[TAO] TAO Digest, Vol 20, Issue 1

[Pam]

Re:  National Licensure bill proposed
Telemedicine/Telehealth is also practiced by non-MDs: DOs, NPs, PAs,  
psychologists and others, and, although not reimbursable for  
telemedicine through Medicare, by OT, PT and SLPs in some settings,  
such as VA.  In Oregon, the 2009 telemedicine insurance mandate bill  
included all licensed health professions.  Please aim to address this  
for all licensed health professionals within their scopes of practice,  
if possible.
Pam Hood-Szivek



On Feb 8, 2012, at 12:01 PM, tao-request at listsmart.osl.state.or.us  
wrote:

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> Today's Topics:
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>   1. National Licensure bill proposed (Catherine Britain)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Wed, 8 Feb 2012 10:51:58 -0800
> From: Catherine Britain <csbritain at gmail.com>
> To: tao at listsmart.osl.state.or.us
> Subject: [TAO] National Licensure bill proposed
> Message-ID:
> 	<CADnKv6YtAytHQJ4w2Xg-YsYgqR2c5n78kjKa2ZnvfNfBFo8C+A at mail.gmail.com>
> Content-Type: text/plain; charset="iso-8859-1"
>
> 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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