New Telehealth Bill Would Penalize States Who Don't Join Licensure Compact

A group of Congressmen wants to prod states into joining the Interstate Medical Licensure Compact, which aims to make it easier for providers to use telehealth to treat patients in other states.

US Rep. Ted Yoho (R-FL) has introduced a bill (HR 8723) that would prevent states from receiving funding from the Bureau of Health Workforce, a branch of the Health and Human Services Department’s Health Resources and Services Administration, unless they’ve joined the compact. The bill would give states three years to join the IMLC.

The bill would also prevent state licensing boards from receiving certain federal grants unless they have a “public awareness campaign to encourage specialty physicians to practice telemedicine.”

The IMLC, launched in 2017 by the Federation of State Medical Boards and now managed by its own governing board, aims to improve multi-state telehealth programs by providing a streamlined process for physicians to apply for and receive licenses to practice in other states.

The compact is now live in 25 states and Guam, while three states are members but not processing license applications and two states and Washington DC have passed legislation to join the compact but not acted on that yet. Another three states are pondering legislation.

Yoho, whose bill is co-sponsored by US Reps. Bennie Thompson (D-MS), Tom Tiffany (R-WI) and Jim Hagedorn (R-MN), is wading into an increasingly contentious debate over one of the biggest barriers to connected health expansion: state regulations that hinder and often prevent providers from using telehealth to treat patients in other states.

While some telehealth advocates support the IMLC, others say it doesn’t do enough to ease the burdensome process of practicing in multiple states – and they note the IMLC isn’t getting support from all the states, as its creators had hoped. An alternative might be a compact that allows states to recognize licenses issued in other states, or even one national license.

In response to the coronavirus pandemic, roughly half the states enacted emergency measures that recognize license portability, enabling care providers to use telehealth across state lines. But those measures have a limited shelf life, and federal lawmakers haven’t yet decided how to address licensure issues beyond COVID-19.

Two other bills before Congress target licensure during the pendemic. The Equal Access to Care Act, introduced in 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. 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.

In a report released in October, the eHealth Initiative recommended federal support for licensure portability through a compact that enables care providers licensed in one compact state to practice in any other compact state – much like the Nurse Licensure Compact (NLC).

“Policymakers should ensure that all financial and policy incentives – including existing and new HRSA grants – encourage states to adopt a similar mutual recognition compact for physicians,” that report noted. “This path forward recognizes the rights of states to regulate the practice of medicine within their borders, protects patients, and at the same time facilitates access to care across state lines.”

The Alliance for Connected Care, meanwhile, is preparing to release a report this month that urges lawmakers to support license recognition in multiple states through “efforts to simplify and accelerate health professional licensure recognition across state lines,” which could come through compacts that allow states to recognize licenses from other states in that compact.

“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 alliance says in a draft letter. “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.”