Medicare and Medicaid Allows Doctors to Practice Across State Lines

One of the biggest health IT related news items to come out was the announcement by Vice President Mike Pence that HHS was issuing a regulation to permit doctors to practice across state lines.  State Medical Licensure is something that has baffled many of us that have worked in healthcare.  I’m sure there’s some historical context that I don’t fully appreciate, but most everyone I know wishes this regulation was gone.  Not the least of which is doctors who have to pay substantial fees to get licensed in a new state.  I’ve even known doctors who were getting licensed in all 50 states to do telemedicine.  You can imagine the waste.

As is often the case, many new outlets just simply reported that doctors can practice across state lines, but the devil is always in the details.  The full text of the Waiver is found here.  Here’s the excerpt that applies:

Requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that State or any State a part of which is included in the emergency area).

A little easier to read is what’s included in the CMS Fact Sheet for the COVID-19 Emergency Declaration which says:

Provider Locations
Temporarily waive requirements that out-of-state providers be licensed in the state where
they are providing services when they are licensed in another state. This applies to
Medicare and Medicaid.

Provider Enrollment
o Establish a toll-free hotline for non-certified Part B suppliers, physicians and nonphysician practitioners to enroll and receive temporary Medicare billing privileges
o Waive the following screening requirements:
• Application Fee – 42 C.F.R 424.514
• Criminal background checks associated with FCBC – 42 C.F.R 424.518
• Site visits – 42 C.F.R 424.517
o Postpone all revalidation actions
o Allow licensed providers to render services outside of their state of enrollment
o Expedite any pending or new applications from providers

It’s great that they’re offering temporary Medicare billing privileges given that some have opted out of Medicare to avoid Meaningful Use and then MACRA/MIPS penalties.  However, the most important line is that the waiver only applies to Medicare and Medicaid.

The FSMB has issued a press release which offers their Physician Data Center (PDC) tool to allow organizations to look up medical licenses for 1 million licensed physicians and physician assistants.

Similar to what we wrote about the HIPAA Waiver for Telehealth, the Federal government and Medicare doing something is one thing.  However, healthcare organizations are still required to abide by state laws.  It behooves every healthcare organization to know what your state has done regarding medical licensure before you proceed.

Lucia Savage said on Twitter that 10+ states have waived Medical Licensure.  Here are the notices we have found so far from states in this regard:

ArizonaCaliforniaFloridaLouisianaMississippiNorth CarolinaTennessee, and Washington.

Of course, be sure to check with your lawyer to evaluate each state.  For example, some states have only applied this waiver to doctors providing free service through organizations like the Red Cross.  If you know of other states who have made it so doctors and other clinicians can practice across state lines, please let us know and we’ll update this list.

Allowing doctors to practice medicine across state lines is the right thing to do at this time as various areas are overwhelmed and may need clinicians from another area to help them manage a surge in patients.  Not to mention telehealth being used across state lines.  Hopefully. every state will follow through with this as well.  I also hope this highlights why state medical licensure should be replaced with nationwide medical licensure and that this change is something that persists and becomes permanent law after COVID-19.


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