COVID-19: Occupational Licensing During Public Emergencies

Iris Hentze 5/26/2020

Doctor talking with a patient

COVID-19 presents an unprecedented crisis for states, requiring swift action on many issues, including the process for licensing essential workers. Temporary suspension of occupational licensing laws in emergency situations is a common approach states take to help manage short-term crises. States have experience in adopting emergency licensing processes, most often in response to natural disasters and their aftermath. Typically, states will lift licensing restrictions on aid workers, including those providing health care, infrastructure and other services critical to disaster recovery. To respond to COVID-19, states are also exploring the temporary suspension of licensure requirements for volunteers and aid workers. 

Many of the occupations that will be in high demand throughout the COVID-19 crisis are regulated in a way that can limit the flow of necessary skilled professionals across state lines. This includes many health care professionals, such as nurse practitioners and certified nurses’ aides, who may be critical in any state’s response to the virus. Most states have responded to the COVID-19 outbreak by activating emergency-response licensure laws allowing volunteers to come in from other states and practice their profession without being required to seek a state-specific license. States are both leveraging existing statutes and taking new actions to help ensure as many health workers are able to work during this time as possible. 

Uniform Emergency Volunteer Health Practitioner Act

The Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) is model legislation developed in 2006 by the Uniform Law Commission. The legislation allows any state that has enacted it to recognize out-of-state licenses for a variety of health practitioners during a state of declared emergency. Participating states must maintain a registration system under which all volunteer practitioners must register. As of 2020, 18 states and the District of Columbia have enacted UEVHPA legislation.

The state of Washington, one of the earliest and hardest hit states so far, has activated its emergency volunteer health practitioners in preparation for surging demands on the state’s health care system. Under its own UEVHPA statute, the state’s Department of Health (DOH) can allow volunteers to practice immediately without obtaining a Washington license as long as they are in good standing in the other states in which they are licensed.

The states with enacted UEVHPA legislation are:

  • Arkansas
  • Colorado
  • District of Columbia
  • Georgia
  • Illinois
  • Indiana 
  • Kentucky
  • Louisiana 
  • Maine 
  • Nevada
  • New Mexico 
  • North Dakota 
  • Oklahoma 
  • Oregon
  • Tennessee
  • Texas 
  • Utah 
  • Washington 
  • West Virginia 

Existing Health Care Professions Compacts

Apart from emergency declarations allowing states to bypass licensing laws during crises, it is worth noting that existing occupational licensure compacts may also be helpful in these circumstances. The Enhanced Nurse Licensure Compact (eNLC), for example, allows nurses who are licensed and in good standing in one of the compact member states to practice in any of the others automatically. Intended to increase cooperation, information-sharing and the supply of trained workers in a high-demand field, 32 states are currently members of the eNLC compact and three states are considering legislation that would allow them to join in 2020. The Recognition of EMS Personnel Licensure Interstate Compact (REPLICA) is similar and allows EMS personnel licensed in any one of the 19 compact states to practice in any of the other member states.

Other State-Specific Responses

States are also modifying their licensure laws in more targeted ways. States are opening up their licensing reciprocity to allow nurses, doctors, respiratory therapists and other health professionals to offer their services across state lines. Many are issuing temporary or emergency licenses that require an applicant to undergo some sort of regulatory review, but on a shortened timeline to help them get to work as quickly as possible. Other states are asking recently retired health workers and students who have recently graduated but haven't yet taken their licensing exam, or who are close to graduation, to offer their expertise and practice on a temporary basis. Finally, states are reducing regulatory burdens for current health practitioners by waiving certain continuing education requirements and fees and by temporarily delaying licensing renewal requirements. 

NCSL is tracking state actions related to licensed workers as part of the COVID-19 response. The below table is a comprehensive list of actions states have taken so far.

