UPDATE: Telemedicine Across State Lines Post-Pandemic

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A silver lining to the COVID-19 pandemic has been the permission given to health care providers to render medical services and telemedicine across state lines. Several states as well as the Centers for Medicaid and Medicare Services (CMS) temporarily waived requirements for licensure in the state where the patient is located. (See here for more information.) With the tremendous expansion of telehealth due to the pandemic, maintaining and continuing growth of service delivery via telehealth will necessitate permanent changes in the law.

State Control of Licensing Across State Lines

Traditionally, beginning in the 1800s and growing substantially in the 1950s, states have had the authority to license healthcare professionals. States have a vested interest in maintaining that authority because it allows them to exert control over the quality of care given to their citizens by setting standards including the passing of a licensing exam. They respond to citizen complaints and increasingly in some states, coordinate efforts with other professional boards in the same state. States also have been responsible for keeping out “bad apples,” shouldering the cost of providing disciplinary action and following up with corrective interventions when needed.

As noted by Dr. Ateev Mehrotra of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston and two colleagues, Alok Nimgaonkar, B.A., and Barak Richman, J.D., Ph.D., in an article in the New England Journal of Medicine, Telemedicine and Medical Licensure— Potential Paths for Reform, maintaining the expanded use of telehealth post-pandemic will require permanent rather than the temporary licensure reform that now exists due to COVID-19. Per Dr. Mehrota et al, “… the growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of healthcare markets and telemedicine across state lines.” A similar movement to reduce the barriers to telehealth practice across state lines is evident in many professions beyond medicine.

These same issues are of relevance to all healthcare professionals, including psychologists, social workers, counselors, MFTs, behavior analysts, speech therapists, occupational therapists, physical therapists, nurses, and nurse practitioners to name a few. For more an earlier summary of COVID’s impact on interjurisdictional issues in other professions, see TBHI’s

Interjurisdictional Telehealth Legislative Action

The issue of interjurisdictional practice across state and international borders is such a hot topic in telehealth that it is front-and-center in several legislative bills currently being argued at both the state and federal levels.

For current updates regarding telehealth legislative actions related to practicing telehealth across state lines, see these TBHI articles:

You may also want to consider registering for one or more no-cost subscriptions to TBHI’s no-cost, telehealth-industry newsletters to be sent to you weekly by clicking here.

A Federal License to Practice Telemedicine and Telepsychology Across State Lines

The federal government has the power to enact laws to prevent practices that limit interstate commerce. Another option would be to have the federal government set up a second, parallel licensing route which would allow healthcare professionals to be licensed to practice nationally, across state lines, in addition to being licensed by their state. However, this could complicate states’ ability to provide disciplinary action when needed.

Physicians: The Interstate Licensure Compact

A seemingly viable solution to physician interstate licensing is the Interstate Medical Licensure Compact introduced by the Federation of State Medical Boards (FSMB). It is an agreement that has grown to include 28 states and Guam that facilitates the acquisition of additional state licenses. It, however, has not been widely used, with only 0.4% of physicians in the participating states utilizing it. One proposed suggestion is for the federal government to pass legislation to encourage the remaining states to join the compact – a move that would lessen administrative burdens and fees for physicians, as well as provide improved advertising. For more information see here.

Psychologists: The Psychology PSYPACT

For psychologists, the Association of State and Provincial Psychology Boards (AASPB) has made significant inroads with legalizing interjurisdictional practice for psychologists with PsyPACT. See this TBHI article for more information about PsyPACT:

Nurses: The Enhanced Nurse Licensure Compact

The enhanced Nurse Licensure Compact (NLC) allows for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to have a multi-state license, with the privilege to practice in their home state and other NLC states. With 25 member states in the NLC, nurses in member states are allowed to practice telehealth across the country without having to obtain additional licenses. For details of the NLC, see this summary. 

Counselors: Licensed Mental Health Counselor Portability Intiviatives

Counselor interjurisdictional initiates have been led by the American Mental Health Counselor Association (AMCHA) Interstate Portability Task Force. They have published a position paper on portability to identify their view of the best features of several portability proposals that have recently developed. Details can be found here on the AMCHA website.

Using Medicare to Lead By Example

It doesn’t seem likely that states would willingly give up their control of the licensing process. Dr. Mehrotra proposes an option in which the federal government could “encourage reciprocity under which states automatically recognize an out-of-state license” by instituting the change in the Medicare program, as is already the case in the VA health system (see here). Following that lead, states would potentially adopt state legislation regarding reciprocity, which would also benefit patients with private payers and other types of insurance.

The pandemic has led to the tremendous expansion in the availability of healthcare via telehealth to millions of Americans, in part by removing federal and state licensure restrictions. Those temporary changes to telemedicine across state lines need to be made permanent in order for telehealth to continue to expand and to be a viable way to improve the quality and availability of healthcare for all Americans.

How Can I Legally Practice Telehealth Over State Lines and International Borders?

