Telehealth usage threatened by state licensing requirements: 7 things to know

When the pandemic began, most states, along with CMS, waived telehealth restrictions requiring clinicians to be licensed in the state where their patient lives. Now, some states are discontinuing those waivers, meaning many patients receiving telehealth care from a clinician in another state may have to find a new care plan.

Seven things to know:

  1. Seventeen states still had waivers in effect as of July 19, according to data from the Alliance for Connected Care.

  2. State medical boards are reluctant to keep the waivers, arguing their licenses and discipline is beneficial to patient safety, Barak Richman, PhD, a healthcare policy expert and professor at Durham, N.C.-based Duke University, told Time Aug. 26. He also pointed out that licensing is a source of state revenue.

  3. Clinicians have a difficult time getting licenses in multiple states, as requirements and fees differ across state lines. Some clinicians are advocating for more flexibility, while others are worried relaxing these restrictions could lead to added competition, forcing them to lose patients and/or jobs.

  4. During a congressional hearing in March, the American Medical Association voiced opposition to waiving multistate licensing requirements. AMA President-elect Jack Resneck, MD, said no longer having a centralized regulator from a patient's home state would present challenges for rule enforcement, as there is no interstate authority to investigate incidents that occur in other states.

  5. After Virginia reinstated multistate licensing requirements, Johns Hopkins Medicine in Baltimore recently notified more than 1,000 Virginia patients that their telehealth appointments were "no longer feasible," Brian Hasselfeld, MD, the system's medical director of digital health and telemedicine told Time. He said about 10 percent of Johns Hopkins' telehealth visits were conducted with patients in states where the system does not have facilities.

  6. Dr. Hasselfeld said the Department of Veterans Affairs is a good example of how multistate licensing requirements can be eased, as it allows clinicians who are licensed in at least one state to treat patients in any VA facility.

  7. Sen. Chris Murphy, D.-Conn., introduced legislation in February that would temporarily allow clinicians licensed in one state to treat patients in any other state, both in-person and via telehealth. It was assigned to the Senate Health, Education, Labor and Pensions Committee, but it has not progressed since that assignment.

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