State

Type of Emergency Action

Description

Alabama Executive Action/Regulatory Action; Executive Action

The Alabama Board of Medical Examiners adopted emergency rules to allow for temporary emergency licenses for physicians, physicians assistants and anesthesiologist assistants in the state. The emergency license does not require a fee, is required to be issued within 48 hours and will expire once the Governor-declared state of emergency in the state is over. Alabama's governor issued an update to the state of emergency declaration on May 8, allowing many different types of health providers who are licensed in other states to practice in Alabama as long as their license is roughly equivalent. 

Alaska Legislative Action; Regulatory Action; Regulatory Action Alaska's Legislature passed legislation that will take a number of steps related to the state's COVID-19 response, including allowing the state's Division of Professional Licensing the ability to expedite the process of issuing licenses to out-of-state applicants. The legislation is awaiting a signature from the governor. The state Division of Corporations, Business and Professional Licensing issued guidance expanding and easing licensing requirements for telehealth occupations. Finally, the University of Alaska has expedited graduation of nursing students in bachelor and associate programs to allow them to get to work more quickly. The state Board of Nursing has granted these students temporary licenses allowing them to practice for now and take the required licensing exam in the future. 

Arizona

Executive Action; Executive Action; Legislative Action

Allows the Arizona Department of Health and Safety to waive licensing requirements to provide health care officials with assistance in delivering services during times of heightened demand. Another executive action coming out of Arizona directs state agencies and boards to defer requirements to renew a license that has an expiration date between March 1 and Sept. 1, 2020, and will defer requirements to complete continuing education by six months, unless those requirements can be completed online. Legislation was introduced in Arizona on May 19 that would limit the liability of businesses and other institutions if they are sued by an individual who contracted COVID-19 on their premises. The legislation would prevent state licensing bodies from revoking business and/or occupational licenses as a disciplinary action. 

Arkansas Executive Action/Regulatory Action The Arkansas State Medical Board is expediting the licensing of health care workers under orders from the state's governor. The Arkansas Department of Health and state Medical Boards are also issuing temporary emergency licenses to medical residents and nursing students and waiving initial licensing fees. 
California Executive Action Retired doctors and nurses, as well as medical and nursing students, will be temporarily eligible to practice in the state. An executive order is also temporarily expanding scope of practice for students and nurse practitioners to allow them to provide a broader scope of care to patients in response to COVID-19.  

Colorado

Executive Action; Executive Action/Regulatory Action; Regulatory Action

Colorado's governor is asking for former health care professionals to "reconnect" with past employers to create a reserve bank of workers. Colorado is also taking executive action to allow pharmacists, nurses and doctors licensed in other states to be able to immediately practice in the state through a reciprocal licensing push led by the state’s main licensing authority, the Department of Regulatory Agencies (DORA). DORA has also created an online tool for specific professions regulated by the state allowing licensees and the public to access information regarding emergency licensing orders and guidance for dental professionals, physicians, nurses, respiratory therapists, and other health and non-health professions. 

Connecticut

Regulatory Action; Regulatory Action; 

Executive Action; Executive Action

The State Department of Health has issued an order temporarily suspending the requirement for licensure, certification or registration for a number of health practitioners. The order lasts for 60 consecutive days and applies to a variety of health professionals such as EMTs, physicians, nurses and respiratory care practitioners. The State Department of Health has also issued an order to suspend licensure renewal requirements for six months after the governor-declared state of emergency expires. 

 

Authorizes the commissioner of Early Childhood to waive certain licensing and other requirements to maintain and increase the availability of child care. Waives certain occupational regulations for pharmacists and face-to-face interview requirements. The governor has also issued an executive order extending temporary permits for certain health care providers and waiving fees. The temporary licenses allow for marital and family therapy associates, professional counselor associates and certain healthcare license applicants and graduates to practice before receiving their state license. 

Delaware Executive Action Two emergency orders issued by the state allow for broad powers to temporarily change licensure for health care workers involved in the response to COVID-19 in the following ways: 1) to allow in-state health care providers retired for less than five years to practice, 2) to allow individuals licensed in other states to practice in Delaware, 3) to allow some nursing and medical students to practice without a license and 4) providers involved in COVID-19-related efforts will be considered public employees in order to be protected from liability so long as they are not grossly negligent.

