A major policy barrier inhibiting the adoption of telehealth is licensing. Licensing of healthcare professionals falls under the purview of each state. Providers must follow state laws regarding licensing that require providers to hold a current and valid license, certification or registration to practice in their specialty in every state in which they will provide care and/or render services. Therefore, for a telehealth encounter, the provider must adhere to the licensing rules and regulations of the state where the patient is located. The licensing rules vary significantly from state to state. A few states issue special licenses or certificates related to telehealth that allow out-of-state providers to render services via telehealth when certain conditions are met. Other states have laws that make allowances for practicing in contiguous states or in certain situations where a temporary license might be issued under certain conditions.[20] However, the vast majority of states require telehealth providers to secure individual state licenses for multi-state practices. The cost in time, money, and resources of applying for licenses in each state in which a physician seeks to practice is a major barrier to expanding access to medical services across state lines. Because of these challenges, states are joining interstate licensing compacts such as the Interstate Medical Compact (IMLC) and Nursing Licensure Compact (NLC). These compacts strive to ensure state-based regulation of the medical profession while easing barriers, however, these strategies remain inadequate. For example, although the IMLC expedites the licensing process, it still requires a physician to apply and pay the full cost for a separate license in every state. These state-by-state approaches ultimately create disincentives for providers to adopt telehealth, thus, preventing patients from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line. Regulatory restrictions also create economic trade barriers and artificially protect markets from competition.
During the PHE, Medicare and Medicaid requirements to be licensed in the state where services are being provided were temporarily waived under certain conditions, although state licensing requirements still apply.[21] All 50 states and DC introduced licensure and renewal flexibilities to expand medical personnel during the PHE. To ensure the benefits of telehealth continue to be accessible by providers and patients across the nation, licensing reforms are needed.
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Policy Recommendations
- Providers
- Stay apprised of licensure policy changes during a pandemic.
- Keep team informed/trained to stay compliant.
- Be aware of licensure compacts and take advantage of these vehicles for cross-state telehealth practice.
- Policymakers
- Permanently remove barriers to interstate licensing requirements for telehealth providers during any pandemic or emergency.
- Stakeholders to collaborate to create an interstate telehealth framework that removes barriers, lays out the rules of the road, spurs healthcare innovation and enables the provision of healthcare across the country.
- Take lessons learned and make process improvements to make participation in a licensing Compact easier and less costly for providers.