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Providing Care Across State Lines

TelemedicineOverview

As of November 2018, more than 3,000 US physicians have received permission to practice in multiple states through the Interstate Medical Licensure Compact Commission, a branch of the Federation of State Medical Boards.

This compact has been approved in 24 states thus far. The compact is one of three currently in operation for health care providers; the others are one for physical therapists and one for nurses.

However, the lack of license portability still remains a barrier. There is an expedited process for licensing board-certified physicians with no background issues. But physicians practicing in multiple states must adhere to a variety of state-specific medical practice regulations and there are annual license renewal fees for each state license. There is no national licensure at present.  

VA telehealth program, in a rule effective 6/11/2018 and posted in the Federal Register, enables VA practitioners to treat veterans no matter where the veteran or the doctor are located, effectively bypassing state licensure laws.
 

Ways to provide telemedicine care across state lines.

Providers who wish to practice in other states can apply for full licenses from those states. However, state boards can issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine. These types of special licenses allow practice under specified terms.  

References:
Federation of State Medical Boards:  Telemedicine Policies – Board by Board Overview.
Center for Connected Health Policy:  State Telehealth Laws & Reimbursement Policies Fall 2018.

Examples:
At least nine states have special licenses related to telehealth.

Texas has an Out-of-State Telemedicine License that limits practice to two types of service; (1) follow-up for a patient where the majority of care was rendered in another state, or (2) interpretation of diagnostic testing, but results must be reported to a fully licensed physician practicing in Texas.

Reference:  
Texas Medical Association:  Texas Laws and Regulations Relating to Telemedicine (white paper).

A License by endorsement grants licenses to out-of-state providers whose states have equivalent standards. This is rare but may become more common. Three states (MD, NY, VA) and Washington DC provide reciprocity to bordering states. Alabama and Pennsylvania have agreements with other states to grant licenses to out-of-state physicians who have licenses in states that reciprocally accept their home state licenses. In Connecticut, an out-of-state physician can obtain an in-state license based on his or her home state standards.  

State-by-state licensing guidelines are noted in this reference.

Interstate compacts as mentioned in the overview are available in 24 states at present.

This is a rapidly changing area and a number of states now have pending legislation for this.  

These links are for research only. They are not endorsed by The American Academy of Allergy, Asthma & Immunology (AAAAI).

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