, before being signed into law the following month. This swift progress reflected the bill’s well-thought-out nature and the consensus that it addressed a real and growing need.

Expanding access with safety

While HB 1267 does not broaden optometrists’ scope of practice, it effectively expands access to care, particularly for patients in rural or underserved communities. With much of North Dakota’s population living far from urban centers, timely access to eye care has long been a challenge.

The new telemedicine regulations make it possible for patients to receive consultations, diagnoses, and treatments remotely without having to travel long distances. By ensuring that all remote services are provided by licensed professionals operating under consistent standards, the bill enhances both access and safety.

Balancing innovation and accountability

This legislation shows that it’s possible to embrace new technologies without compromising care quality. By requiring initial in-person exams, clear informed consent procedures, and professional verification, the law ensures that telemedicine augments rather than replaces traditional eye care practices.

Furthermore, by limiting the use of telemedicine to professionals with physical offices within the state, North Dakota ensures local accountability. This approach avoids the risks associated with cross-border telehealth providers who may not be subject to state disciplinary measures.

A model for telemedicine in eye care

North Dakota’s HB 1267 serves as a blueprint for other states considering how to regulate telemedicine in healthcare fields like optometry. By balancing access, accountability, and patient safety, the law demonstrates how a state can adapt its healthcare regulations in a responsible, forward-thinking way.

Since the bill’s passage, stakeholders from other healthcare sectors in North Dakota have expressed interest in adopting similar principles for their own telemedicine practices. The state’s proactive and inclusive approach—combining local needs with national expertise—has made it a model for telemedicine legislation across the United States.

As telemedicine tools continue to evolve, such as AI-assisted diagnostics or portable imaging devices, HB 1267 provides a legal framework that can adapt to these innovations. Because the law empowers the North Dakota Board of Optometry to set and update practice rules, it creates a flexible yet firm foundation for the future.