Florida

Executive Action; Regulatory Action

Florida’s governor issued an executive order allowing medical professionals, social workers and counselors licensed in other states to practice in Florida immediately during this emergency with the condition that their services be rendered free of charge. The state Department of Health has taken some additional actions, including changing in-person licensing requirements for some health professionals to allow them to substitute for remote learning and simulations, expanding the ability for out-of-state licensed professionals to practice telehealth in Florida, and expanding scope of practice for EMTs. 

Georgia

Executive Action; Executive Action

Georgia’s governor issued a declaration on March 14 to allow some nurses from other states to get temporary licenses to practice in the state. Then on March 17, the governor acted again to extend the deadline for 3,396 EMTs whose licenses would expire on March 31, 2020, to June 30, 2020.

Hawaii Executive Action An executive order issued by the governor allows health care professionals to engage in telehealth without an in-person consultation or a prior existing physician-patient relationship. The order also enables out-of-state physicians, osteopathic physicians and physician assistants with a current and active license, or those who were previously licensed but who are no longer current and active, to engage in telehealth in Hawaii without a license.

Idaho

Executive Action

State licensing entities are authorized to temporarily exercise enforcement discretion, implement temporary rules, and waive licensing and related requirements to maximize access to health care services and provide support in response to COVID-19.

Illinois Executive Action Under direction from the state's governor, the Illinois Department of Financial and Professional Regulation is allowing health care workers with expired licenses to temporarily restore them to join the state's health care workforce in response to COVID-19. Doctors and physician assistants who have inactive or expired licenses for less than three years can return to work without paying any licensing fees or updating their continuing education requirements. Nurses and respiratory therapists can do the same as long as they have an inactive or expired license of fewer than five years.
Indiana Executive Action; Regulatory Action Governor Eric Holcomb issued new executive orders aimed at responding to the coronavirus, including one that will extend the renewal deadline for all state occupational licenses by 60 days and prohibiting law enforcement from writing citations for expired licenses during that grace period. The Indiana Professional Licensing Agency has created a registry for those who do not hold a valid in-state license but can be mobilized to help fight COVID-19. Out-of-state health care practitioners, retired health care professionals, and recent graduates of accredited medical, registered nursing, pharmacy, physician assistant and respiratory care programs may use the registry and work for 90 days (extendable in 30-day increments) or until the public health emergency is over.

Iowa

Executive Action; Executive Action; Executive Action  

With the issuance of a state public health emergency, parts of Iowa’s Disaster Emergency Plan have been enacted to allow the state to implement a number of public health measures. This includes allowing a variety of medical practitioners to volunteer their skills and services even if their license is inactive or has lapsed. On March 22, the governor issued an additional proclamation allowing licensing boards to grant emergency licenses to applicants even if they do not yet have an initial license if the board determines they have completed sufficient education requirements. This applies to a number of health care professionals, including respiratory therapists, physicians, physician assistants and nurses. Iowa is also allowing for temporary teacher licensure, granting applicants a one-year temporary license if they are unable to complete the requirements for initial licensure due to COVID-19.

