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Telehealth practitioners are finally seeing signs of permanent change concerning practicing telehealth across state lines with fewer barriers. The Centers for Medicare & Medicaid Services (CMS) and psychology’s PSYPACT have made notable gains. This article outlines both.
Medicare Coverage for Practicing Telehealth Across State Lines
CMS has clarified its policy on Medicare coverage of healthcare professionals licensed through interstate licensure compacts. Previously, several states determined either to restrict the use of telehealth or to recognize its benefits. Some states approved the bill to ensure telemedicine services will continue. Other states have already revoked orders that would have extended telehealth coverage. See Telehealth.org’s previous article Telehealth Coverage Update: 7 States Announce Changes to Telehealth Reimbursement Post-COVID and Telehealth Expansion: 6 Additional States Announce Telehealth Coverage for more information regarding states coverage expansion.
CMS has now issued an updated Medicare Learning Network (MLN) notification for physicians and non-physician practitioners (NPPs) who bill for services provided to Medicare enrollees through Medicare Administrative Contractors (MACs). The upgraded guidance is pertinent because many states eased their laws to allow telehealth services from out-of-state providers during the pandemic. Some states have kept those freedoms in place or updated their guidelines to maintain that impetus. It is fueling enthusiasm in interstate licensing compacts as a means of supporting telehealth across state lines.
Licensure Compacts for Medicare Coverage
CMS distinguishes between the Interstate Medical Licensure Compact (IMLC), which requires physicians to go through a separate licensing process for each participating state, and some other NPPs compacts, such as the Nurse Licensure Compact (NLC) of the National Council of State Boards of Nursing, which allows a provider to work in a compact member state other than their home state without going through the typical licensing process. Apart from the IMLC and NLC, the CMS said it is conscious of other compacts for physical therapists, occupational therapists, speech-language therapists, and psychologists. CMS says,
“For physicians and NPPs, we’ll treat licenses through the interstate license compact pathway as valid, full licenses to meet our federal license requirements.”
CMS Application Enrollment and License Verification
According to CMS, MACs will accept CMS-855 enrollment applications and verify the provider’s license through the acceptable compact or request additional information from the provider for the verification. It also instructs MACs to re-open any previously denied enrollment applications that resulted from a license compact issue.
The need for Medicare coverage during the pandemic has prompted significant changes in healthcare delivery. Telehealth providers will benefit from CMS’s clarification and ground rules on recognizing interstate licensure compacts, which will allow them to treat patients in other states.
Psychology’s PSYPACT is an interstate compact between states to enter into a contract to allow psychologists to practice telehealth legally and with minimum paperwork across state lines. Once signed into law by the governor of a state, the PSYPACT allows psychologists licensed that state to practice in other states that have also adopted the PSYPACT. An added feature of the PSYPACT is that practitioners who wish to practice in another PSYPACT temporarily do so in person.
Initially funded in 2015 by a 3-year grant from the Office for the Advancement of Telehealth, the Association of State and Provincial Psychology Boards (ASPPB) PSYPACT uses a shared licensure model rather than a shared documentation model the Federation of State Medical Boards. It allows professionals in good standing with their board(s) and who have been accepted into the ASPPB PSYPACT program to be duly licensed in other PSYPACT states. The rigorous process requires a fee that is paid to ASPPB by the PSYPACT applicant.
Rocketed by the COVID pandemic, 27 states have currently enacted the PSYPACT. Of those, 23 are effective, three will be effective in the next several months, and three are considering the legislation, but it has not yet been signed by the governor and therefore has not yet become state law. Until it has formally become state law and the start date has occurred, the states are considered enacted but not effective. Another issue that can delay the effective date is whether the PSYPACT commission has not yet formally adopted the state after PSYPACT becomes effective.
A current list of states and their statuses from the PSYPACT website is listed below:
PSYPACT Participating States (27 Enacted, 23 Effective)
- Alabama – AL SB 102 (Enacted 3/18/2021)
- Arizona – AZ HB 2503 (Enacted on 5/17/2016)
- Colorado – CO HB 1017 (Enacted 4/12/2018)
- Delaware – DE HB 172 (Enacted 6/27/2019)
- District of Columbia – DC B 145 (Enacted 3/16/2021)
- Georgia – GA HB 26 (Enacted 4/23/2019)
- Illinois – IL HB 1853 (Enacted 8/22/2018)
- Kentucky – KY HB 38 (Enacted 3/18/2021)
- Maine – ME HB 631 (Enacted 6/22/2021)
- Maryland – MD HB 970 (Enacted 5/18/2021)
- Minnesota – MN SB 193 (Enacted 5/25/2021)
- Missouri – MO HB 1719/MO SB 660 (Enacted 6/1/2018)
- Nebraska – NE L 1034 (Enacted 4/23/2018)
- Nevada – NV AB 429 (Enacted on 5/26/2017)
- New Hampshire- NH SB 232 (Enacted 7/10/2019)
- North Carolina – NC 361 (Enacted 7/1/2020)
- Ohio – OH S 2 (Enacted 4/27/2021)
- Oklahoma – OK HB 1057 (Enacted 4/29/2019)
- Pennsylvania – PA SB 67 (Enacted 5/8/2020)
- Tennessee – TN S 161 (Enacted 5/11/2021)
- Texas – TX HB 1501 (Enacted 6/10/2019)
- Utah – UT SB 106 (Enacted on 3/17/2017)
- Virginia – VA SB 760 (Enacted 4/11/2020)
PSYPACT Enacted but Not Yet Effective
- Kansas – KS SB 170 (Enacted 5/17/2021/Becomes Effective January 1, 2022)
- New Jersey – NJ A 4205/NJ S 2506 (Enacted 9/24/2021/Becomes Effective November 23, 2021)
PSYPACT Enacted but Under Further Review
- Arkansas – AR HB 1760 (Enacted 4/25/2021/Becomes Effective March 1, 2022)*
- West Virginia – WV SB 668 (Enacted 4/21/2021/Becomes Effective July 6, 2021)*
* Indicates PSYPACT legislation has been enacted in a state but has not been formally adopted by the PSYPACT Commission. PSYPACT authorizations are not yet valid.
PSYPACT Legislation Introduced
*Please note the following states have introduced PSYPACT legislation but have not yet enacted PSYPACT and therefore are not considered PSYPACT participating states.
Dealing with States Who Have Not Joined the PsyPact
If a reader’s state is not on the list, it would be advisable to check one’s state board website(s) for any mention of the PSYPACT. It also is helpful to be the “pebble in the shoe” of that state board by writing to inquire respectfully. If the reader feels as if their clients or patients would benefit from that state’s adoption of the PSYPACT Model Act, corresponding to one’s board by email to explain their rationale is warranted and could be helpful in many circumstances. Include the mention of a case where the lack of ability to engage in lawful inter-jurisdictional practice has harmed one or more people under your care. Keep such letters to a single page.
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Like Barbara R., I am hoping to find out how LMHCs etc can legally practice over state and international lines. Please update
Alietha and Barbara R.,
Thank you for your questions. Our 1-hour program goes into explicit detail about how to practice legally over state lines. It is a quick on-demand hour and comes with 1 CME or CE. See details: “Telehealth: How to Legally Practice Over State Lines” https://blog.telehealth.org/?s=state+lines&post_type=page&training=telehealth
This is helpful for doctors, nurses, and psychologists, but what about LCSWs and LPCs (LCMHCs). What’s being done so that we can provide mental health care across state lines? Are there any states that allow us to provide care without needing to get licensed in their state too?