Facilitating Interstate Telemedicine.

• Author: Svorny, Shirley
• Position: BRIEFLY NOTED

COVID-related concerns have led to a sharp climb in the use of telemedicine. Increased investment in telemedicine-related equipment, discovery of its convenience, and familiarity with its process make it all but certain that telemedicine will play a permanent, substantive role in U.S. health care going forward. Yet, state licensing laws impose a barrier to the practice of telemedicine across state lines. Imagine building a highway system throughout the country and then not letting anyone use it for interstate travel.

In the United States, for licensing and reimbursement, state laws define the site of care of a physician-patient interaction as being at the location of the patient. This means that physicians may not offer telemedicine services to patients in other states without a license to practice in those states. Many physicians are deterred by the time and expense involved in gaining those additional licenses and because it is challenging to adhere to multiple state-specific regulations and policies.

This limits access to care. This is especially true in rural communities, for patients with rare diseases who would benefit from access to specialists in other states, and for patients with serious illnesses who are too poor or fragile to travel.

In the wake of COVID-19, 18 states have waived restrictions on the cross-state practice of telemedicine. These waivers apply to out-of-state physicians and other clinicians in good standing in their home states, but the waivers are to last only for the duration of the pandemic. Most of the remaining states have also adopted temporary waivers, but they require out-of-state physicians to register (eight states), apply for a temporary medical license or permit (17 states), or have an association with an in-state provider (five states). To accommodate those actions, the Centers for Medicare and Medicaid Services temporarily waived requirements that out-of-state practitioners be licensed in the state where they are providing services.

On June 19, Senators Marsha Blackburn (R-TN) and Ted Cruz (R-TX) introduced a bill that would allow licensed providers to use telehealth to treat patients in any state based on their home state license--ending 180 days after the end of the national emergency. In Missouri, Gov. Mike Parson justified his state's decision to temporarily allow out-of-state physicians to offer care in Missouri on the basis that it is important to "provide as much access to care as possible for...