Medicare Compliance & Reimbursement

Hint: Not every state is on board.

If you practice medicine in a state that’s part of the Interstate Medical Licensure Compact (IMLC), you may find it easier to offer telehealth services to patients living in another state. But, be warned — it’s not as simple as it sounds, and the individual states still make the final call on licensure, not the Compact.

Details: Due to the rise of telemedicine, state medical boards began looking into a nationwide “compact” to allow physicians a quicker pathway to multi-state medical licensure in 2013, IMLC guidance suggests. Deliberation ensued and an amalgam of parties weighed in, including the Federation of State Medical Boards. After a model compact was drafted in 2014, “state legislatures soon began adopting it, and in April 2017, the Compact became operational,” the IMLC says.

The Compact streamlines the licensure process; plus, there is a similar program for nurses, indicated attorney Kyle Y. Faget with Foley and Lardner LLP in the “Regulatory and Compliance Issues in Telehealth” session at the Collaborative Compliance Conference, presented by AAPC and the American Health Law Association (AHLA).

Some states have been slower than others to agree to multi-state licensure — which is voluntary — but bills to adopt the Compact have been introduced in state legislatures across the country. Right now, 29 states are part of the IMLC, as well as Washington D.C. and Guam; Louisiana will be the 32nd member, but its implementation in the program was delayed, an IMLC map notes.

Here’s the Problem

The Compact has been around for a while, but physicians haven’t jumped on the multi-state option until recently. For starters, the criteria for eligibility is complicated and revolves around where a physician practices, where their employer is located, how long they spend practicing medicine in their state of principal licensure (SPL), and where they’re taxed for work.

Plus, the application carries a plethora of other requirements in regard to physicians’ medical schooling and certifications as well as any past disciplinary actions or investigations. The cost is steep, too, at $700 for the initial application and additional state medical board fees.

COVID boost: But now, the Compact has experienced a renaissance of sorts during the pandemic. COVID-19 has significantly increased physician interest in the Compact, which registered 47 percent growth between March 2020 and March 2021, according to American Medical Association (AMA) guidance. The Medicare telehealth expansion is considered a major factor in the number of applicants.

Legislation: Last October, House Rep. Ted Yoho (R-Fla) introduced legislation to support “interstate telemedicine” in the future since the Centers for Medicare & Medicaid Services (CMS) telehealth waivers put in place for the public health emergency (PHE) won’t last.

The proposed legislation would require state medical boards to join the Compact within a three-year period and would tie Health Resources and Services Administration (HRSA) funding to Compact membership. “Additionally, to receive certain grants to address barriers to telemedicine, physician licensing boards must carry out campaigns to encourage interstate telemedicine use by specialists,” the bill summary says.

“This licensure waiver paradigm is very popular with providers,” Faget says. But the real issue on the waivers and the IMLC may rest with the state medical boards, which want to have control over the physicians in their states,” she cautions.

Resources: Review the Compact application at http://www.imlcc.org/apply and read the particulars on the proposed legislation at http://www.congress.gov/bill/116th-congress/house-bill/8723?s=1&r=67.