Nearly every state has deliberated one or more bills dealing with virtual care since the pandemic, Alaska included. Unfortunately, few states have seriously considered allowing out-of-state providers to permanently provide telehealth services to state residents. West Virginia and Arizona have implemented the right policies, several other states are inching towards freedom for patients, and some states are headed in the wrong direction. To expand access and affordability of health care, especially in rural areas, Alaska ought to grant recognition to out-of-state medical providers with licenses in good standing to provide telehealth to Alaska patients. If the pandemic has taught us anything, it is that unnecessary restrictions on telehealth care do nothing but drive costs up, reduce access, and harm patients.
Arizona signed into law HB 2454 on May 5, 2021, which makes permanent the changes Governor Ducey issued in his executive order last March. Arizona’s law covers several important reforms, such as requiring insurance companies to compensate providers equally for telehealth visits. What makes Arizona’s law game-changing for telehealth, though, is that out-of-state health care professionals – not just physicians – in good standing may provide telemedicine in Arizona after registering with the appropriate board. The license must only be “substantially similar to a license issued in this state,” to register in Arizona to provide telehealth, and the provider must not provide in-person care services to Arizonans. Uniquely, providers do not have to register if in consultation with an Arizona provider, or if they provide “fewer than 10 telehealth encounters in a calendar year.”
West Virginia passed HB 2024 on May 20, 2021, which allows providers with licenses in good standing from other states to practice telehealth. Out-of-state providers must register with the appropriate state board and pay a registration fee “not to exceed the cost of a license,” which is an important caveat to include in telehealth bills – if it costs less to become a fully-licensed provider, then why be restricted to providing only telehealth?
Some states have passed bills that only qualify as a partial victory for patient and provider freedoms. Washington has passed SSB 5423, which allows a licensed out-of-state practitioner to consult through telemedicine with a practitioner licensed in Washington. Another related bill expands the definition of telemedicine to include audio-only telemedicine, an important step toward ensuring access for rural areas. Unfortunately, neither bill addresses cross-state licensing requirements, and Washington patients will have to have a Washington health care provider to benefit from out-of-state consultations.
Kentucky has also made strides through HB 140, which authorizes providers in a “recognized interstate compact” with Kentucky to provide telemedicine. Regrettably, medical interstate compacts take the wrong approach to solving health care cost and accessibility issues. Rather than eliminating barriers entirely, providers in states that are members of an interstate compact can apply for expedited licensing and reduced fees in other member states. The Interstate Medical Licensure Compact, by far the most popular compact, is limited to physicians and has 30 member states – Alaska not being one of them. Kentucky, and the other member states, ought to think seriously about recognizing all out-of-state licenses for all providers, rather than excluding some states and most medical professions.
Connecticut is kicking the can down the road by simply renewing emergency authorization for physicians until 2023. In effect, the bill extends the provisions in the emergency order until June of 2023, purportedly to formulate a long-term policy over the next two years. Although this means that out-of-state physicians can continue to provide telehealth to Connecticut residents through 2023 without restrictive licensing requirements, the question remains whether the changes will be made permanent at the end of 2023 – or if Connecticut will return to the pre-pandemic status quo.
A litany of telehealth bills has been passed without reference to cross-state licensing recognition, as was done in Texas and Montana, though they make other beneficial changes that expand telehealth access for patients and providers in their respective states. Texas HB 4 ensures that Medicaid patients can be treated through telehealth and adds substance abuse treatments to the list of approved providers for telehealth. Montana’s HB 43 removes the “established patient-provider relationship” qualification as well as geographic proximity and location restrictions. It also permits audio-only calls.
The enacted telehealth bill in Kansas indicates a compromise that destroyed the cross-state licensing element, though preserving other necessary changes to telehealth. Out-of-state physicians in good standing can practice telemedicine in Kansas if granted a temporary emergency license. The original wording was: “holds an unrestricted license to practice medicine and surgery in the other state.” Depending on state government boards to grant emergency licenses is a far cry from allowing any doctor with a valid license in another state to practice telehealth in Kansas.
Arizona stands to be a shining example of telehealth expanding access and lowering costs, and Alaska would do well to implement similar changes. With Alaska’s lack of a medical school creating a provider shortage, the ongoing need to respond to COVID, and the mounting evidence that telehealth expands access and lowers costs, telehealth is more important than ever to Alaskans. It is critical to allow out-of-state providers to supply telehealth to Alaska patients. Although half-measures and compromises have delayed telehealth cross-state licensing recognition in most states, the strides made in 2021 will define the telehealth debate for years to come.