Kansas Executive/Regulatory Action; Executive Action The Kansas Board of Healing Arts is issuing temporary emergency licenses to health providers which will allow them to temporarily engage in the practice of their profession related to COVID-19 response efforts. Kansas' governor issued an executive order extending professional and occupational licenses in the state for the duration of the pandemic, waiving late fees and expiration fees as well as extending the deadline for completion of continuing education requirements. 
Kentucky Legislative Action The Kentucky General Assembly passed legislation at the end of March 2020 to deal with the state's response to COVID-19. The legislation, among other things, allows the state medical and nursing boards to waive licensure requirements for out-of-state health practitioners and opens up scope of practice for medical students, allowing them to provide more health care services than they would under normal circumstances. The bill also temporarily allows doctors who practice in one medical field to switch over and assist in another if necessary. 
Louisiana Executive Action/Regulatory Action Louisiana's governor issued an executive order to give state agencies and licensing boards the authority to adopt temporary rules in order to respond to COVID-19. To get more providers into the field, the state is currently expediting graduation for medical, nursing and other students, expediting licenses for health professionals licensed in other states and asking retired medical professionals to return to practice to help support the state's healthcare systems. Additionally, specifically for nurses, the State Board of Nursing is extending and/or reinstating expired temporary permits for RN applicants and allowing advance practice registered nurses (APRNs) to extend their practice to new sites not previously reported to the board during the public health emergency.
Maine Legislative Action Before adjourning, the legislature passed omnibus coronavirus legislation, significantly expanding the powers of the governor during a public health crisis. One aspect of the bill allows the governor to modify or suspend requirements for occupational licenses if those requirements would hinder an effective emergency response. 

Maryland

Executive Action

Allows health care practitioners licensed in another state to immediately practice in a Maryland health care facility (including hospitals) and extends any licenses that are due to expire during the current state of emergency to be extended until at least the 30th day after the state of emergency is lifted.

Massachusetts

Executive Action; Regulatory Action

Governor Charlie Baker announced nurses and other medical professionals who are licensed in any other state can now be licensed in Massachusetts within a day. Retired physicians will also be allowed to reactivate their license. Beginning on April 5, the State Medical Board will accept applications for emergency temporary 90-day licenses. To qualify, a physician must currently hold an active Massachusetts limited license in good standing and must have completed postgraduate training as outlined in the applicant qualification requirements section of the application.

Michigan Executive Action Michigan is currently pursuing a number of licensing strategies in response to COVID-19, including waiving continuing education requirements for current licensees, expanding scope of practice for licensed practical nurses (LPNs) and RNs to allow them to provide more care than they may under typical circumstances, and allowing students who are enrolled in programs to become licensed, registered or certified health professionals to volunteer to work to support the state's COVID-19 response. 
Minnesota Executive Action Minnesota's governor issued an executive order temporarily relaxing a number of mandatory licensing requirements in order to help the state respond to COVID-19. This includes pushing back upcoming expiration deadlines and renewal deadlines for health care provider licenses. The State Board of Nursing is also allowing nurses to seek temporary permits to practice without a license for the duration of the declared state of emergency.
Mississippi Executive Action/Regulatory Action Out-of-state physicians may use telemedicine when treating patients in Mississippi without securing a license to practice medicine in the state, provided the out-of-state physician holds an unrestricted license to practice medicine in the state in which he or she practices and is not subject to a disciplinary proceeding.

Missouri

Legislative Action

HB 2046 would allow individuals licensed in certain trades who move to Missouri to be eligible for state license reciprocity. The individual would need to have had his or her out-of-state license for at least a year and be in good standing. This legislation is still pending.

Montana Executive Action Under an executive order issued by Governor Steve Bullock, health professionals who are licensed in another state can register in Montana to work during the duration of the state's emergency declaration. There are no licensing fees for the emergency registration and providers can begin practicing immediately. 
Nebraska Executive Action The governor's Additional Healthcare Workforce Capacity executive order temporarily allows anyone licensed and in good standing in another state across a variety of health care professions to be allowed to immediately practice in the state. The order also allows formerly licensed individuals to renew their license after it has expired without having to provide documentation of continuing education, defers license renewal fees, and opens up scope of practice for a number of health professions, including registered nurses, physical therapists and emergency medical technicians.  
Nevada Executive Action; Executive Action All licenses and permits issued by the state that expire or are set to expire during the declared state of emergency will have their expiration dates extended to 90 days past the date the state of emergency is terminated. Nevada's governor has also issued an executive order authorizing licensing entities in the state to waive licensing requirements for medical professionals who have received training in another country, but who are not currently licensed in the U.S. Their credentials would still need to be verified. 
New Hampshire Executive Action Under the governor's declaration of emergency directive, any out-of-state health care practitioners may practice in New Hampshire to assist with the state's response to COVID-19, provided they are licensed and in good standing in their home state. With this order, the governor also granted the commissioner of the Department of Health and Human Services broad authority to waive any of the licensing or credentialing requirements for the occupations regulated by the department to improve access to treatment and protect public health and safety.
New Jersey Executive Action New Jersey's governor has issued an executive order addressing the licensing of health care workers in the state in response to COVID-19. The order takes a number of actions, including allowing for temporary reactivation of licenses of recently retired health care professionals and granting temporary licenses to doctors licensed in foreign countries. 
New Mexico Executive Action In response to COVID-19, New Mexico's Regulation and Licensing Department Boards & Commissions Division has suspended the requirements for proof of continuing education for those who have licensure expiration dates through June 31 of this year. 

