[TAO] National Licensure bill proposed

[Catherine Britain]

Good morning,

I am passing on this article sent to me by Mike Stinebiser of AMD Global
Telemedicine, one of TAO's newest sponsors.  For many years a national
telemedicine license has been vehemently opposed by many state medical
boards with the concern for patient safety being the primary reason cited.
The Federation of State Medical Boards has taken steps this past year
toward an easier process by creating a standard application for licensure
and urging states to adopt it.  They have also created a Credentialing
Verification Service for those wishing to practice across state lines that
will hopefully enable those seeking to credential out-of -state physicians
to do so more easily.

There is, however, a growing synergy among telemedicine providers to create
a national form of licensure for physicians who wish to practice
telemedically across state lines.  The proposed bill is a step in that
direction.  It's passage during this session is doubtful, but it will begin
the conversation and we will see it return and likely pass in some form in
a future session (my opinion, only).

We at TAO will keep you posted about its progress.

Best,
Cathy

U.S. bill aims to clear telehealth state licensing bottlenecks
By Erik L. Ridley, AuntMinnie staff writer

February 7, 2012 -- All physicians must be licensed in any state in which
they practice, a requirement that can be time-consuming and costly for
those wanting to practice telemedicine and teleradiology. But a bill
expected to be introduced in Congress this year aims to make it easier to
use medical licenses across state lines.In addition to creating a
comprehensive and interoperable database of verified physician credentials,
the legislation being developed by U.S. Sen. Tom Udall (D-NM) calls for the
creation of a tandem state/national license that would allow physicians to
provide telehealth services in states accepting the tandem license,
according to Fern Goodhart, Udall's legislative assistant."We're exploring
how to build in streamlined or automatic license portability across state
lines," she said.Goodhart discussed the planned bill during a briefing on
state medical licensure reform on January 31 in Washington, DC, sponsored
by the American Telemedicine Association (ATA).A vital toolWhile state
medical licensure is a vital tool for patient protection, fees for medical
license applications vary across states, from a low $110 to more than
$1,300, Goodhart said. "And the time to obtain these licenses varies from
three to 12 months, although the actual state requirements for these
licenses varies little, if at all," she said.Unless physicians work within
the Department of Veterans Affairs (VA) or the Indian Health Service (IHS),
there is no current state reciprocity for licenses; each state requires its
own license to practice medicine within its borders, Goodhart said.Udall
began working on the bill to address concerns over whether the duplication
of health licensing and credentialing delayed patient care, slowed the
hiring of healthcare workers, and increased costs and administrative
burdens.The legislation has several parts. First, the bill would expand
license portability within all federal agencies that provide healthcare and
for licensed first responders in case of an emergency."For example, a
physician could transfer from the VA to the IHS without getting
recredentialed," she said. "[Also,] a physician could respond to an
emergency without having first registered with the surgeon general or
responding nongovernmental organization since they already would be in this
database."The bill would also streamline credentialing by developing a
unified set of standardized data via a comprehensive, interoperable data
system of primary, source-verified credentials, Goodhart said. Claims
history, hospital privileges, and criminal background information would be
included with a unified application."All of the information is collected
once, and it's stored in an interoperable database," she said, "It wouldn't
have to be one database, as long as the databases could talk to each
other."For example, physician credentials could be more easily reviewed by
employers, health plans, and hospitals without resupplying the same
information, she said. License renewals would also be on the same date and
cycle, instead of having state licenses that renew at different
times."Think of it as a national practitioner database or unified provider
database or federation credentials verification source on steroids, with
improvements," she said.State, national optionsFive state options could
provide license portability, Goodhart said. Consulting exceptions would
allow a physician who is unlicensed in one state to practice medicine in
that state if consulting on a case for a licensed physician.A reciprocity
approach would involve states entering into agreements to recognize certain
medical privileges on the condition that the other states' physicians enjoy
the same privileges in the state, she said. A mutual recognition policy
would allow a licensing authority to voluntarily accept the home state
licensure of the applicant.With registration, physicians could register to
practice in that state and agree to operate under the legal authority and
jurisdiction of that state, she said. In addition, an expedited endorsement
could occur, enabling states to accept the license of an out-of-state
physician provided certain conditions are met.The bill's authors have also
identified two potential nationwide options to provide license portability.
A national licensure approach would issue licenses based on a universal,
national standard, while a federal licensure model would issue licenses by
the federal government, Goodhart said.Tandem licenseLegislative language in
the current draft bill calls for a voluntary tandem license: one state
license with a national license. This would enable a licensed healthcare
professional to provide telehealth services with a tandem license in any
state recognizing that license, Goodhart said.Incentives would be provided
for states to accept tandem licenses, she said. States would maintain
authority for investigation and discipline; all physicians practicing in
their states would be registered, allowing access to real-time information
regarding any problems with physicians."So we see this would allow less
delay, less redundancy, less cost, more patient care, and greater data
sharing," she said.The bill also calls for a national task force for
communication, coordination, and collaboration, as well as to cover
e-health needs, standards, federal goals, and efforts, Goodhart said.The
American College of Radiology (ACR) declined to comment on the planned
legislation until it's formally introduced in Congress.The wrong
target?While there is obvious appeal to knocking down barriers to
telemedicine and teleradiology, the challenge will be to ensure that
adequate safeguards remain in place to maintain the accountability that now
resides with the states for licensing physicians, said Tom Greeson, a
partner at law firm Reed Smith who specializes in radiology-related
regulatory matters.Furthermore, state licensure is not the biggest obstacle
to the multistate practice of teleradiology, Greeson said. A bigger
roadblock, for example, is the U.S. Centers for Medicare and Medicaid
Services' carrier jurisdiction rule, which requires groups that bill for
physician services to enroll and submit claims to the Medicare
administrative contractor for the state in which the interpreting physician
is located, Greeson told AuntMinnie.com."For example, the hypothetical
group in State A that has a contract with a teleradiology group with
radiologists providing services via teleradiology in States B, C, D, and E
must enroll and submit claims to each of those Medicare carriers depending
on where the interpreting physician happened to be sitting when the service
was performed," Greeson said. "This is the barrier the Congress should be
knocking down."
Copyright © 2012 AuntMinnie.com
-- 
Catherine S. Britain, Project Director
Telehealth Alliance of Oregon
csbritain at gmail.com
541-910-7366
www.ortelehealth.org
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