Prior to the COVID-19 pandemic, states typically required providers to be licensed in the state(s) where they were practicing. In response to the pandemic, nearly all states provided temporary waivers of these requirements. State-by-state flexibilities varied, but many states allowed out-of-state providers to practice in state without a license if they were licensed and in good standing in another state. These waivers enabled providers from across the United States to deliver care to patients in other states via telehealth at a time when many patients were seeking remote care to avoid exposure to COVID-19 and health systems and practices were experiencing severe provider workforce shortages. This article outlines emerging state legislative trends in out-of-state licensure and can serve as an early guide to state policy makers and other stakeholders as to how the out-of-state licensure policy landscape may evolve over the coming years.
Common Approaches to Enabling Providers to Deliver Telehealth Across State Lines
Many states have already taken legislative action to make it easier for out-of-state providers to deliver care via telehealth across state lines. Common approaches include:
- Licensure Compacts: More than 35 states and territories are now members of the Interstate Medical Licensure Compact, which provides an expedited pathway for physician licensure in member states. Various other compacts exist for other provider types (e.g., Nurses Licensure Compact, Physical Therapy Compact, Psychology Interjurisdictional Compact).
- Telehealth Registries or Special Licenses: A handful of states, including Florida and New Jersey, have established new out-of-state telehealth registries that enable providers licensed and in good standing in other states to register and deliver care via telehealth to state residents.
- Reciprocity: Some states, such as Pennsylvania, issue extraterritorial licenses to physicians who reside or practice in adjoining states. (Note: This reciprocity is not specific to telehealth.)
Recently Introduced Legislation: How States Are Now Contemplating Out-of-State Telehealth Provider Licensure
Through Manatt on Health’s ongoing telehealth policy tracking, Manatt has identified a growing number of states that have recently introduced legislation aimed at enabling providers located in other states to deliver care via telehealth on a long-term basis. While similar in their end goal, the bills vary in their approach:
Three states introduced legislation that would allow health care providers licensed, certified or registered in another state to provide services via telehealth to patients in state if specific criteria are met.
- Alaska House Bill No. 265 would allow health care providers licensed and in good standing in other states to provide telehealth services within their scope of practice, as long as the treated patient is referred to the out-of-state provider by a licensed in-state provider.
- Vermont House Bill No. 654 would allow health care professionals licensed, certified or registered in good standing in another U.S. jurisdiction to provide telehealth services in the state through March 31, 2022, as long as they are not barred from practice in Vermont or subject to disciplinary proceedings in another jurisdiction. Starting on April 1, 2022, through June 30, 2023, out-of-state providers would be required to register with the Vermont Office of Professional Regulation and Board of Medical Practice to provide telehealth services to patients in Vermont.
- Virginia Senate Bill No. 369 would allow practitioners licensed and in good standing in another state or the District of Columbia to provide services via telehealth to patients in Virginia if the provider conducted an in-person evaluation with the patient in the previous 12 months and the purpose of the telehealth visit is to provide continuity of care.
One state has introduced a bill that specifically creates an allowance for out-of-state providers who deliver behavioral or mental health services.
- Maryland Senate Bill No. 398 would enable health care practitioners licensed in other states to provide tele-behavioral health services to patients located in Maryland so long as they are licensed and in good standing in another U.S. jurisdiction.
Three states introduced bills that would enable providers licensed in the state in which their patients are located to deliver telehealth services without being physically present in the state.
- Kentucky House Bill No. 188 would forbid state agencies from:
- Prohibiting the delivery of telehealth services by a provider who is licensed and credentialed in Kentucky to Kentucky residents who are temporarily located out of state;
- Prohibiting the delivery of telehealth services to nonpermanent residents of Kentucky who are temporarily located in Kentucky by a provider who is licensed and credentialed in an individual’s state of permanent residence; and
- Requiring a provider to be physically located in the state where they are licensed and credentialed to practice in order to deliver telehealth services to an individual who is a permanent resident of the same state.
- New Jersey Assembly Bill No. 1946 would allow providers who are licensed to practice in New Jersey to deliver care via telehealth to patients with whom they have an established relationship, from any location (including outside of New Jersey).
- Oregon House Bill No. 4034 would allow physicians or physician assistants licensed in Oregon to deliver services via telehealth to patients located in Oregon without being physically present in the state.
Two states introduced bills that would require the creation of a commission or regulatory system to support and guide state actions related to out-of-state providers delivering care via telehealth.
- Maryland House Bill No. 670 would establish the Maryland Health Care Commission, which would be charged with evaluating ways to allow state residents to receive telehealth services from out-of-state providers.
- Vermont House Bill No. 655 would require the General Assembly to create a regulatory system that would allow health care professionals licensed, certified or registered in another state to obtain a license or registration to deliver care via telehealth to Vermont residents.
Manatt anticipates that maintaining access to telehealth across state lines post-public health emergency (PHE) will be a central telehealth policy issue for many states in 2022. Manatt will continue to track state legislation and policy developments related to this issue and others through our COVID-19 Telehealth Policy Tracker.
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