America Needs Federal Telehealth Licensure Legislation
Over the past decade, the use of telehealth has grown exponentially in the United States. Driven by improvements in technology, convenience, and its lower cost compared to traditional in-person visits, it’s widely estimated that 20% of all medical visits will be conducted virtually by the end of 2020. To contextualize this growth, it is estimated that in 2013, only 350,000 medical visits were conducted virtually.
Despite the significant growth in patient utilization of telehealth services and its popularity among both patients and providers, state-level licensure restrictions routinely prevent qualified out of state physicians from providing important virtual care to patients. The problem is particularly pronounced in rural communities where access to health care is difficult and more expensive and in states, such as Mississippi, Idaho, and Wyoming, that are experiencing a shortage of physicians. One way to mitigate the consequences of a physician shortage and expand access to a popular service would be for Congress to pass legislation that allows licensed physicians to practice telemedicine across state lines.
Currently, the United States is a hodgepodge of telehealth licensure laws with each state dictating which providers can or cannot practice telehealth, what services they can provide, and whether they are reimbursed by insurance providers at the same rate as an in-person visit. These differences among states have created a situation whereby patient access to telehealth is determined by the state patients reside in, not provider availability or medical need. The inconsistent access to telehealth created by differing state laws should be particularly concerning to policymakers given access to telehealth is linked to better health outcomes for patients.
In 2016, the Alaska legislature passed SB74 that allowed out of state providers to offer telehealth services in the state so long as they are registered in another state, sign onto the state’s Telemedicine Business registry, and obtain an Alaska Business License. If filed online, registration is almost instant, meaning there is often no wait time for out of state providers to begin providing virtual health services to Alaskans. The minimal legislative barriers to providing telehealth and fast licensure has led to significantly better health outcomes for all Alaskans who need both normal and specialized care.
Unlike Alaska which outlines the importance of allowing providers to practice freely across state lines, Hawaii exists at the other end of the regulator spectrum. Currently, Hawaii law requires physicians who wish to practice telemedicine in the state to be fully licensed in both Hawaii and their home state. This double licensure requirement is problematic for patients seeking telehealth services in Hawaii because it can take four months for the state Medical Board to grant a license. During this time, the physician is not able to deliver telehealth service to the state’s residents who are currently facing a significant shortage of physicians.
A federal law allowing telehealth providers to see patients across state lines would also go a long way to mitigate the consequences of physician shortages such as the inability to quickly access care. Currently, 32 states are experiencing a physician shortage. States such as Mississippi, Idaho, and Wyoming are facing the most severe shortages, with fewer than 200 doctors per 100,000 people. Nationally, estimates suggest by 2030, the United States will have a shortage of 120,000 physicians. A shortage of this magnitude will mean future patients will struggle to access health care when they need it.
A federal law allowing physicians to seamlessly practice telehealth across state lines would mean providers who work in states without a shortage can easily provide service in areas facing a shortage. This would ensure that, even though states face a shortage of providers, residents can still receive virtual care promptly.
The federal government also has the constitutional authority to enact legislation allowing providers to freely practice across state lines. The Interstate Commerce Clause explicitly grants the federal government the authority to regulate commerce between states. As the service is occurring between patient and provider who are in different states, regulating it would fall to the federal government, not the individual state governments.
As a result of the Coronavirus pandemic, the federal government recognized the importance of allowing telehealth providers to practice freely across state lines. In March 2020, the Center for Medicare and Medicaid Services (CMS) relaxed regulations through the 1135 waiver authorizing providers to receive reimbursements for services they provided across state lines.
Given the exponential growth in the use of telehealth and its substantial popularity with patients and providers, it became clear that it would become an important part of delivering health care in the twenty-first century. Despite this fact, state legislation makes it difficult for providers to deliver telehealth across state lines. This has serious costs for patients, especially those in rural communities and states experiencing a physician shortage.
The federal government should see an urgency in stepping in to allow telehealth providers to practice across state lines. Not only will this help with access to care, but it can help mitigate the current geographical disparities and inequities currently plaguing the health care system in rural America.
Edward Longe is a research associate at the American Consumer Institute, a nonprofit educational and research organization. For more information about the Institute, visit www.TheAmericanConsumer.org or follow us on Twitter @ConsumerPal.