Practicing telehealth across state lines or international borders? Operate legally & ethically 100% of the time.

Disclaimer: The Telebehavioral Health Institute (TBHI Telehealth.org) offers information as educational material designed to inform you of issues, products, or services potentially of interest. We cannot and do not accept liability for your decisions regarding any information offered. Please conduct your due diligence before taking action. Also, the views and opinions expressed are not intended to malign any organization, company, or individual. Product names, logos, brands, and other trademarks or images are the property of their respective trademark holders. There is no affiliation, sponsorship, or partnership suggested by using these brands unless contained in an ad. We do not and cannot offer legal, ethical, billing technical, medical, or therapeutic advice. Use of this site constitutes your agreement to TBHI Privacy Policy and Terms and Conditions.

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Jill
Jill
1 year ago

I appreciate these updates as I have been confused by what I can and cannot do as a Licensed Marriage and Family Therapist regarding providing services across state lines. I am wondering if anyone has feedback in a case where I am providing services in a role that does not require me to have a license (i.e., general case management, Employee Assistance Program, etc.), yet I do, in fact, have a license. Am I still bound to state mandates, even if I am providing more general services that are not license-related?

Laurie
Laurie
1 year ago

This is misleading. Therapists can only practice in the state they are licensed and where their clients reside.

Alex
Alex
1 year ago

It’s clear that state licensing is increasingly absurd. Why can’t a mental health counselor from one state practice in another? Clinically, it makes no difference. Laws and rules may vary in some minor respects, but this doesn’t justify the fragmentation between states. Can you imagine visiting, say, Oregon and not being allowed to drive a car there because your driver’s license is from, say, Pennsylvania?

Julie
Julie
1 year ago

Covid-19 has proven to be a much needed catalyst and a turning point in mental health care.
Ironically, professionals claiming to believe in change were forced
to open their minds to online treatment and reciprocity between states in order to survive. Some of them, older adults, including myself had to learn new skills.
What is being done to arm long time providers with facts to reduce fears created by their peers and the organizations that they believe they must agree with to protect them?
How can we create more
awareness about the modern and forward thinking needs of the future, specifically, for licensed clinical social workers?
How can we help to grow a strong lobby for the freedom to provide needed mental health services across state lines?
Thank you,
Julie Lyons, LICSW
Licensed in RI
Currently in California
Serving clients across the globe
aboldstep.org
401-575-7640

Toni Napoli
Toni Napoli
1 year ago

I am in the process of moving our home right now and cannot take the time to do the interactive training. I’d
appreciate knowing the status of Washington state.

Carla Laos MD
Carla Laos MD
1 year ago

Great update, super important for us physician/telemedicine providers and leaders to stay informed.

Arlen Keith Leight, LCSW, PhD
Arlen Keith Leight, LCSW, PhD
1 year ago

Question: Does this apply to Tele-Mental Health with psychotherapists or is this limited to physicians? I’m a licensed clinical social worker. Thank you!

Steven T. Griggs, Ph.D.
Steven T. Griggs, Ph.D.
1 year ago

I’ve been practicing outpatient psychotherapy only in California, where I’m licensed, and only with clients who legally live here. Is it legal to see patients who live out of state at this time? Where is there an article that sums all this up?

Abby Kercorian
Abby Kercorian
1 year ago

Can you please tell me if this also is true for mental health care workers, like psychologists, psychiatrists, and other clinical mental health therapists, like LMSW’s?

Ajay Dheer
Ajay Dheer
1 year ago

What are the states and for what license(s)?

Vicki A Zeitner
Vicki A Zeitner
1 year ago

This notification of potential changes appears to be relevant only to medical providers, but not to mental health clinicians and therapists.
Can you please inform of any changes that may expand reciprocity to licensed mental health clinicians (notably, LPC’s and LPCC’s)?

Cathy Menzies
Cathy Menzies
1 year ago

Yes as a trauma therapy practice owner the demands for service continues to be at extreme levels . We are receiving requests for service for many states. This type of legislation will help provide critical mental health services with no walls.

tom gumprecht
tom gumprecht
1 year ago

The biggest barrier to telehealth is inconsistency of payment policies, and arbitrary fees by medicare and private carriers. Medicare and private carriers should have “an electronic services rider” attached to medicare and private carriers where in: Pay is based on the providers BILLED CHARGES for an electronic service (phone, fax, email, zoom, facetime etc. etc.) wherein the carrier (Medicare or private carrier) pay 50% of the billed charges with the patient responsible for the other 50% up to an annual electronic benefit limit of $1000.00. Again, this should be based on physician billed charges not some arbitrary fees by the carrier. This would encourage doctors to actually make themselves available readily for providing electronic services, and with the patient co-pay would limit excessive utilization by the patient ant excessive charged fees by the doctor.

Margaret L Bluhm, PhD, LMSW, LCSW
Margaret L Bluhm, PhD, LMSW, LCSW
1 year ago

This notice only mentions medical practice. Does this also cover behavioral health/psychotherapy?

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