- Physicians looking to practice telemedicine in multiple states can now apply for a license in 18 of the 22 states in the Interstate Medical Licensure Compact.
An ongoing dispute with the FBI is hindering the process in some states but not preventing doctors from applying for licenses, according to Jon Thomas, MD, chairman of the commission overseeing the IMLC.
The compact, launched in 2014 by the Federation of State Medical Boards, went live on April 16, when the 18th state approved legislation to join the compact. It gives physicians in member states an expedited process for obtaining licenses to practice in multiple states, with each member state retaining its right to regulate clinicians and take punitive action, if necessary.
Shortly thereafter the compact went live, Thomas said the FBI notified member states that they couldn’t conduct criminal background checks, which were placed under federal jurisdiction in 1973, without an “enabling statute” with specific wording that that had to be approved by the FBI. Seven states have amended their legislation to the FBI’s approval, enabling them to process licenses and seek background checks from the FBI, while the other 11 states can process licenses without those background checks.
“It’s really not that complicated to understand,” said Thomas, a Minnesota physician whose home state is still seeking FBI approval. “Several states are still tweaking their language.”
Four other states have approved legislation joining the IMLC but haven’t become active yet, including Tennessee, which is delaying activation until 2019. In Pennsylvania, Gov. Tom Wolf told the State Board of Medicine in March he won’t approve the state’s participation in the compact until he’s convinced the issue with the FBI is settled.
Thomas said some other states are considering legislation to join the compact, while others have voted it down. The most common complaints are that the compact adds a layer of bureaucracy to the healthcare profession and allows state medical boards to unfairly dictate who can and who can’t practice telemedicine in their backyards.
“This is really the way that physicians want to self-regulate,” Thomas said, adding that healthcare systems, managed care organizations, locum tenens providers and telemedicine providers are fueling the effort to expand the compact. “People intuitively think it’s the medical boards who are the movers in this area, but it’s the providers.”
A lot of work remains to be done. The compact commission, which recently received approval for the second year of a three-year, $250,000 grant from the Health Resources and Service Administration (HRSA), is working to set up the IT platform to handle administrating the compact, and expects to soon hire an executive director.
The commission is also starting to see revenues from its member states, which will be used to keep the compact going. The IMLC charges $700 per application, with $400 going to the commission and $300 going to the state medical board.
“Because of the FBI problem, we haven’t seen the revenues we expected just yet,” he said.
The FSMB’s efforts to launch a compact are actually predated by the National Council of State Boards of Nursing, which is currently one state short of launching its Enhanced Nurse Licensure Compact (eNLC). The NCSBN began its work in 1997, and Thomas said the two groups have sometimes worked in tandem.
Thomas said the work of the NCSBN - and other professional organizations working to craft licensing compact for healthcare providers - shows that the healthcare industry is moving forward in its efforts to abolish barriers to expansion and access and promote telemedicine and telehealth.
He also said the IMLC’s ongoing conversation with the FBI might offer a lesson plan to others drafting model legislation for their states.
“It’s going to take us a while to work all the kinks out,” he said. “We’re learning as we go.”