A Solution to Cross-State Licensure: Regional Medical Excellence Zones

During the COVID-19 pandemic, all 50 states have used emergency authority to waive some aspect(s) of state licensure laws. Additionally, the Emergency Management Assistance Compact (EMAC) was amended to create a model executive order to allow for care across state lines. This is the first time that consumers have had the ability, on a widespread basis, to access care from providers in other states. 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.

As the pandemic continues on, some governors are assessing the impact of telemedicine waivers. Idaho Governor Brad Little determined that the waiver of the rules did not compromise public safety, and made them permanent through Proclamation in June. A group of western Governors, including Governors Inslee, Brown, Sisolak and Polis are working together to identify best practices that support telehealth services for residents of their states.

If governors and state legislators are interested in giving their citizens access to care from out of state providers, and their in-state providers access to out of state patients, they cannot affect this change on their own. The laws of the state can only be changed to allow providers in.

It is imperative, therefore, that states band together.

The Medical Excellence Zone is an area defined by multiple state borders where medical practitioners may practice across state lines. Practitioners may not establish physical practices in states where they are not licensed but as long as they are licensed and in good standing with one state in the Zone, they may practice across state lines.

Key features of the Medical Excellence Zone include:

  • The medical board or nursing board in the state in which the provider is licensed remains primarily responsible for the oversight of the practitioner.
  • Close and ongoing collaboration and information sharing between states ensures that medical malpractice and other important licensure issues are dealt with proactively and effectively.
  • Practitioners wishing to practice within the Zone register and are verified by a central regional registrar.
  • Patients 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.

Immediate benefits of the Medical Excellence Zone include:

  • Patients will have better access to their clinicians, allowing stronger patient-clinician relationships, as well as more convenient telehealth and after-hours care from those clinicians.
  • Participation in the Medical Excellence Zone allows states to ensure all of their citizens are able to access best-in-class care regardless of whether they live in urban or rural areas, eliminating needless care disparities resulting solely because of geographic differences.
  • The ability to more easily practice in multiple jurisdictions will be attractive to clinicians – improving their ability to provide comprehensive care, and helping to attract top talent to health organizations in the region.
  • Facilitating the delivery of healthcare across these state lines will unleash new opportunities for (and foster greater competition between) across the Medical Excellence Zone’s centers of excellence.
  • States participating in the Medical Excellence Zone will be looked to as a model by other regions where metropolitan areas span state lines and lead to significant cross-border care.

Please find model legislative language to create a Interstate Medical Excellence Zone here and below:

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