Center for Connected Health Policy: State Telehealth Laws and Reimbursement Policies Report, Spring 2023 (5/16/23) – The Center for Connected Health Policy (CCHP) released its Spring 2023 Summary Report of state telehealth laws and Medicaid program policies. The Summary Report provides highlights on certain aspects of telehealth policy and the changes that have taken place between now and the previous edition, Fall 2022. The information for this summary report covers updates in state telehealth policy made between January and March 2023. Notably, the report found that 26 states have professional boards that issue special licenses or certificates or have exceptions to licensing requirements related to telehealth that may include registering with an in-state board rather than obtaining full licensure. Only Washington has added a cross state licensing exception since Fall 2022. However, this may be due to 2023 state legislation not yet being enacted at the time states were reviewed. Most of these states are not allowing for broad cross-state practice. The majority of the states that have added licensure exceptions in the past two years are for specific types of healthcare professionals in specific situations where the patient has moved or is visiting a certain state and has a pre-existing relationship with a provider in their former state. This has become a common issue of concern for college students wanting to continue care with their established mental health professionals in their home state, or for those that may be traveling for a limited amount of time.
Milbank Memorial Fund: Can Interstate Licensure Compacts Enhance the Health Care Workforce? (4/11/23) – Although health care licensing is traditionally a state function, rigid state borders can be ill-suited to meet needs in terms of access to care for underserved populations, emergency preparedness, and the changing nature of telemedicine-based care delivery. During the COVID-19 pandemic, at least 45 states waived or modified existing rules to allow health care practitioners to work across state lines through temporary licensure reciprocity. Policymakers and researchers are now debating options for longer-term licensure policy to mitigate the workforce crisis.
Politico Pro: States’ Experiment Helps Make Case for Easing Cross-State Licensure Rules (3/22/23) – A report from Cicero Institute found that telehealth did not spark more patient concerns than in-person care (read more in the research section). Many states waived licensing rules during the pandemic to allow their residents to meet with out-of-state doctors via telemedicine, and are now grappling with whether to continue to permit it. Telehealth lobbying groups like the Alliance for Connected Care have asked states to treat medical licenses like they do driver’s licenses, recognizing each other’s.
Stat News: How Cross-State Licensure Reform Can Ease America’s Mental Health Crisis (3/8/23) – Teletherapy has made mental health care more accessible than ever before, making care possible for people who otherwise would never have been able to get it. But the antiquated system of licensure in the United States is creating a huge barrier to realizing the potential for telehealth. Founder and CEO of Alma, Harry Ritter emphasizes the need for cross-state licensure reform now to address the needs of America’s growing mental health crisis and to ensure accessibility for everyone, regardless of their geographical location or identity.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School – Achieving Telehealth’s Potential Webinar Series (March 2023)
- Achieving Telehealth’s Potential: The Federal Policy Landscape for Interstate Telehealth Practices. Prior to the pandemic, most states required a physician to be licensed in the state in which the patient is located, and reinstating this standard—which was among those relaxed during the COVID-19 crisis—will be a major deterrent to interstate telehealth use. This event, the first of three in a series, maped out the impact of our current physician licensure framework on the delivery of specialty care to patients through the patient, provider, and health system perspective.
- Achieving Telehealth’s Potential: The Federal Policy Landscape for Interstate Telehealth Practices. This event, the second of three in a series, mapped out the current and potential federal initiatives to facilitate interstate telehealth practices. Krista Drobac, Executive Director of Alliance for Connected Care, speaks in the panel.
- Achieving Telehealth’s Potential: The Federal Policy Landscape for Interstate Telehealth Practices. This event, the final of three in a series, explored some of the state leadership, challenges, and opportunities to build interstate telehealth practices.
Axios: States Eye Compacts, Scope of Practice Laws to Fill Holes in Health Workforce (2/2/23) – More states are working out differences over what medical services non-doctors can provide in order to ease stubborn workforce shortages plaguing health systems. The pandemic prompted states to waive certain licensure requirements which allowed providers to more easily practice in other states or to expand the services they were allowed to provide to patients, including via telehealth. However, without a permanent fix, health workers’ autonomy over patient care could conflict with the patchwork of state “scope of practice” laws.
