Eliminate out-of-state licensure requirements
Recommendation
To address the continued need for provider flexibility and remove federal barriers to meeting workforce demands, Congress should permanently eliminate the out-of-state licensure requirements under Medicare and Medicaid. Congress should also direct the Department of Health and Human Services (HHS) to convene a working group representing state health profession licensure boards to identify barriers to participation in state licensure compacts and develop a framework or model application for reciprocity to facilitate provider approval to practice across state lines.[1]
Background/summary
In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) temporarily waived requirements that out-of-state Medicare practitioners be licensed in the state where they are providing services.[2] CMS also released guidance stating that state Medicaid agencies could use Section 1135 waiver authority to permit providers located out of state to provide care to another state’s Medicaid enrollee impacted by the COVID-19 emergency.[2] These changes were particularly helpful in enabling mental health and substance use disorder (MH/SUD) providers to meet increasing demand for services around the country throughout the pandemic. While the public health emergency has officially ended, the need for increased flexibility to maintain the capacity of providers has not. Congress should amend the Social Security Act to allow licensed providers participating in Medicare, Medicaid, and CHIP to provide services across state lines.
In May 2023, the Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth released new resources on interstate licensure.[3] These resources include the latest guidance on how to practice telehealth across state lines legally while encouraging the uptake of licensure models that increase access to health care. As part of this ongoing work, HHS and HRSA should convene stakeholders to identify remaining barriers to participating in interstate compacts and develop a framework for overcoming those obstacles.
citations
1. Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. Last Updated March 2021.
2. Centers for Medicare and Medicaid Services (CMS). COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Last Updated October 13, 2022.
3. Health Resources and Services Administration (HRSA). Interstate Licensure Resources on Telehealth.HHS.gov. Last Updated May 23, 2023.