Health Professional Licensing Update: Practicing Medicine Across State Lines Without a License to Respond to Covid-19

CLIENT ALERT

By: Andrew Eills

March 23, 2020

The spread of Covid-19 will require many healthcare professionals to counter the potential surge of patients with the disease.  These professionals are on the front lines of the pandemic and their services will be needed throughout the country.

Regulatory developments to ensure that patients have access to physicians and other professionals to treat patients with coronavirus are evolving at a rapid pace.  Federal and state declarations pertaining to less restrictive professional licensing requirements are accelerating.

In response to the pandemic, Vice President Pence last Wednesday announced that the U.S. Department of Health and Human (HHS) will issue regulatory initiatives to allow healthcare professionals (physicians and other medical professionals) to practice across state lines without a license in order to practice in a particular state. The Vice President https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-5/ said that the regulation would be implemented “to meet the need of hospitals that may arise in adjoining areas.” It is unclear at this time whether this provision would only pertain to hospitals directly adjoining the boundaries of other states. As of the end of last week, HHS had yet to release necessary regulations to implement the Vice President’s announcement.  By all accounts, HHS shortly will issue regulatory guidance on the conditions by which health professionals may practice across state lines.

In the meantime, many states have issued a flurry of emergency declarations addressing professional licensing renewals and waivers.  These are designed to make healthcare professionals available to areas where they are, or will be, most needed, and focus on utilization of both in-state and out-of-state physicians and other medical personnel.

Massachusetts 

Emergency Temporary Licenses

Under Governor Baker’s Executive Order No. 591, Declaration of an Emergency to Respond to Covid-19, the Board of Registration in Medicine has established an Emergency Temporary License Application to enable out-of-state physicians to assist in meeting what the Commonwealth expects will be an increased demand for physician services. https://www.mass.gov/doc/physician-emergency-temporary-license-application-pdf/download Physicians possessing a current license in another state may use the simple application form to obtain clearance to practice in Massachusetts.

In order to facilitate retired physicians’ return to medical practice, under the Governor’s Executive Order the Board of Registration in Medicine also has issued an application to permit any physician who has retired within one year of March 20, 2020, to reactive his or her license through an accelerated process. https://www.mass.gov/doc/physician-emergency-reactivation-from-retirement-pdf/download We are awaiting guidance as to whether an otherwise qualified retired physician from another state could complete both emergency temporary applications. Emergency temporary licenses will be valid until the Executive Order is rescinded or the Emergency Declaration is terminated. 

Internal Moonlighting

Because of the expected surge in caseloads, physicians enrolled in post-graduate training programs in health care facilities (holders of “limited licenses”) may now provide patient care activities outside of their specialty training program. A post graduate, therefore, may render such patient care activities as long as (1) it occurs under the direction of a faculty member associated with the training program, (2) it occurs at the health care facility as stated on the limited license or at the facility’s approved affiliates, and (3) the “internal moonlighting” must be in the same specialty as the limited licensee’s specialty training program or is approved by the program director as a training area related to the specialty.

New Hampshire

Executive Order 2020-04, Declaration of Emergency due to Covid-19 (March 13, 2020)

Executive Order 2020-04 is a broad declaration of emergency in the face of the Covid-19 crisis and delineates a number of emergency measures to contain the spread of the virus. Paragraph 5 of the Executive Order permits out-of-state personnel, including medical personnel, to perform services in response to the medical emergency occasioned by the coronavirus. https://www.governor.nh.gov/news-media/orders-2020/documents/2020-04.pdf Physicians and other healthcare professionals entering the state for the purpose of rendering care related to the effects of Covid-19 are permitted to do so “in the same manner and as prescribed in RSA 21-P: 41 [which pertains to Homeland Security and Emergency Management] and any other applicable authority with respect to licensing and certification regarding mutual aid during emergencies…”  Health care facilities, therefore, may avail themselves of the professional services of locum tenens and others who are not licensed in New Hampshire to assist in patient care coverage while the Emergency Declaration is in effect.

While the Executive Order does not supersede the Interstate Medical Licensure Compact (N.H. RSA 329-C), it does “turbo-charge” the ability of licensed healthcare professionals to come to New Hampshire to help with treatment efforts.

NH DHHS request for 1135 Waiver

On March 18, 2020, the NH Department of Health and Human Services requested waivers under Section 1135 of the Social Security Act from particular requirements under Medicaid and the Children’s Health Insurance Program.  To ensure “that sufficient health care items and services are available to meet the needs of the State during the emergency declaration,” New Hampshire has requested a “blanket waiver from professional licensure requirements for out-of-state physicians and other health care providers permitting such providers to provide services to the State’s Medicaid enrollees, during the health emergency declaration, so long as they have equivalent professional licensing in another state.”

In the same request, the State has requested waivers for Medicaid providers from payments of application fees, criminal background checks, and site visits.  It is anticipated that the Centers for Medicare and Medicaid Services soon will respond to this waiver request.

https://www.dhhs.nh.gov/ombp/medicaid/documents/nh1135request031820.pdf

Maine and Vermont

While the Governors of Maine https://www.maine.gov/governor/mills/sites/maine.gov.governor.mills/files/inline-files/Proclamation%20of%20State%20of%20Civil%20Emergency%20To%20Further%20Protect%20Public%20Health.pdf and Vermont https://governor.vermont.gov/sites/scott/files/documents/EO%2001-20%20Declaration%20of%20State%20of%20Emergency%20in%20Response%20to%20COVID-19%20and%20National%20Guard%20Call-Out.pdf recently have issued declarations of emergency, as of March 22 further guidance has not been issued which directly addresses regulations pertaining to healthcare professional licensing.

Conclusion

Given the rapidity of the issuance of governmental directives and guidance, we expect new and supplementary regulatory guidance from federal and state agencies in the near term to further flesh out the initial changes described above.