Association of State and Territorial Health Officials (ASTHO): Telehealth and Licensure Policies Improving Healthcare Access for Rural Communities (1/26/23) – During the COVID-19 pandemic, states granted temporary waivers permitting telehealth licensure for out-of-state providers to deliver services in their own jurisdiction. ASTHO released a blog outlining the recent legislation at both the state and federal levels which has significantly affected the ability of health care providers to serve patients virtually and across state lines. The rapid adoption of telehealth during the COVID-19 pandemic, coupled with a renewed interest in cross-state licensure for providers, offer insights on how states can expand access to health care services, which is a central mission of public health departments.
Inside Telehealth: Interstate Compacts, Controlled Substance Prescribing, Payment Parity: Over 200 State Telehealth Bills Pre-Filed For 2023 (1/12/23) – More than 200 telehealth bills were pre-filed by states last year for the 2023 legislative session, including proposed laws letting states join interstate compacts, prescribing laws that include controlled substances, and payment parity laws. Interstate licensure is the next frontier for states in the expansion of telehealth. Cross-state licensing has been made available by interstate compacts, which an increasing number of states are attempting to join this year.
Inside Telehealth: FBI Misinterpreting Law, Slowing Interstate Telehealth (1/10/23) – Five interstate licensure compact leaders say the FBI is misinterpreting state laws that require federal background checks of providers, which is preventing, or slowing, states from joining interstate licensure compacts as demand for treatment across state lines via telehealth skyrockets with the recent two-year extension of most COVID-19 pandemic-era waivers. Confusion among compact leaders remains as they scramble to find a way to remedy the miscommunication on background checks and question whether proposed solutions would even be effective due to a lack of response from the FBI. Last Congress, Rep. Mann (R-KS) introduced the States Handling Access to Reciprocity for Employment Act to expedite and streamline the current licensing process and clarify any misconceptions surrounding background check requests. If reintroduced and passed, the legislation would in essence direct the FBI that if a state has a background check requirement because it has joined a state compact, the agency must approve the request eliminating some of local FBI’s discretion.
The Hill: State lines should no longer be barriers to health care (9/9/22) – Former VA Secretary David Shulkin penned an op-ed on how the VA expanded flexibility to provide care across state lines for Veterans, calling for this model to be replicated to benefit all Americans. The Veterans Administration has led the way in expanding the boundaries of care. While Sec. Shulkin was secretary, the VA changed outdated regulations that prevented veterans from accessing qualified providers simply because of geography. Veterans are now able to see their providers without regard to location.
Inside Telehealth: Cardiology, Family Physician Leaders: Continue Audio-Only Telehealth, Care Across State Lines (6/16/22) – During a recent FiscalNote webinar, leaders at the American College of Cardiology, and Alliance Advisory Board Member American Academy of Family Physicians (AAFP), expressed support for the federal government and states making pandemic-era allowances for telehealth across state lines and audio-only services permanent beyond the COVID-19 public health emergency. Members of the American College of Cardiology are invested in making sure patients with chronic heart conditions can see their regular provider via telehealth while traveling or spending part of their time in another state.
Inside TeleHealth: Medical Boards to Vote Saturday on New Telemedicine Policy (4/29/22) – The Federation of State Medical Boards is set to vote on its first update in nearly a decade to guidance on the appropriate use of telemedicine in the practice of medicine. The updated document contained sections related to licensure exceptions, standards of care, patient privacy, and health equity, among others. The Alliance for Connected Care submitted comments in response to the draft document in February, recommending that the FSMB consider broadening the circumstances in which it recommends interstate licensure for telehealth treatment.
