- With the enactment of the Interstate Medical Licensure Compact, Alabama has triggered the formation of an interstate commission to address the licensure challenges telehealth providers face treating patients in multiple states.
“Now that seven states have enacted the Compact legislation, we can begin the real work of establishing the Compact to ensure patients have access to quality healthcare services, while maintaining the highest level of patient protections,” the Alabama Board of Medical Examiners Executive Director Larry D. Dixon said in a public statement earlier this week. "“The Interstate Medical Licensure Compact will ease the physician shortage in rural and other underserved areas."
Dixon was referring to a provision in the compact that requires no less than seven states to approve the legislation before the Interstate Medical Licensure Compact Commission can be formed.
In fact, a total of eight states have enacted the compact. Minnesota enacted the bill the same day as Alabama.
Ten other states have introduced legislation to the state legislatures. Alabama and Minnesota join six other states that will provide members to the commission:
- South Dakota
- West Virginia
The purpose of the compact is straightforward:
to develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards, provides a streamlined process that allows physicians to become licensed in multiple states, thereby enhancing the portability of a medical license and ensuring the safety of patients.
Comprising two voting representatives from each member state, the commission now has 12 months to adopt bylaws necessary for carrying out the purposes of the compact.
An important provision the Interstate Medical Licensure Compact Commission must tackle is how physicians designate a state for their principle license. The compact lays out four criteria:
(1) the state of primary residence for the physician, or
(2) the state where at least 25% of the practice of medicine occurs, or
(3) the location of the physician's employer, or
(4) if no state qualifies under subsection (1), subsection (2), or subsection (3), the state designated as state of residence for purpose of federal income tax.
The purpose of the legislation and its commission is to create "another pathway for licensure" and it is not intended to circumvent any extant state regulation governing medical practices. What it does stipulate is the importance of the treatment site in dictating where licensure applies.
"The Compact also adopts the prevailing standard for licensure and affirms that the practice of medicine occurs where the patient is located at the time of the physician-patient encounter, and therefore, requires the physician to be under the jurisdiction of the state medical board where the patient is located," the compact states.
While the compact and commission will focus on licensure, telehealth reimbursement remains a challenge. Ostensibly, participating states would still need to enact legislation to ensure that telehealth services provide a useful complement or alternative to face-to-face encounters