Feature

States allow doctors to practice across state lines during COVID-19 crisis


 

Legal orders and waivers of licensing requirements could change the way many doctors see patients during the COVID-19 crisis.

A number of states have already taken steps to waive their requirement that a physician be licensed in the state in order to provide care to patients. California and Florida are among the states that have done so – through their respective declarations of statewide emergency. More states are sure to follow.

Another route around traditional medical licensing requirements is the Uniform Emergency Volunteer Health Practitioner Act (UEVHPA), which – in the 20 or so states that have adopted it – can take effect once a statewide emergency is declared. This law lets volunteer health practitioners who are licensed in another state practice in the state where the emergency was declared, without first needing to obtain a license there. The practitioner need only be in good standing with any state in which he or she is currently licensed and be registered as a volunteer in the system. The Washington State Department of Health was one of the first such departments to invoke the UEVHPA in response to the coronavirus.

“The waiving of state licensure requirements should help ease a number of stress points of the current crisis in ways that benefit society,” said Gregory A. Hood, MD, an internist in Lexington, Ky., who is on the advisory board of Medscape Business of Medicine.

“As many have chosen to shelter in place, hoping to ride out the end of winter and, optimistically, the COVID-19 pandemic, there are physicians with second homes in South Carolina, Florida, and elsewhere who could be envisioned being brought into service to ease staffing shortfalls should the crisis exceed available resources.

“However, likely the most novel, necessary, and widespread impact of the waiving of licensure requirements will be aiding physicians in practicing telehealth video visits, as now authorized by Medicare and (hopefully) commercial insurers,” said Dr. Hood.

“Historically, there has been concern regarding the fact that most state medical boards require the physician to be licensed in the state where the patient resides or is located,” he said. “[Recently] I was able to conduct a video visit with a patient in Florida, at her initiation, over the potential of a broken bone. The case should be expected to have fallen under an emergency, but this waiver provides reassuring clarity.

“With the assistance of her boyfriend performing elements of the physical examination under my direction, we were able to establish a probable diagnosis, as well as a treatment plan – all while avoiding her exposing herself by leaving voluntary self-isolation or consuming resources in the emergency room,” Dr. Hood said.

Elsewhere, in response to the COVID-19 pandemic, the Federation of State Medical Boards has announced that it will act to verify licenses and credentials for doctors wishing to practice across state lines.

The “emergency exception” to in-state licensing requirements

Most state medical boards recognize some version of an exception to the in-state licensing requirement if a doctor or other healthcare professional is providing emergency care to a patient. But these exceptions rarely define what qualifies as an emergency. So, whether treatment of a COVID-19 patient or treatment of a non-COVID-19 patient who requires care in a triage setting constitutes an emergency – so that the exception to the licensing requirement applies—has been something of an open question.

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