Docs Can Work Across State Lines in COVID-19 Crisis: White House

Ken Terry

March 20, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Despite the White House's announcement on Wednesday that physicians would be allowed to practice across state lines during the COVID-19 crisis, the Department of Health & Human Services (HHS) had still not issued the necessary regulation at press time.

"The Trump administration is continuing to take quick and decisive action to combat COVID-19 and protect Americans," an HHS spokesperson told Medscape Medical News on Thursday in an emailed response to an information request. "We will keep you updated on this front."

At the White House news conference on Wednesday, in contrast, Vice President Mike Pence said, "HHS is issuing a regulation today that will allow all doctors and medical professionals to practice across state lines to meet the needs of hospitals that may arise in adjoining areas."

Pence's language suggested that the administration intends to limit the cross-state privileges to hospital care in areas near state lines. There is no indication that the White House plans to override the rules of state medical boards that prohibit physicians from practicing in their states unless they have valid licenses in those states.

Nothing in Pence's statement, likewise, indicates that physicians will be allowed to conduct telehealth consults with patients who reside in states where those doctors aren't licensed.

The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday that it would cover virtual visits with Medicare patients across the country for the duration of the COVID-19 emergency. However, a CMS fact sheet didn't say that the new regulation allows physicians to practice telehealth in states other than their original state of licensure.

Licensing Data Made Available

On the same day that Pence announced the plan to let doctors practice across state lines, the Federation of State Medical Boards (FSMB) offered free access to its licensure data to help facilitate the national response to the coronavirus pandemic.

"The FSMB has decided to provide free access to its Physician Data Center (PDC), the nation's largest and most comprehensive repository of licensure and disciplinary information for the more than 1 million physicians and physician assistants licensed in the US," said Humayun J. Chaudhry, DO, president and chief executive officer of the FSMB, in a letter to Vice President Pence. "Through the PDC, state medical boards, hospitals, and eligible state and federal agencies have the ability to instantly verify licenses and other credentials for physicians and physician assistants being deployed to practice across state lines to treat patients in areas impacted by the COVID-19 virus.

"President Trump's declaration of a national emergency and numerous state emergency declarations have mobilized thousands of physicians to volunteer for in-person care and to practice remotely through telehealth. While some state licensure laws are temporarily waived, it is essential that hospitals, payers, and licensing and credentialing entities have complete and up-to-date information to quickly and accurately verify licensure status, specialty information, and disciplinary history, at a minimum.

"The FSMB has expanded its free access to the PDC to hospitals, federal agencies, and other entities in order to immediately expedite the mobility of qualified physicians and physician assistants without compromising patient safety and quality."

Chaudhry was unavailable for comment at press time.

Interstate Medical Licensing Compact

Over the past 6 years, the FSMB has spearheaded the creation of the Interstate Medical Licensure Compact (IMLC), which helps eligible physicians get licensed quickly in multiple states.

As of today, the compact includes 29 states, the District of Columbia, and the territory of Guam. Legislation to join the agreement is pending in Florida, Missouri, New Jersey, Rhode Island, and South Carolina.

Under this agreement, licensed physicians can qualify to practice medicine in states that belong to the compact if they meet certain eligibility requirements. According to the IMLC website, "approximately 80% of physicians meet the criteria for licensure through the IMLC."

When a physician submits an application to the IMLC, their state of principal license verifies the doctor's existing information and conducts a background check. Once the physician has qualified for the compact license, he or she may practice in any compact state.

More than 6900 applications have been processed through the IMLC, resulting in 9046 medical licenses being issued by compact member states, FSMB spokesperson Joe Knickrehm told Medscape Medical News.

By making it easier to obtain multiple licenses across much of the country, the compact has benefited locum tenens doctors, physicians who practice in areas that cross state lines, and those who perform telehealth consults in more than one state.

Although it seems like the IMLC is a well-suited complement to what the Trump administration has proposed, it's unclear whether HHS will take advantage of the compact in its forthcoming regulation.

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