A Solution to Cross-State Licensure: Regional Medical Excellence Zones
The COVID-19 pandemic exposed the barriers posed by the fragmentation of state licensure laws. At the outset of the pandemic, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure laws to facilitate patient access to care. 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. The Alliance also helped convene a letter urging all 50 governors to maintain or expand licensure flexibilities put in place at the start of the pandemic for the duration of the federal public health emergency, which garnered over 230 signatures from supporting organizations.
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.
We must take advantage of this opportunity to expand access and choice for patients.
It is imperative, therefore, that states band together. As such, legislators in D.C., Maryland, and Virginia are preparing to introduce legislation in 2022 to establish a first-of-its-kind, regional Medical Excellence Zone.
The DMV region has world-class medical providers in the area, and policy change is necessary to ensure accessibility to that care. Telehealth was key to achieving that goal during the pandemic. Not only did telehealth increase patient access to primary and specialty care, it improved care coordination, boosted patient and caregiver engagement, reduced missed appointments and patient travel burden, and improved post-operative care.
The region’s families and medical providers would benefit from the continued ability to give and receive care throughout the region regardless of which jurisdiction licenses the provider. Patients should take priority over bureaucratic processes and artificial state boundary lines.
The Medical Excellence Zone legislation will create a “Zone” defined by multiple state borders (in this case, that of Maryland, D.C. and Virginia) where health care professionals that are licensed and in good standing in one jurisdiction that is part of the Zone may practice across state lines via telehealth without having to obtain another license, creating a policy of mutual recognition of licensure.
Key features of the Medical Excellence Zone include:
- Patient access to care via telehealth as the paramount objective.
- Close and ongoing collaboration, and information sharing between jurisdictions, ensures medical malpractice, discipline and other licensure issues are dealt with proactively and effectively.
- Designated regional coordinating body coordinates guidelines for the Zone, manages and gives notice of registration into the Zone for health care professionals, processes and collects fees associated with application to practice in the Zone, and develops a process for coordination between the jurisdictions on provider discipline.
- Health care professionals wishing to practice within the Zone apply and are verified to receive an authorization to practice in the Zone participating states by a regional coordinating body.
- Health care professionals will be governed by and attest to understanding the laws (including scope of practice) in the state or jurisdiction in which they practice, and will be disciplined by their home state licensing board. The state in which the patient received services will coordinate with the provider’s home state when such instances of adverse action and discipline arise.
- Authorizes a range of health care professional types to practice within the Zone, that have similar education, clinical and continuing education requirements as determined by the jurisdictions.
Immediate benefits of the Medical Excellence Zone include:
- Increased flexibility for patients to access their health care providers, enabling stronger patient-provider relationships and the enhancement of continuity of care, as well as more convenient telehealth and after-hours care from those clinicians.
- Ability to ensure patients have access to best-in-class care regardless of whether they live in urban or rural areas, eliminating needless care disparities resulting solely because of geographic differences. This is not only about convenience and choice, but about increasing access for medically underserved communities and patients regardless of where they are located.
- Improved ability for health care professionals to provide comprehensive care to patients via telemedicine who cannot otherwise easily come for in-person visits.
- Ability to address health care workforce shortage issues exacerbated by the COVID-19 pandemic.
- Jurisdictions 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.
More details on the policy can be found below: