Mobile healthcare, telemedicine, telehealth, BYOD

On Telehealth License Portability, Each State Follows its Own Path

While a national licensure compact is gaining momentum, some states are setting their own rules for telehealth across state lines.

Not content to wait for a regional or national solution, at least three states are mulling legislation that would allow healthcare providers to practice telehealth across state lines.

Florida’s long-awaited telehealth legislation, HB 7087, filed on January 21, includes a provision allowing licensed healthcare providers from other states to treat Florida residents via telehealth, provided he or she meets certain criteria – including that the professional pay a $150 registration fee and not open an office in Florida or treat Florida residents in person.

The bill stipulates that the provider “annually registers with the applicable board, or the department if there is no board, and provides healthcare services within the relevant scope of practice established by Florida law or rule.”

In New Mexico, SB 78, introduced on January 11, would permit osteopathic physicians to practice in the state provided they hold a valid license from another state. Such a telemedicine license would be valid for three years. The state already has telehealth licensure legislation on the books for non-osteopathic physicians.

And in Missouri, HB 2350, introduced on January 25, would allow providers from other states to treat Missouri residents via telehealth if he/she is properly licensed and has first examined the patient in person.

The American Telemedicine Association calls licensure portability “a contentious issue for healthcare providers” regardless of whether they’re using telehealth. “Most states require that a physician is licensed in the state where their patient is located,” the organization wrote in its May 2015 analysis of each state’s physician practice standards and licensure requirements. “However, these state-by-state approaches prevent people from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line. They also create economic trade barriers, restricting access to medical services and artificially protecting markets from competition.”

In its report card for 2015, the ATA noted that no state achieved an A for licensure and out-of-state practice. “This means that every state imposes a policy that makes practicing medicine across state lines difficult regardless of whether or not telemedicine is used,” the report stated.

According to the ATA, Michigan, North Dakota, Pennsylvania and South Dakota are the only states that don’t allow licensure exemptions for physician-to-physician out-of-state consultation (for which those states earned an ‘F’ from the ATA) while Massachusetts does allow telemedicine to be used for peer-to-peer out-of-state consults.

In addition, Washington D.C., Maryland, New York and Virginia allow licensure reciprocity from bordering states, while Alabama, Louisiana, Minnesota, Nevada, New Mexico, Ohio, Oregon, Tennessee and Texas offer conditional or telemedicine licenses to out-of-state providers. Montana scrapped its telemedicine license law last year in favor of a full unrestricted license requirement for physicians from other states.

On a national level, 12 states have enacted the Interstate Medical Licensure Compact created by the Federation of State Medical Boards, while another six states have introduced legislation since the beginning of the year to join in. The compact offers a streamlined licensing process for providers wishing to practice across state lines, particularly via telehealth, while ensuring that each state still has regulatory control.

“I’m pleased to see that additional states are considering legislation to adopt the Interstate Medical Licensure Compact,” Ian Marquand, chairman of the Interstate Medical Licensure Compact Commission, said in a Jan. 21 press release. “The compact represents an innovative approach to multi-state physician licensing, one that can bring benefits to states across the country. I look forward to having more states join us at the table.”

To date, Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin and Wyoming have adopted the compact. Nebraska, Oklahoma, Michigan, Pennsylvania, Rhode Island and Vermont are mulling legislation introduced in 2015 to join the compact; joining that group this year so far are Alaska, Arizona, Colorado, Kansas, New Hampshire and Washington.

According to the FSMB, some 31 state medical and osteopathic boards have expressed support for the compact, as have the American Medical Association and American Osteopathic Association.

On January 12, the National Stroke Association added its endorsement of the compact, saying it would ease barriers to the fast-growing network of telestroke programs.

“The compact will continue to ensure state-based regulation of the medical profession while simultaneously promoting access to qualified and experienced physicians in high-need specialties and in rural and underserved areas,” Matt Lopez, the association’s CEO, said in a press release. “Not only does the compact protect patients, but it will increase the availability of telestroke care and help control stroke risk factors like high blood pressure and diabetes.”

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