Pharmacy Times: The Challenge of Multistate Pharmacy Licensure in the Telehealth Era (4/27/22) – Telehealth use expanded in pharmacies during the pandemic, however, pharmacy personnel face challenges when implementing these services, beginning with regulatory requirements affecting their ability to provide telehealth. Challenges for pharmacy personnel who wish to fully use telehealth to serve patients in multiple states include obtaining licenses to practice in each of these states. Acute shortages of pharmacists and pharmacy technicians in certain geographic regions and across areas of practice can be exacerbated by licensure requirements for such professionals. The American Society of Health-Systems Pharmacists (ASHP) has developed a series of policies that support the harmonization of laws and regulations impacting pharmacy practice across states and enhances the ability of pharmacists to practice in multiple states.
MedTech Intelligence: Telemedicine Moved Forward During the Pandemic. Our Policies and Regulations Need to Catch Up (4/22/22) – Outdated policies and regulations threaten to bring progress to a standstill, restrict vital telehealth access to millions of Americans, and exacerbate health inequities. All 50 states and the District of Columbia, as well as CMS, waived state licensure requirements so physicians could treat patients virtually across state lines during the pandemic. These flexibilities opened up a wave of record-breaking new investments in digital health technology, providing patients with new options in telehealth services and remote-monitoring solutions. However, according to a tracker by the Alliance for Connected Care, only 23 states still have those licensure waivers in place, and the future remains unclear for expanded telehealth benefit coverage and loosened prescription regulations. Permanently eliminating geographic and financial barriers to telemedicine is essential to reducing the health care access gap, providing consumers with greater choice in their medical care, and encouraging continued innovation in the digital health space.
Politico Pro: Telehealth growing pains (4/20/22) – The telehealth industry faces some uncertainty as more states end waivers allowing care across state lines. As many states’ emergency regulations permitting such care wind down and the patchwork system of state rules becomes patchier, millions of patients are losing expanded access to telehealth. The Alliance for Connected Care has proposed a voluntary national system, similar to the driver’s license system, that would enable states to recognize each other’s licenses. Patient advocates, public health officials and telehealth and provider groups are pushing for utilization of telehealth across state lines.
Politico Pro: Millions set to lose telehealth access across state lines as waivers wind down (4/19/22) – Millions of patients are losing expanded access to telehealth across state lines as many states’ pandemic emergency declarations wind down, prompting patient advocates, public health officials and telehealth and provider groups to call on states and Congress for a fix. According to data from the Alliance for Connected Care, states could see expanded access lapse in the second half of the year, with flexibilities intact for 15 states, down from 24 in early March. Access to virtual care across state lines, which patients increasingly took advantage of during the pandemic, is overwhelmingly popular among patients and providers. National data on the rise of care across state lines is sparse, but one in five providers say they provided care across state lines amid the pandemic, according to a recent Morning Consult poll conducted on behalf of the Alliance for Connected Care.
Additional articles worth a read!
- Forbes – Gas Prices Hurt People Going to the Doctor, But Interstate Telehealth Can Help (July 19, 2022)
- STAT – Sunsetting medical license reciprocity would return medicine to the dark ages (March 7, 2022)
- Progressive Policy Institute – Telehealth Saves Money and Lives: Lessons from the COVID-19 Pandemic (November 2021)
- BPC – What Eliminating Barriers to Interstate Telehealth Taught Us During the Pandemic (November 30, 2021)
- WSJ – Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say (November 22, 2021)
- KHN/Time – Telehealth’s Limits: Battles Over State Lines and Licensing Threatens Patients’ Options (August 31, 2021)
- STAT – ‘The Party is winding down’: States and insurers resurrect barriers to telehealth, putting strain on patients (July 13, 2021)
- WSJ – A Cancer Patient’s Brutal Commute (July 12, 2021)
- Health Affairs – Mutual Recognition of Physician Licensure by States Would Provide for Better Patient Care (May 10, 2021)
- NEJM – Telemedicine and Medical Licensure – Potential Paths for Reform (February 25, 2021)
- JAMA Internal Medicine – The COVID-19 Pandemic – An Opportune Time to Update Medical Licensing (January 13, 2021)
- AJMC – Eliminating Barriers to Virtual Care: Implementing Portable Medical Licensure (October 17, 2019)