Licensure & Cross-state Practice


Remove licensing board barriers to telemedicine


Telemedicine is a way of delivering health services and should be regulated comparably with services provided in-person. An increasing problem is states adopting clinical practice rules with higher specifications for telehealth than in-person care, such as prerequisites for an in-person assessment, established relationship, or physical examination. Extra, often higher, standards for telemedicine are bad for patients’ access and choice. A result of the U.S. Supreme Court’s recent decision on N.C. State Bd. of Dental Examiner v. FTC is that state licensing boards, as traditionally constituted, are now exposed to the risk of federal lawsuit for anti-competitive rules and other actions.

Although providers of telemedicine services are reimbursed based on their location, state licensing laws and regulations generally require they also be licensed and follow the practice rules of the patient’s location. This impedes smooth and efficient interstate use of telemedicine and the mobile patterns of 21st century patients, providers, and health delivery systems. Such state-by-state approaches inhibit people from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line. These barriers also cost health professionals and taxpayers hundreds of millions of dollars each year.

ATA encourages state lawmakers to accommodate interstate care. A range of options have been proposed for licensure reform, including multi-state compacts based on mutual recognition. We support state action to join the pending compacts for nurses, physical therapists, physicians, and psychologists. Further, for many federal health professionals, one state license is now sufficient to serve patients in any state. The “one state license” model should be used for all federal health care, notably agencies (such as the Department of Veterans Affairs and of Health and Human Services), health benefit programs (such as Medicare and TRICARE), federally-funded health sites (such as community health centers and rural clinics), and during federally-declared emergencies or disasters.

Regarding internet prescribing, state regulations should not interfere with the ability of a duly licensed and authorized healthcare provider from using telemedicine to prescribe or dispense, for a patient with a pre-existing relationship, regardless of the patient’s location, with the exception of federally controlled substances. Further, states should pursue policies that enforce prescription drug monitoring to mitigate the abuse, misuse, and diversion of controlled substances.