Hello my name is Mei WA Kwong, and I'm the executive director at the Center for Connected Health Policy, which is the federally designated national telehealth Policy Resource Center. Do you see Davis School of Medicine has asked me to speak to you today about licensure and credentialing and how telehealth works with those two issues. Before we get started a few disclaimers. Please note that any information provided in today's talk is not regarded as legal advice. It is strictly for informational purposes. See, CCHP always recommends that you consult with legal counsel if you're interested in formal legal opinion. Also, if I happen to mention a company or show a picture of product, know that neither I nor see CCHP has any relevant financial interest arrangement, affiliation or relationship with such a company. So, the objectives for today's talk is really to understand the difference between what licensure and credentialing is and what that means for utilizing telehealth when you're trying to deliver services. We're also going to learn about what licensure compacts are and also how credentialing and privileging. Privileging works in the context of telehealth and learn how hospital bylaws fit into this entire discussion. So what's the difference between licensure, credentialing and privileging? So licensure basically means is that you are granted a license by some state entity to practice medicine or to practice your profession in within that state's borders. It's usually a state board that grants this license and the state's control their own licensing laws, which is where it runs to an issue with telehealth in that because each state controls their Licensing Laws. You have 51 if you include dc jurisdictions that may have different laws, rules and regulations. But it also means that if you wanted to practice in all of those states, you need to get 51 licenses. Credential means a review of our providers qualification and usually happens when you are trying to work in another institution such as a hospital or a clinic. And they're going to basically check your credentials, your education, that you have a license, if there's like sort of outstanding complaints against you, etc. Privileging is basically an institution like a hospital authorizing you as a provider to provide a specific set of services in their institution. So they're granting you the privilege to provide those services within their organizations or within their institution. So, these are all what the differences are between these three things. And we kind of like have a sort of like, top tier two, like where you're actually practicing. So licensure, you're granted a license by some state body credentialing is more of a review process of your background and your information in order to try to grant. So hopefully grant new privileges to provide those services within an institution. Now, what does licensure mean for telehealth? I mentioned earlier that it's controlled by the states and that means each state has their own laws and rules regarding licenses and practicing within their borders. So that can get very difficult for a telehealth provider because telehealth really kind of eliminates the problem of borders. And that you can use telehealth to easily cross the border to provide a service in another state from which you are located, which your license did. So that's become an issue for the telehealth field. The licensure issue has become a significant barrier because of the ease of being able to provide services in another state. But those licensure rules and regulations haven't really like developed with the development of like telehealth and the technology where you can provide services very easily across borders. So because you have 50 states with their own laws and regulations, it can be very difficult for a telehealth provider who wants to practice in multiple states. Because going through the licensure process can be pretty, intensive. It can be long and it can be expensive. So what are some of the ways in which that's been addressed or tried to be addressed. So, as I mentioned earlier, states control their rules around licensure. Sometimes there are narrow exceptions to those licensure laws. Such exceptions can be such as you are doing in frequent consultations. So like maybe you do one or two consultations a year, was somebody whos located another state, but you're not licensed in that state. There are some states that say that's totally fine, we're not going to require you to like get another license. But they put caveats on, in that you agree never to like open up an office in that state etc. Or maybe they have like a law in their books which says you don't need to get a license if you are providing services to people within a certain amount of miles from the border. So this is usually happening where you have smaller states who would not take too long to like cross the border. I'm in California might take a while to like get from one in California to other, but some of the smaller states, it may take a little bit less time to cross the border. And some of them have laws on the books where they say, well if you're within a certain mile distance within the borders between states. Or certain states, they may even call it the states, then we're not going to require a license. Sometimes also, licensure laws are relaxed during times of emergency, so if there's a natural disaster and maybe they're trying to get medical assistance into a particular area. Or if the public health emergency has been declared, sometimes you'll see those licensure requirements and laws relaxed as well. And also, some states may have a special license or certificate that they issue specifically for telehealth providers. This is a little bit rarer, there's only like a couple of States that do this like about nine or ten. But they do exist and they do specific say it's a tele health certificate or it's a telehealth license. However recently, and this is being recorded in 2021. There have been two states that have passed laws where they said we're going to set up a special registry where if a provider. Or physician in this case, it gets on that registry or applies to be on that registry, then you don't have to get a license in our state. And that's happened in Florida and Arizona. This is very new right now. So, I don't know how onerous of a process it is to get on that registry because this is literally just happened fairly recently. So I don't know what all the regulations are, but it is a different sort of tackle a different channel that they're using to address this whole licensure barrier issue. Now, another way that's been used to try to address this barrier issue is licensure compacts. And you might ask, well, what does that mean? So basically a compact is an agreement between states on how they're going to treat this licensure issue. So, there are two types of compacts that exists out there. One is called the mutual recognition one and ones an expedited process. So, a mutual recognition compact means you have states that are in this compact, they will recognize the license in another compact member States. So state a I'm a provider in state A I am licensing state A state B who is also in that compact. I can practice in state B and not get a state B license because state B is in that compact and that compact is a mutual recognition one. An expedited process compact means it's a compact agreement where the states agree that they will accept this sort of faster process of processing a license. And say that and in effect like gets you a full license there. So it doesn't mean like one license, I can practice in multiple states. It means like I can get a license faster in another compact member state because there's an expedited process in place. So generally for the compacts that currently exists out there, they're either one of these two types. Now these are agreements through between states. So that means that there needs to be legislation passed in each of the compact member state in order for them to be within the compact. And those pieces of legislation, they have to have the exact same language in order for them to be able to join the compact because that means everybody has agreed to all the terms. And usually compacts have a minimum number of states that they note need to be actual members in order for it to be activated. So you might, their compact might say like we need seven state members before this compact like becomes active. Or we have ten and they do vary in the types of numbers amount of numbers of compact member states that are required. This is really quickly just a snapshot of some of the compacts that are out there and what types they are as you can see the medical licensure compact. The first one that's for physicians, it's an expedited process. So it's not again one license, I can practice in multiple states. It's, I can get a license a faster way then I could, if I had gone through the regular process, you compare that with the nurse licensure compact. That is a mutual recognition compact and that means that one, I have a license, one compact member state. I compact practice in other compact member states without getting another license in those particular states. So these are the ones that currently exists out there was, this is being recorded just to give you a snapshot and an idea of like the variety. And the different professions that actually have these in place or have them maybe starting to get in places. You can see the counseling compact at this time has not been activated yet because they don't have enough member States who agreed to join yet.
