By Sydne Enlund and Iris Hentze
To help states manage the unprecedented demand for health care workers in response to the coronavirus (COVID-19) pandemic, both state legislatures and the federal government have adopted policies to enhance workforce capability.
On March 18, the Trump administration announced a new regulation that temporarily waives Medicare and Medicaid billing requirements that out-of-state providers be licensed in the state where they are providing services. This allows certain licensed medical personnel to practice across state lines, regardless of their state license, to treat more patients with COVID-19.
Under normal circumstances, health care practitioners—from doctors, physician assistants and nurses to pharmacy technicians and respiratory therapists—are required to seek licensure in each state they wish to practice. This creates a complicated regulatory landscape that can limit health care practitioner’s ability to offer their services and expertise across state lines.
The new rule, promulgated by the Department of Health and Human Services (HHS), will help states, “meet the need of hospitals that may arise in adjoining areas,” as stated by Vice President Mike Pence at a March 18 press conference.
In addition to new federal regulations, states can also request approval from the Centers for Medicare & Medicaid Services (CMS)—through Medicaid Section 1135 waivers—to temporarily waive federal telehealth regulations related to professional licensing, billing, point of service and delivery modality.
Even before these federal actions, states had been taking targeted steps to reduce barriers to licensure for healthcare professionals in the event of a public health emergency. For example, in 2019 Governor Ralph Northam (D-Va.) authorized EO-42, allowing out-of-state medical licenses issued in good standing to be deemed active in Virginia to provide certain health care services at hospitals, licensed nursing facilities or dialysis facilities during a pandemic response.
In response to COVID-19, at least 33 states have changed licensing requirements to leverage more health care workers. Washington state adopted the Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) in 2018 to allow volunteer physicians and health practitioners to practice immediately without obtaining a Washington license as long as their home state license is current and in good standing. In response to COVID-19, Washington has now activated the UEVHPA to help with surging demands on the state’s health care system.
Colorado is pursuing reciprocal licensing which would allow a variety of medical professionals who are licensed elsewhere to receive immediate licensure to practice in Colorado. Other states, such as South Carolina and Texas, have ordered their medical and nursing boards to expedite temporary, out-of-state licensure for physicians, nurses and other license types. To learn more, visit our webpage on occupational licensing during public emergencies.
In addition to increasing the number of providers, state policymakers have also adopted modifications to current telehealth policies to increase access to care remotely. Telehealth allows for remote screening, triage and treatment of symptoms and can also potentially help reduce the transmission of diseases between health care providers and patients, in addition to patient-to-patient transmission in the waiting area of health care facilities.
At the federal level, CMS released guidance temporarily broadening access to telehealth services in Medicare under the Coronavirus Preparedness and Response Supplemental Appropriations Act. The guidance removes rural and site limitations so that telehealth services can be provided regardless of where the enrollee is located geographically and type of site. CMS has also waived the requirement that a patient have a prior established relationship with a provider.
Sixteen states and the District of Columbia have revised their telehealth policies in response to the pandemic. Arizona now requires insurance companies and health plans to cover out of network telehealth providers and decrease co-pays for telehealth visits. New York allows providers who submit a self-attestation form to provide telemental health for people affected by disaster emergency for a time-limited period. Some states like Missouri and Texas will allow for phone consults, which were previously not allowed.
Finally, several private health insurance companies are changing their telehealth coverage policies as well. For example, Aetna is offering telehealth visits for any reason without copays and Humana is waiving telehealth costs for urgent care visits for 90 days.
For more information on resources for states in response to COVID-19, please visit NCSL’s comprehensive webpage, which features resources updated daily.
Sydne Enlund and Iris Hentze are policy specialists in NCSL's Health Program.