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What Eliminating Barriers to Interstate Telehealth Taught Us During the Pandemic

Early in the COVID-19 pandemic, nearly all states and the federal government approved unprecedented flexibilities in licensing rules to allow more interstate mobility for health care professionals. The lifting of restrictions on out-ofstate practitioners significantly aided the response to the crisis by expanding telehealth, bolstering care in underserved areas, increasing access to mental health services, and importantly, providing some relief for overstressed hospitals and health systems losing health care workers. Now, as temporary waivers in most states are expiring, there are opportunities to improve interstate licensure requirements so that lessons learned during the pandemic can bring long-term benefits to the health care system.

The Centers for Medicare and Medicaid Services (CMS), as well as almost every state in the country, temporarily waived the requirement that physicians be licensed in the state where their patients are located.1,2 In a matter of months, a famously territorial and complicated area of health policy unwound, creating new opportunities for patients to access care. Patients could suddenly receive care from providers practicing anywhere in the country. This was especially important for patients living in remote or medically underserved areas, as well as those with rare medical conditions. The loosened requirements also greatly expanded access to behavioral health professionals during a time of growing anxiety, depression, and substance abuse.

The temporary suspension of occupational licensing laws during state emergencies, such as natural disasters, is not new. States typically lift licensing laws for relief workers, including health care workers, to practice on a volunteer basis during disaster recovery. But the COVID-19 pandemic has impacted all states simultaneously and continues to linger almost two years later. Unfortunately, the aftershocks on the American health care workforce will be evident long after the pandemic ends.

Over the past year, states’ temporary COVID-19 flexibilities for out-of-state licensure began expiring, despite the federal public health emergency due to COVID-19 remaining in effect.3,4 By the end of 2021, only about a dozen state emergency waivers for licensure requirements are expected to continue.5 A handful of states, such as Arizona, West Virginia, and Florida, passed permanent legislation allowing physicians not licensed in the state to register and provide telehealth services to in-state patients.6

Policymakers are now faced with important decisions that will affect provider licensure and patient access to care across state lines — beyond the current pandemic.

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