States Support License Portability as a Key to Telehealth Expansion

Doctors in 35 states and the District of Columbia can now use telehealth to treat patients in other states, as part of the massive national effort to tackle the Coronavirus pandemic.

Officials in those states have passed or are in the midst of passing emergency legislation on license portability, according to a database kept by the Federation of State Medical Boards. That’s more states than have signed up for the Interstate Medical Licensure Compact (IMLC), launched in 2017 by the FSMB to facilitate an easier process to acquiring licenses to practice in multiple states.

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Healthcare providers are flocking to telehealth and mHealth solutions to treat patients in remote settings, reduce hospital crowding and protect their doctors and nurses during the pandemic. Those platforms offer the potential to treat many more people if providers are free to treat patients regardless of where they’re located.

That’s why interstate licensure is considered of the strongest barriers to the broad adoption of connected health.

“It is increasingly challenging for physician practices to compete with large commercial entities that are contracting with payers to provide telemedicine services, including primary care services,” the American Medical Association said in a report adopted late last year in support of the IMLC. “Commercial direct-to-consumer telemedicine enables patients to receive care from their homes, offices or mobile devices; however, these encounters are provided outside of a patient’s medical home and can lead to fragmented care. Where there is an established patient relationship, a physician should be able to use telemedicine to provide quality emergent or urgent care for a patient’s existing condition when that patient is traveling in another state.”

Without the ability to treat patients in multiple states, “a lot of large telehealth programs will struggle,” adds Aaron Martin, EVP and Chief Digital Officer for Providence St. Joseph Health, the Washington-based health network spanning several states.

According to the FSMB database, which is updated regularly, many states are filing emergency rules that waive licensing and credentialing requirements during the pandemic.

Delaware, for instance, is enabling physicians, pharmacists, respiratory therapists, physician assistants, paramedics, EMTs, nurses, nursing assistants, psychologists, mental health counselors, clinical social workers, chemical dependency counselors and marriage and family therapists in good standing in their own states to practice in that state.

“Any out-of-state personnel, including, but not limited to, medical personnel, entering California to assist in preparing for, responding to, mitigating the effects of, and recovering from COVID-19 shall be permitted to provide services in the same manner as prescribed by Government Code section 179.5, with respect to licensing and certification,” California Gov. Gavin Newsom wrote in his state of emergency declaration, issued earlier this month.

To aid states that haven’t yet taken this action, the FSMB has created a guidance document for license portability during the pandemic.

Federal officials created some confusion around the delegation of license portability on March 18, when Vice President Mike Pence announced that the Health and Human Services Department would issue a regulation allowing doctors and medical professionals “to practice across state lines to meet the needs of hospitals that may arise in adjoining areas.”

Telehealth experts criticized the announcement, saying the federal government doesn’t have that authority, which rests with the states. HHS hasn’t clarified Pence’s statement or issued any directives regarding licensure since then.

An ongoing concern is what happens once the emergency is over. Most, if not all, of the declarations are temporary, leaving healthcare providers and telehealth advocates to go back to the licensure compacts created for doctors, nurses, physical therapists, psychologists and EMT providers prior to the pandemic. The hope is that lessons learned during the pandemic will spur more states to join the compact or help federal officials in drafting new rules for interstate licensure.

“I’m not sure that they’ll be able to pull all the way back,” says Martin. “There will be too much pressure from consumers (and providers). We’re already thinking about what’s the new normal.”