STATE OF TELEHEALTH — The telehealth industry, which has grown tremendously amid the pandemic, faces some uncertainty as more states end waivers allowing care across state lines.

As many states’ emergency regulations permitting such care wind down and the patchwork system of state rules becomes patchier, millions of patients are losing expanded access to telehealth.

“We have thousands of patient stories about how much they valued the opportunity to utilize telehealth to see their health care providers and are no longer having to get in the car and drive across three different states,” said Heidi Ross, vice president of policy and regulatory affairs at the National Organization for Rare Disorders. “You end up with patients who last month could see their provider across state lines and now no longer can. … For a lot of them, Covid isn’t over, and they are still very much risk-averse to getting on a plane.”

Patient advocates, public health officials and telehealth and provider groups are pushing for a fix, but they’re not on the same page despite sharing similar goals.

More than 30 states and Washington, D.C., have signed on to the Interstate Medical Licensure Compact, favored by the powerful American Medical Association and the Federation of State Medical Boards. The compact serves as a common application so providers can seamlessly apply for licensure in multiple states.

But it doesn’t go as far as some in the telehealth industry would like. Unlike the industry proposals, the compact doesn’t allow for reciprocity, meaning if a doctor is licensed in one state, other states could recognize the license.

“[The compact] streamlines the application process, but it doesn’t do a lot to reduce the burdens and costs of maintaining a multistate licensure footprint. That is a source of a lot of frustration for physicians in telemedicine,” said Nate Lacktman, partner and chair of law firm Foley & Lardner’s telehealth and digital health team.

“This pandemic has really brought to a head that a system that was reasonable at the time no longer really fits the modern era,” said Ateev Mehrotra, a prominent Harvard telemedicine researcher.

In the telehealth industry, the lobbying group Alliance for Connected Care has proposed a voluntary national system, similar to the driver’s license system, that would enable states to recognize each other’s licenses. The American Telemedicine Association also encourages so-called reciprocity with a federal role — meaning a license in one state is good in another — but because of federalism, says state legislatures have to adopt licensure compacts or other forms of recognition across state boards.

The federal government still has a role in that proposal: It could tie federal funding, possibly Medicaid, to states that agree to accept each others’ licenses, said Kyle Zebley, the executive director of ATA’s lobbying arm.

“A carrot-and-stick approach — perhaps heavily on the carrot — would be an acceptable way for the federal government to encourage something that’s national,” Zebley said.

Don't miss out

Subscribe now for access to exclusive content.