The introduction of technology-enabled health care over secure, high-speed broadband connections has made it possible for consultations to occur over distances. While this can contribute significantly to improving access to care, professionally licensed providers in most cases are limited to practicing in the state(s) where they are licensed. Typically, during a telehealth encounter the originating site (the location of the patient) is considered the “place of service”, and the distant site provider must adhere to the licensing rules and regulations of the state in which the patient is located, even if the distant site provider is not a resident of the patient’s state. The policies governing telehealth and physician licensure vary widely across the country. Some states provide exceptions to allow for cross-border delivery of health care in limited circumstances, while others ban it entirely.
Many telehealth proponents have cited licensing as one of the most significant barriers to the ubiquitous use of telehealth. Currently, medical licensing falls under the purview of each state, leading to the need to secure individual state licenses for multi-state practices. This endeavor can not only be time consuming, but expensive. Providers may find themselves limiting their potential practice areas to a few states, possibly furthering unequal distribution of expertise in the nation.
Current Activities Related to the Cross-State Licensure Barrier
State licensing requirements have been identified as a key policy barrier in telehealth. Several pieces of federal legislation have been introduced to address this. Some legislation attempts to re-define the “place of service” from the originating site (site of the patient) to the distant site (site of provider delivering care). This would resolve the licensing barrier because a provider would then only need to be licensed in the state in which they are physically located in, as opposed to the state of the patient. However, none of these bills have successfully made it through the legislative process and into law.
The Nurse Licensure Compact (NLC) allows nurses to have one license viable in other compact member states, allowing for a nurse to practice in both their home state and other states which have signed on to the compact. The Federation of State Medical Boards (FSMB) drafted model language for states to create an Interstate Medical Licensure Compact, which has been adopted by one third of states. Unlike the NLC, this particular Compact creates an expedited medical licensure process with the goal of allowing physicians to become licensed in multiple states more easily, while protecting patient safety. Currently, eighteen states have joined the Compact and the Commission formed to administer the Compact is in the process of developing the processes by which expedited licensure would be granted (as of January 2017). See CCHP’s policy brief on the Compact for a detailed analysis.
Federal Trade Commission
The Federal Trade Commission has also shown interest in examining whether the restrictions on telehealth providers by state licensing boards are anti-competitive. See the section on the Federal Trade Commission for more information.