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Telehealth Licensure Compact for Nurses Gets the Green Light

North Carolina becomes the 26th state to pass legislation joining the compact, which will give nurses the ability to practice telehealth in multiple states under one license.

Source: ThinkStock

By Eric Wicklund

- Nurses in 26 states will soon be able to practice telehealth in multiple states under one license.

North Carolina Gov. Roy Cooper signed legislation last week making his state the 26th to join the enhanced Nurse Licensure Compact (eNLC), triggering enactment of a compact that allows registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to have one multistate license, with the ability to practice in person or via telehealth in both their home state and other eNLC states.

Launched roughly 18 months ago by the National Council of State Boards of Nursing (NCSBN), the eNLC is the third such agreement designed to enable healthcare practitioners to practice across state lines, either under one license or through an expedited process of applying for license in multiple states.

The Interstate Medical Licensure Compact for physicians, overseen by the Federation of State Medical Boards, went live on April 6, though it has been plagued by a dispute with the FBI over access to criminal records for background checks. To date, some 25 states have signed onto that compact, but only a few are processing license applications.

On April 25, Washington became the 10th state to sign onto the Physical Therapy Licensure Compact, overseen by the Federation of State Boards for Physical Therapy (FSBPT), enabling that compact to go live. In all, 13 states have now joined that compact.

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According to NCBSN officials, eNLC states have aligned their licensing standards so that applicants for a multistate license need only meet one set of standards, which include federal and state fingerprint-based criminal background checks. 

While hailing the impending activation of the eNLC – representatives of the 26 member states now have to elect an eNLC Interstate Commission, which must meet and set operational rules and implementation dates before nurses can begin applying for a license, likely in 2018 – NCBSN officials said they would continue efforts to get all 50 states to join the compact.

 “We have made great strides in unlocking access to nursing care across the nation and are thrilled to begin this process,” NCSBN President Katherine Thomas, MN, RN, FAAN, executive director of the Texas Board of Nursing, said in a press release. “Even as we work on implementing this first phase our efforts continue to aid other states in passing eNLC legislation so our ultimate goal of having all 50 states in the compact is realized.”

As of July 24, states in the eNLC are Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia and Wyoming.

The original Nurse Licensure Compact was designed to make it easier for nurses to work across state lines; the eNLC, introduced in 2015, specifically targeted “the growing need for nurse mobility and clarification of the authority to practice for many nurses currently engaged in telenursing or interstate practice.” 

READ MORE: The Benefits and Challenges of Telehealth for Specialists

According to the NCBSN, Colorado, New Mexico, Rhode Island and Wisconsin have enacted only the original NLC and will continue under those guidelines until they’re enacted the eNLC. In eNLC compact states, a nurse holding a multistate license on the effective date of the eNLC will be grandfathered, though that nurse would have to apply for a license in states that are not part of the eNLC compact. 

“Boards of nursing were the first health care profession regulatory bodies to develop a model for interstate licensure, and we are looking forward to the implementation of this new phase of nursing regulation,” NCSBN CEO David Benton, RGN, PhD, FFNF, FRCN, FAAN, said in this morning’s press release. “Patient safety was of paramount importance in the development of eNLC leading to the addition of new features found in the provisions of the model legislation.”

Not everyone is in agreement with the eNLC, however. Last year, the Washington State Nurses Association announced that it “strongly opposed” the compact in its current form.

Judy Huntington, MN, RN, the WSNA’s executive director, said license jurisdiction should lie with the state where the nurse is located, rather than where the patient is located.

“When a nurse is providing consultation or follow-up care using [an online platform, smartphone or some other means of mHealth communication], he or she may not even know the exact location of the patient,” Huntington said in a July 2016 press release. “The patient may be on a cruise ship, located in another country or in an entirely different state than the actual home residence of the patient. It only makes sense that the nurse should be held to the standards of the home state in which she or he is actually practicing and where the patient originally sought care.”

READ MORE: Factors Behind the Adoption of School-based Telehealth

“Another problem with the NLC premise that practice occurs where the patient is located is the NLC assumes that scope of practice in all states is the same for the registered nurse and that the practicing nurse is familiar with every state’s scope of practice in which they are practicing,” she added. “This is especially problematic for cross-border telehealth post-hospitalization follow-up calls.”

Finally, Huntington said the WSNA isn’t on board with having a commission oversee licensure issues.

“In the NCSBN’s plan, the compact is overseen by an interstate commission of compact administrators that can make binding decisions on member states, without being held accountable to any state or government. WSNA believes that handing over our state’s practice authority is not in the best interest of the public or of practicing nurses.”

Huntington said the American Nurses Association, of which the WSNA is a part, has launched a workgroup with the NCBSN in hopes of finding “a possible third option or other alternatives to appropriately address interstate nurse-patient communications and telehealth issues and resolve license jurisdiction.”

Another group closely watching this development is the mental health field.

Nevada, Arizona and New Mexico have agreed to implement the Psychology Interjurisdictional Compact (PsyPACT), overseen by The Association of State and Provincial Psychology Boards, while Texas, Illinois and Rhode Island have pending legislation and Wisconsin, New Mexico, Missouri and Ohio are considering it. That compact goes live with ratification by seven states.

In a recent blog, Marlene Maheu, founder and executive director of the TeleMental Health Institute, said several groups, including the American Association of State Counseling Boards (AASCB), the Association of Counselor Education and Supervision (ACES), the American Mental Health Counselors Association (AMHCA) and the National Board for Certified Counselors (NBCC), are working to enhance multistate services for more members of the counseling profession.

“Healthcare providers across behavioral and related disciplines have long seen licensure as a barrier to telehealth growth,” Maheu wrote. “Practitioners are seeking to not only develop their specialty niche and make themselves available to more patients but also to companies seeking to create multi-state services. Regardless of the discipline, the fetters of outdated and often contradictory state regulatory requirements have led to growing discontent with existing interjurisdictional barriers as well as a focused effort on the part of many disciplines to keep up with 21st century lifestyles.” 


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