The Novel Coronavirus (COVID-19) pandemic has changed the way in which the world lives and the way in which people interact with each other. Almost every day, new directions are given, and new orders are issued by either the federal or state governments. The virus has infected people in all 50 states and the number of those who have contracted the virus increases every day. Some have died and the number of fatalities also increases daily.
The federal government has issued orders to the public. For example, among other recommendations, it has banned people from getting together in large groups. Many governors or mayors have issued “shelter in place” orders which require people to stay home except for emergencies and trips to the grocery store.
The pandemic has placed an undue burden on the healthcare system that finds providers reeling due to a lack of personnel and equipment. Physicians and patients are encouraged to use telemedicine as much as possible, but stringent rules requiring physicians to be licensed in the state of the patients they are treating has hamstrung some providers.
Getting licensed in a state may cost a physician thousands of dollars and take months before the vetting is complete. The president and his task force have recognized that there is now no time to wait. Physicians are needed and changes to the licensing rules are needed now.
March 13, 2020: The President Declares a State of Emergency
On March 13, 2020, the president declared a state of emergency. He also announced the funneling of more than $42 billion to expand resources in the country including the provision of funds to telehealth.
Under the state of emergency declaration, the Centers for Medicare and Medicaid Services (CMS) was authorized to provide blanket waivers to federal licensing requirements so that out-of-state physicians could treat Medicare and Medicaid patients via telehealth services. The requirement that providers licensed in one state must also be licensed in a state where they are providing services was lifted.
Those who could apply for temporary waivers for treating Medicare and Medicaid patients under the March 13 Declaration of Emergency included providers who are located and licensed in one state but need a waiver of the “requirements that physicians and other healthcare professionals be licensed in the state in which they are providing services, so long as they have an equivalent licensing in another state…” The state where they are providing services means the state where the patient they are treating lives.
States have the authority to waive those restrictions. Eight states waived licensing requirements for certain health care providers so they could assist with providing telehealth services during this pandemic. Those states are Arizona, California, Florida, Louisiana, Mississippi, North Carolina, Tennessee, and Washington.
March 18, 2020: The President Holds a Press Conference
On March 18, 2020, in an attempt to cope with COVID-19 and provide some relief to overworked healthcare providers, vice-president Mike Pence announced at a press conference that, at the President’s discretion, the Health and Human Services Department (HHS) “is issuing a regulation today that will allow all doctors and medical professionals to practice across state lines to meet the needs of hospitals that may arise in adjoining areas.” The ruling does not eliminate interstate licensing completely, but gives providers the ability to treat patients in states other than where the provider is licensed.
As of March 19, 2020, the regulation itself had not been released and, to date, healthcare providers are waiting for HHS to provide more details about how this new regulation will work.
Waivers Still Require Verification of State Licensure and Disciplinary History
The snag could come with verifying that a doctor is licensed in one state and has no disciplinary history. The Federation of State Medical Boards (FSMB) has offered its assistance to state medical boards and health departments in order to simplify and speed up the verifying of licenses and credentials of providers “who wish to practice across state lines to assist those impacted by COVID-19.”
The FSMB’s Physician Data Center (PDC) provides a way for instant verification of licensure and disciplinary history for physician licenses and licenses for physician assistants. The FSMB hopes that state boards and health departments will utilize its PDC as a key resource.
Collaborative Imaging and Teleradiology Across State Lines
At Collaborative Imaging (CI), we stand strong with our 500 radiologists and healthcare partners in the fight against COVID-19. We work around the clock seven days a week in order to deliver subspecialty radiology interpretations to your facility when you need them. If you let us know how we can help, we can deploy and be live with coverage in less than 24 hours!
Collaborative Imaging has developed and deployed a proprietary, cloud-based Radiology reading workstation into large hospital-based radiology practices. This represents an important safety solution in this COVID-19 Pandemic. The CI solution integrates all PACS systems that a practice may be reading into a unified work list on industry standard viewers and dictation systems.
Vice-President Pence’s announcement to allow healthcare providers to practice across state lines was heartily welcomed by the American Telemedicine Association (ATA) which has been lobbying the government to relax its restrictions on the interstate practice of telemedicine “so that care providers would have the freedom to treat patients wherever they live.”
A few days before the announcement, the CEO of ATA expressed the need for the government to relax this regulation stating that the “Requirements that a provider be licensed in the state where a patient is located present significant challenges to rapidly expanding access to care as we work to combat COVID-19.…Providers should be able to use every tool at their disposal to keep health care providers safe and ensure that resources are reserved for those individuals in need of in-person care.”
It is expected that the HHS will soon issue its regulation. As more states declare public health emergencies due to COVID-19, more waivers are expected even if the federal regulation is delayed. Providing telehealth services across state lines should have a significant impact as the COVID-19 pandemic continues.
There may still be confusion and questions by providers who are unsure of what the new federal regulation, state laws, and waivers mean and question how they should go about providing their services. At CI, we have a robust “Help Desk” and embedded messaging capability that facilitates the communication between the radiologist and the referring physician as well as hospital imaging department personnel and patients. CI provides nationwide 24/7 sub-specialty reads and can deploy the solution quickly and effectively in a tight time frame to facilitate the solution needed today between hospital and reading radiologist.
We provide all this while maintaining safe distancing with no compromise to turnaround time. We provide quality with all the existing specific protocols in place. Meanwhile, we look forward to the details of the new federal regulation and for working with those states that have already waived their requirements and those states that will be follow suit.
It remains to be seen if the new regulations will remain in effect after the pandemic is over. Will the emergency measures taken during this critical time remain in effect or will life go back to how it was before?