Telehealth utilization has exploded over the past six months, marking a paradigm shift in health care delivery. According to the U.S. Department of Health and Human Services (HHS), 43 percent of Medicare primary care visits were provided via telehealth in April 2020, compared to less than one percent (0.1) in February 2020.

Patients are adapting to the new care delivery paradigm, and studies show very high telehealth satisfaction rates. Telehealth quickly has become a key feature in our health care delivery system, but current health care requirements are struggling to keep pace, particularly as they relate to state licensure.

Federal Level Flexibilities

At the beginning of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services issued dozens of regulatory flexibilities for providers, including expanding the list of services eligible for telehealth, lifting telehealth site origination requirements, and waiving Medicare and Medicaid requirements that practitioners be licensed in the state where they are providing services. These federal flexibilities are beneficial for seniors and have allowed the use of telehealth to grow in Medicare. However, these flexibilities are still subject to state licensure requirements.

Multiple State Rules

Since states and state medical boards remain the primary regulatory body for physicians and other health care providers, this has created a myriad of state licensure rules and regulations that are confusing for physicians to navigate and restrict access to care for patients.

Small and solo practices have been reporting to ACOFP about the difficulties of complying with multiple state rules. Unlike many larger physician groups, most small and solo practices did not already have an established telehealth program and therefore lack the experience and administrative resources to comply with the multitude of state regulations.

To help small and solo practices navigate the various state laws, we have provided a few resources below.

State Licensure

Almost every state has modified their licensure requirements or renewal policies for health care providers in response to COVID-19, which includes telehealth requirements. The following sources provide updates on each state’s requirements (also available at the HHS website):

Interstate Compacts

Interstate compacts make it easier for providers to practice in multiple states. One major compact is the Interstate Medical Licensure Compact (IMLC), which is an agreement among 29 states to streamline the process for physicians who want to practice in multiple states. Approximately 80 percent of physicians meet the criteria for licensure through the Compact, according to the IMLC website.

Interested in joining the compact? Learn more.

ACOFP Member Impact

State licensure issues will likely continue to be a barrier to the adoption of telehealth. In order to gauge ACOFP member interest in telehealth issues and determine member priorities, we have launched a member survey. Please take a minute to share your feedback in this survey to help ACOFP develop our policy principles in 2021 and inform policymakers of family medicine telehealth priorities.

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