Lawmakers Face Pressure to Address Licensure Barriers for Telehealth Adoption

The Alliance for Connected Care is putting pressure on lawmakers at both the state and federal levels to relax licensing barriers that interfere with multi-state telehealth programs.

The alliance has sent an open letter to policymakers in a bid to create consensus principles for telehealth across state lines.  The letter, which was introduced last November, is now endorsed by dozens of groups and providers, including Ascension, the American Association of Nurse Practitioners, Amwell, Intermountain Healthcare, Johns Hopkins Medicine, MedStar Health, Nemours Children’s Health System, the National Committee for Quality Assurance (NCQA), Stanford Health Care, URAC and the Michael J. Fox Foundation for Parkinson’s Research.

The letter takes on a significant challenge to telehealth expansion: licensing rules and guidelines that hinder providers in treating patients in other states. Some states have relaxed those rules to recognize providers from other states during the coronavirus pandemic, but those emergency measures will end with the public health emergency.

“Patients have long traveled across state lines for specialty care, but the COVID-19 pandemic has demonstrated that this care, particularly delivered through telehealth, can also help alleviate access issues in many other areas of health care,” the letter states. “Looking beyond the public health emergency, one important way policymakers and health care regulators can permanently facilitate access to care is by allowing providers and patients to connect with each other regardless of their physical location.”

The letter recommends “state leadership with federal support,” and supports “efforts to simplify and accelerate health professional licensure recognition across state lines.”

Portability – or allowing states to recognize a license from another state – is fast gaining attention in the effort to tackle this issue. One organization that uses portability is the National Council of State Boards of Nursing, whose Nurse Licensure Compact (NLC) allows nurses to practice in member states without having to obtain additional licenses.

Among those supporting that concept is the eHealth Initiative, which included licensure portability in its October 2020 recommendations for federal policy changes to expand telehealth access and coverage during and after the COVID-19 crisis.

Another supporter is New York Governor Andrew Cuomo, who introduced a telehealth bill as part of his state budget this past week that calls for “interstate licensing reciprocity” with states throughout the Northeast.

But it’s not the only option. Several groups have created interstate licensing compacts, which create an expedited pathway for applying for and receiving licenses in member states. In addition, some have floated the idea of having one license for the entire country.

Congress is certainly aware of the issue. The Equal Access to Care Act, introduced last June by Senators Marsha Blackburn (R-TN) and Ted Cruz (R-TX), would allow a provider in any state to use telehealth to treat a patient in any location for up to 180 days after the national emergency. And the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, introduced in August by Senators Chris Murphy (D-CT) and Roy Blunt (R-MO), would enable healthcare providers in good standing to use connected health to treat patients in any state during the pandemic.

This past November, Florida Congressman Ted Yoho introduced a bill that would prevent states from receiving Bureau of Health Workforce funding unless they’ve joined the Interstate Medical Licensure Compact, which governs doctors. Some 29 states and Washington DC have signed up for that compact, though interest in that effort is waning.