CMS Clarifies Medicare Recognition of Interstate Licensure Compacts

With so many states allowing telehealth services delivered by out-of-state providers, the Centers for Medicare & Medicaid Services has clarified its policy on Medicare recognition of providers licensed through interstate licensure compacts.

CMS last month published an updated Medicare Learning Network (MLN) notice for physicians and non-physician practitioners who bill through Medicare Administrative Contractors (MACs) for services provided to Medicare enrollees. The three-page notice emphasizes that not all licensure compacts are the same.

The updated guidance is timely, in that many states relaxed their rules during the pandemic to facilitate telehealth services from out-of-state providers, and some states have kept those freedoms in place or updated their guidelines to continue that momentum. This is also fueling an interest in interstate licensing compacts as a means of supporting telehealth expansion.

The CMS document references the Interstate Medical Licensure Compact (IMLC), launched in 2017 by the Federation of State and Medical Boards to help physicians treat patients in other states. The IMLC offers an expedited pathway for physicians to apply for and receive licenses from other states, and is now in effect in more than half the states.

That compact is different from other compacts, such as the National Council and State Boards of Nursing’s Nurse Licensure Compact (NLC). Launched in 2018, that compact allows states to recognize licenses issued by other states in the compact, and now comprises roughly 33 states.

Aside from the IMLC and NLC, the agency said it’s aware of other compacts for physical therapists, occupational therapists, speech-language therapists and psychologists, and notes that others may be in development.

“For physicians and NPPs, we’ll treat licenses through the interstate license compact pathway as valid, full licenses for the purposes of meeting our federal license requirements,” CMS says in its bulletin. “Your MACs will accept CMS-855 enrollment applications from providers reporting a license through the interstate license compact pathway.”

The agency said MACs will either verify a provider’s license through the appropriate compact or ask the provider for more information to validate the license. They’ll also re-open any enrollment applications that had been denied to check the validity of those licenses against available compacts.