New York

Executive Action; Executive Action 

New York is asking former doctors and nurses to “reconnect” with their past employers, in order to create a reserve workforce of health care professionals. The state’s Department of Health has also been asked to accelerate the processing of license renewals in order to expedite the process. New York is also allowing people who are not licensed in the state as clinical laboratory technicians, but who "meet the federal requirements for high complexity testing," to be allowed to perform COVID-19 tests. Physicians who are licensed anywhere else in the country will now be eligible to practice in New York; the same goes for nurse practitioners, physicians assistants and nurses. Finally, individuals who are not currently registered as nurses but who meet certain requirements can engage in certain tasks for which one currently must be licensed.

North Carolina Executive/Regulatory Action; Executive Action The North Carolina Medical Board typically requires a background check as part of the licensure process. Due to COVID-19, certain agencies and organizations that perform services in association with background checks, including the preparation of fingerprint cards, have temporarily ceased operations. As a result, the board has temporarily suspended the background check requirement for licensure meaning applicants will not need to have a background check at this time to be issued a North Carolina medical license. Additionally, the governor has issued an executive order temporarily waiving licensing requirements for health care and behavioral health care personnel who are licensed in another state to provide services within North Carolina.
North Dakota Executive Action The governor of North Dakota has issued an executive order temporarily suspending certain licensing requirements in state statute to allow individuals with inactive or lapsed licenses to return to work during the state's COVID-19 response. This executive order applies to a variety of health care and behavioral health providers. The order also temporarily suspends the requirements for respiratory care therapists and respiratory care practitioners in the state, directing the state Board of Respiratory Care to grant temporary provisional licenses to applicants.
Ohio Regulatory Action Ohio law allows nurses to practice in the state during a declared emergency without an Ohio license, including the deployment of licensed nurses from other states. In addition, the state Board of Nursing is expediting the issuance of temporary permits, in three business days or less, for applicants. 
Oklahoma Executive Action; Regulatory Action On April 6, the governor of Oklahoma approved an emergency rule that provides for temporary emergency waivers for the employment of nurse aide trainees in employer-based nurse aide training programs. The rule is intended to improve the state's ability to respond to COVID-19 by bolstering the number of workers who can serve as nurses aides. The Oklahoma Medical Board is also allowing temporary licensure for eligible providers, including doctors, physician assistants, anesthesiologist assistants, physical therapists and occupational therapists who are licensed and in good standing in any other state.
Oregon Regulatory Action The Oregon Medical Board is temporarily allowing physicians and physician assistants who are currently working on temporary licenses to have their licenses extended beyond the statutory maximum of 240 days a year. Retired doctors are able to return to practice if their license has lapsed or they have retired, as long as they were in practice in the previous three years and were in good standing. Finally, the state is allowing physicians and physician assistants with out-of-state licenses to practice in Oregon as long as they are in good standing in their home state. 
Pennsylvania Executive Action The Department of State has suspended or made changes to several licensing rules in the state, including temporarily extending license expiration dates and waiving associated fees, extending temporary nursing practice permits and graduate permits beyond one year, and allowing nursing school graduates who meet certain requirements to immediately apply for a graduate permit in the state.
Rhode Island Regulatory Action  Some medical students in the state are being allowed to graduate early in exchange for staying in the state and assisting with the COVID-19 pandemic response. Temporary licenses will be granted to the students allowing them to practice during the declared state of emergency. 

