How One Word Could Preserve Access to Telehealth in Montana
Montanans are free to drive to another state to receive care from a medical provider of their choice. Why are they not free to do the same virtually?
Since the COVID-19 pandemic began, Montana has taken dramatic steps to reduce regulations to respond to the public health crisis. Without action from policymakers after emergency orders expire, Montanans could lose access to their healthcare as red tape and paperwork creep back into the picture.
Provider Licensing and Telehealth
A substantial amount of healthcare regulations center around the licensing of healthcare professions. While often implemented with safety in mind, licensure requirements can differ significantly state-to-state. This requires providers who practice in multiple states via telehealth to gain unique licensure in each state, a process that can be both complex and expensive.
As a result, telehealth advocacy groups say that state licensing regulations are “one of the most significant barriers to the ubiquitous use of telehealth.”
In a January 2021 letter to state and federal lawmakers, a broad coalition of healthcare organizations underscored the need to permanently address licensure barriers in telehealth: “one important way policymakers and health care regulators can permanently facilitate access to care is by allowing providers and patients to connect with each other regardless of their physical location.”
Policymakers have slowly begun to implement reforms. For example, the Veterans Administration and TriCare (the military health plan) consider a medical license in one state sufficient to provide services to their patients in all 50 states. More recently, CMS and numerous other states streamlined licensure for out-of-state providers in response to COVID-19. This Spring, Arizona notably made broad universal licensure recognition for telehealth permanent.
Cross-State Telehealth in Montana
Traditionally, out-of-state physicians who care for Montana patients via telemedicine must first be professionally licensed through the Board of Medical Examiners. This is due to regulations in ARM 24.156.813, which recognize the “practice of medicine” as occurring where the patient is physically located, rather than the state the doctor is:
“(1) Treatment of a patient who is physically located in Montana by a licensee using telemedicine occurs where the patient is physically located.”
Montana Telehealth Licensure During COVID
Recognizing licensure as a barrier to healthcare access, Montana made the “the rapid licensure, renewal of licensure, or reactivation of licensure” a top priority during COVID. Emergency regulatory flexibilities allowed a streamlined process for medical professionals to remotely practice across state lines as long as they had a license in good standing in another state. According to documents obtained by the Frontier Institute from the Department of Labor and Industry, approximately 2,500 medical professionals received a temporary license to treat Montana patients under this system, with many practicing virtually.
However, the expiration of COVID emergency orders means that those 2,500 licenses are now terminated, requiring out-of-state providers to go through a professional licensing process to continue practicing in Montana despite being qualified in their home state to practice medicine.
The Montana Board of Medical Examiners should adjust administrative rules to allow patients to receive care from physicians licensed in other states via telehealth without requiring Montana licensure.
Montana’s licensure regulations put a complicated paperwork process in between patients and doctors connecting virtually. Montanans are free to drive to another state to receive care from a medical provider of their choice. Why are they not free to do the same virtually?
Montana policymakers have an opportunity for a simple administrative remedy to cross-state telehealth licensing issues. By simply replacing two words with one in ARM 24.156.813, the Gianforte administration could facilitate seamless telehealth across state lines for physicians:
“(1) Treatment of a patient who is physically located in Montana by a licensee provider using telemedicine occurs where the patient provider is physically located.”
This reform would resolve licensure concerns by treating telehealth from out-of-state physicians the same as patients physically traveling across state lines. Treatment would be considered to occur where the licensed doctor is, rather than where the patient is. Doctors would still be required to be meet licensing standards in the state they practice in, ensuring patient safety and practitioner competency.
Importantly, these reforms could be practically implemented with an administrative rule change long before the 2023 legislative session, improving the resiliency of Montana’s healthcare system in the near-term and making the state better prepared for future public health emergencies.
Similar reforms could be made by other professional licensing boards with nearly identical regulations, such as the Board of Psychologists and The Board of Speech-Language Pathologists and Audiologists.
To date, no other state has permanently allowed patients to receive care from providers licensed in other states via telehealth without requiring some sort of licensure process. This simple change would continue to make Montana a national leader in healthcare reform and improve access to telehealth for years to come.