Connected Care Alliance Unveils Telehealth Licensing Portability Plan

The Alliance for Connected Care is adding a new twist to the growing debate over telehealth licensure.

The alliance has introduced draft legislation for a Medical Excellence Zone, a regional licensure portability program aimed at allowing participating states to recognize each other’s medical licenses. Providers in those states wouldn’t be allowed to establish physical offices in other states, but they would be able to use telehealth to treat patients there.

The proposal comes in response to a bill currently being debated in Maryland. HB 732 aims to allow out-of-state providers to treat patients in the state by completing an application and registering as such. The application process includes a registration fee and the requirement to re-apply every two years, or according to a time period set by the state.

“While we are absolutely on board with the idea of cross-state licensure, and have lobbied intensely to break down state barriers to licensure portability, we stand in opposition to House Bill 732,” the alliance said in written testimony submitted earlier this month to Maryland lawmakers. “We believe that without amendments, this bill re-creates the burdens of the licensing process, and unnecessary requirements to ensure patient safety, under a different name. It does not help Maryland providers treat patients outside of Maryland nor does it significantly reduce the administrative and financial burden of allowing non-Maryland providers to treat Maryland patients by telemedicine.”

According to the alliance, a Medical Excellence Zone would:

• Allow the medical or nursing board in the state in which the provider is licensed to maintain oversight of that provider;
• Enable collaboration and information-sharing between states to ensure “that medical malpractice and other important licensure issues are dealt with proactively and effectively;”
• Allow providers to register to practice within the zone and be verified by a central regional registrar; and
• Allow patients to give their consent to being treated by an out-of-state provider and attest to understanding that the laws of the provider’s state apply to the visit.

The proposal is the latest wrinkle in a growing debate over one of the primary barriers to telehealth adoption and expansion. With states maintaining their own licensing rules, providers are forced to go through a complex and expensive process to apply for licenses to practice in each state. This presents a significant burden for health systems serving patients in multiple states, as well as for providers and specialists who want to use telehealth to grow their business.

The coronavirus pandemic has helped to shine a spotlight on the issue. Almost all states have issued emergency actions, good for the duration of the public health emergency, that ease licensing barriers and allow some portability for providers using telehealth. In addition, the Emergency Management Assistant Compact (EMAC) has been amended to allow for interstate care.

“This is the first time that consumers have had the ability, on a widespread basis, to access care from providers in other states,” the alliance says in documents supporting the Medical Excellence Zone. “Prior to the pandemic, only medical practitioners serving active duty military or veterans through the Veterans Administration, and registered nurses in certain states, could provide care across state lines without a license in the state where the patient is located.”

But those freedoms will end with the PHE, and state governments and Congress are under pressure from telehealth advocates to find a permanent solution. The Alliance for Connected Care has sent an open letter to policymakers calling for consensus principles for telehealth across state lines, and at least two bills have been filed in Congress calling for permanent license portability.

Some states have moved to extend license portability beyond the pandemic, in some cases permanently, while some are also exploring licensing portability partnerships with neighboring states. And last fall, governors in Washington, Oregon, Nevada and Colorado announced their own plan to collaborate on telehealth issues, including licensure portability.

The type of license portability called for in the Medical Excellence Zone is similar to that afforded nurses in the Nurse Licensure Compact, and it’s one of three popular proposals aimed at solving the telehealth licensure issue. Under license portability, each state controls its own licensing process and recognizes licenses issued by other states for certain services, such as telehealth.

A second option – one hewing closer to the proposed bill in Maryland – is the licensure compact. The Interstate Medical Licensure Compact, launched by the Federation of State Medical Boards in 2017 and now active in almost 30 states, gives doctors an expedited pathway to applying for and receiving a license in other states. It’s one of several compacts up and running.

A third option would create one medical license good for the entire country.