South Carolina

Executive Action/Regulatory Action

The State Medical Board is authorized to expedite temporary licensure for out-of-state physicians, physicians assistants and respiratory care practitioners within 24 hours.

South Dakota Executive Action South Dakota's governor issued an executive order granting full recognition to the licenses held by a medical professional in any of the compact member states in accordance with the Uniform Emergency Management Assistance Compact (EMAC).
Tennessee Executive Action Governor Bill Lee signed an executive order implementing a number of actions related to licensing in the state to assist with the response to COVID-19. The executive order extends deadlines for an initial license applicant to pay application fees, provides that application documents do not need to be notarized, gives the commissioner of Health the ability to grant licenses for retired health care professionals, and suspends the requirement for individuals to submit proof of continuing education requirements. 

Texas

Executive Action

The governor has asked the Texas Medical Board and the Texas Board of Nursing to expedite temporary licenses for out-of-state practitioners and to allow for the provision of limited emergency licenses. Doctors retired less than two years may also apply for a temporary license under the new directive.  

Vermont Executive Action The legislature passed emergency legislation that was signed by Governor Phil Scott on March 30, 2020, allowing individuals who are licensed and in good standing elsewhere to practice in the state, and those with expired licenses to return to work during the declared state of emergency. it also provides temporary licenses to students who have graduated from an approved program but have not yet been able to take an exam required by statute due to COVID-19.
Virginia Executive Action Virginia's governor issued an executive order on April 17 allowing nurse practitioners and doctors licensed in other states to be able to practice in Virginia. The order also allows nurse practitioners licensed in the state with two or more years of clinical experience to practice without a collaborative agreement. 

Washington

Executive Action

The state Department of Health is easing certain licensing requirements under a declared state of emergency. This includes allowing doctors, nurses and other practitioners to work in Washington without an active state license. The allowance applies to health care practitioners now licensed in other states, or those who have inactive Washington licenses. Those eligible can register with the Department of Health as an “emergency volunteer health practitioner.”

West Virginia  Executive Action West Virginia's governor has issued an executive order making a number of changes to licensing in the state in response to COVID-19. They include suspending the requirement that any medical provider holds an "active, unexpired license" issued by the Board of Medicine to practice, extending the period of time during which medical licenses and educational permits are valid, and suspending the requirements for physician assistants licensure.
Wisconsin Executive Action On April 6, Governor Tony Evers issued two emergency orders related to health care worker licensure. The first allows health care facilities, providers and emergency medical services flexibility in addressing staffing needs. The order does this by pushing back license renewal deadlines, adjusting the required training hours nurse aides need to practice, and temporarily suspending requirements for resident care staff. The second order allows health care provider licenses that would have expired during the declared public health emergency to remain active until 30 days after the emergency is over and allows individuals who are licensed in other states additional time to apply for a Wisconsin license than they would normally have.
Wyoming Regulatory Action; Regulatory Action The Wyoming Board of Medicine is temporarily expediting temporary licenses and extending expiration dates for licenses in need of renewal this year from June 30 to Sept. 20. The board is also allowing doctors with expired licenses to return to practice for the duration of the public health state of emergency. 

 Other Resources

  • The Mercatus Center at George Mason University published a policy brief of licensing during COVID-19, entitled “A Primer on Emergency Occupational Licensing Reforms for Combating COVID-19.” The brief examines the trends in state licensing actions in response to the pandemic and offers analysis on which approaches are most effective. 

  • The National Council of State Boards of Nursing (NCSBN) has compiled a list of changes some state nursing regulatory bodies have implemented to help nursing students complete clinical experiences critical for their ultimate licensure. Many current nursing students have faced educational uncertainty due to the pandemic.