COVID-19: Occupational Licensing During Public Emergencies

Iris Hentze 4/1/2020

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 during 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. A number of states are already responding to the COVID-19 outbreak by activating emergency-response licensure laws that allow volunteers to come in from other states and practice their profession without being required to seek a state-specific license.

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

Some states are modifying their licensure laws in more targeted ways. The Florida Legislature passed legislation in response to COVID-19 that will allow qualified nurse practitioners to independently operate primary care practices without an attending doctor. Advanced nurse practitioners would need to have completed some graduate-level coursework and have at least 3,000 hours of experience logged under a physician to qualify. Florida Governor Ron DeSantis has already signed the legislation into law.

In South Carolina, several of the state’s licensing boards that regulate health care professionals are issuing “emergency” nursing and medical licenses. The state permitted its medical board to expedite temporary, out-of-state licenses for physicians, physician’s assistants and respiratory care practitioners. While the state is a party to the eNLC, the nursing board is also currently authorized to expedite nursing licenses for individuals licensed in states outside of the compact. Georgia and Texas have also pursued similar strategies, allowing for expedited licenses of nurses and physicians at this time.

The governors of Colorado and New York have both urged former health care practitioners who may no longer be working in the field, but who still have an active license, to consider volunteering their skills during this time. New York Governor Andrew Cuomo is asking former doctors and nurses to “reconnect” with their past employers in order to create a reserve of health care professionals who may be called on to help respond to the coronavirus. Colorado Governor Jared Polis said, “I’m asking you to reconnect with your past employer in the event that we need surge capacity” at a press conference on March 13th. 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.

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 The Alabma Board of Medical examiners adopted emergency rules to allow for temporary emergency licenses for physicians, physician 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.
Alaska Legislative Action Alaska's legislature passed legislation that will taken 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 signature from the Governor. 

Arizona

Executive Action

Allows the Arizona Department of Health and Safety to waive licensing requirements to provide healthcare officials with assistance in delivering services during times of heightened demand.

Arkansas Executive Action The Arkansas State Medical Board is expediting the licensing of healthcare workers under orders from the state's Governor. The Arkansas Department of Health and state medical boards are also issuing tempoary 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 tempoarily eligible to practice in the state. An Executive Order is also temporarily expanding scope of practice for students and nurse practicioners to allow them to provide a broader scope of care to patients in response to COVID-19.  

Colorado

Executive Action;  Executive Action

Colorado's Governor is asking for former healthcare professional 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.

Connecticut

Executive Action

Authorizes the Commissioner of Early Childhood to waive certain licensing and other requirements to maintain and increase the availability of childcare. Waives certain occupational regulations for pharmacists and face-to-face interview requirements.

Delaware Executive Action Two emergency orders issued by the state allow for broad powers to tempoarily change licensure for healthcare workers involved in the response to COVID-19 in the following ways: 1. to allow in-state healthcare providers retired for less than 5 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; Legislative 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 Legislature also passed legislation to allow qualified nurse practitioners to independently operate primary care practices without an attending doctor.

Georgia

Executive Action; Executive Action

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

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 provider 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 healthcare workers with expired licenses to tempoarily restore them to join the state's healthcare workforce in response to COVID-19. Doctors and phycician 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 less than five years.
Indiana Executive Action Governor Eric Holcomb issued new executive orders aimed at responding to Coronavirus, including one that will extend the renewal deadline for all state occupational licenses by 60 days and law enforcement will not be writing citations for expired licenses during that grace period. 

Iowa

Executive Action; Executive Action 

With the issuance of a State of 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 22nd, 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. This applies to a number of healthcare professionals including respiratory therapitsts, phycicians, phycician's assistants and nurses. 

Kentucky Legislative Action The Kentucky General Assembly passed legislation at the end of March 2020 intended 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 practicioners and opens up scope of practice for medical students allowing them to provide more healthcare 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 Louisiana Governor Edwards issued an Executive Order to give state agencies and licensing boards 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 healthcare 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 adjourining, the legislature passed omnibus coronavirus legislation, significantly expanding the powers of the Govenor during a public health crises. One of the aspects of the bill includes allowing the Governor to modify or suspend requirements for occupational licenses if those requiremetns would hinder an effective emergency response. 

Maryland

Executive Action

Allows healthcare practitioners licensed in another state to immediately practice in Maryland 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

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.

Michigan Executive Action Michgian is currenlty 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 alowing students who are enrolled in programs to become licenses, registered or certified healthcare professionals to volunteer to work to support the state's COVID-19 response. 
Minnesota Executive Action Minnesota's Governor issued an exeuctive order tempoarily 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 healthcare licenses. The State Board of Nursing is also allowing nurses to seek tempoary permits to practice without a license for the duration of the declared state of emergency.

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 their out-of-state license for at least a year and be in good standing. This legislation is still pending.

New Mexico Executive Action In response to COVID-19, New Mexico's Regulation and Licensing Department Boards & Commissions Divsion 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 healthcare 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 preform COVID-19 tests. Physcians who are licensed anywhere else in the country will now be eligible to practice in New York - the same goes for nurse practicioners, physicians assistants and nurses. Finally, individuals who are not currently registered as nurses but who meet certain requirements can engage in certain tasks that one currently needs to be licensed for.

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.

South Carolina

Executive Action

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

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.  

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 Health Department as an “emergency volunteer health practitioner.”