With the recent licensing policies the telehealth providers are allowed to provide services temporarily to patients beyond their target geography. These flexibilities though momentary it has served as a blessing in disguise. While emergency requirements are falling down, licensing issue is becoming critical as many providers and patients are doing cancellations for their pre-booked services. Ex. a provider in Virginia had to cancel about more than 1000 appointments due to expiring orders. On an average about 10% visits are from out of the state where one needs to drive for hours together to reach the destination.
The cross city travel not only becomes difficult for the provider, it also needs to follow other cross-state licensure procedures to enter the new state. This takes lot of time and effort getting the procedures sorted. There have been certain flexibilities provided in the times of Covid-19 but these needs to be regularized on permanent basis and should be devised as a part of permanent policies by the governing bodies.
Policy Overview
Interstate licensure is an old concept which has always been controversial. The federal government has different licensing terms for different states which becomes difficult for out-of-state providers to tresspass those laws. This may seem detremental to the current providers in the state as cheaper providers may enter their territories. Both providers and labours consider this to be a threat on functioning. Licensing board needs to find a way out that allows consumer protection, provider protection at the same time allowing out-of-state providers to enter the territory and provide services in times of dire necessity. New rules need to be implemented which would take care of every aspect of inter state licensing policies affecting the segment of telehealth. All legitimate concerns need to be adhered to and more safety measures to be implemented. All past concerns and turf wars need to be addressed effectively and new policies to be implemented with greater flexibilities taking into consideration the quality of life provided to the patients.
State Licensing Laws
State licensing laws are different for different states in united states and out-of-state providers need to have full licensure in order to practice. They need to register with the state regulation body in order to start practicing in that state. Various states like West Virginia, Minnesota and Florida do allow out of the state registration processes however states like New York, Utah have made registration mandate in the regional state. Even practitioners with more than 10 years of experience need to re-register in the state to start the practice.
Licensure Compacts
There should be some laws devised at national level which grows hand in hand with the state partnerships providing both the providers across different states with more flexibility for performance and at the same time abiding by the licensing. In these times of covid-19, several states have passed legislation enabling more standardized processes for the providers which are related to licensure compacts. 44 states in US atleast have one compact in place at the moment.
Compact laws are different at different state levels. IMLC ( Interstate Medical Licensure Compact) is a standard licensure procedure which allows the providers to practice in any state they are not licensed as long as the state allows practitioners from other states. This also regulates the number of practitioners in any state at any point of time. These compacts are based on therapy. Occupational therapy licensure compact has a threshold of 10 states while PSYPACT (Psychology Interjurisdictional Compact) has a compact of 26 states. For NCL (Nurse Licensure Compact), the compact is 22 states. Compacts do change from time to time and it is a pathway to practice in more than one states.
Following these rules should be a mandate for the providers as it not only increases safety standards but also provides quality healthcare. It provides an opportunity to practice in different states by also abiding by the licensing policies in place. There should be a new post-pandemic policy that fits in the requirement of the changing telehealth segment.
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