Licensure

Licensure or Licensure Portability

What is it?

Traditionally, healthcare professionals must obtain a medical license from a government-approved professional association or government agency. This process may take months and can be expensive as physicians endure extensive background checks, education, training and other verifications. In addition, this license must be in the state where they wish to practice medicine.

In the United States and its territories, the individual medical licensing authorities (“state medical boards”) of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure for physicians.

For nurses, there is a Nurse Licensure Compact that twenty-four (24) states honor that allows nurses to have one multistate license, with the ability to practice in both their home state and other party states. States included in the compact as of this writing:

Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin.

Telemedicine impact

With the advent of Telemedicine, a physician or nurse may have their practice in one state, that is, be physically located in one state, and still administer care to patients in other states.  This delivery of services across state lines can be a major issue.

Physicians

Physicians practicing telemedicine are required to obtain licensure for the state where they will be practicing and located physically as well as for states where the patients will receive medical care under the physician’s direction.

Nurses

Nurses in states participating in the Nurse Licensure Compact (NLC) must obtain licensure within the state they themselves will physically be in and will need to register with the NLC to be able to practice in other states. For states not participating in the NLC, the nurse will need to apply for a nursing license for that specific state. More information on the particular requirements is available at theNLC website. (http://www.ncsbn.org/nlc.htm)

Some states have special arrangements to accommodate telehealth, such as reciprocity or special licenses.

The Office for the Advancement of Telehealth (OAT) prepared a report pertaining toTelemedicine Licensure for the Senate Appropriations Committee. The report contains information about the Licensure System, Major Licensure Models for Nurses and Physicians, Portability Grants, etc.

Note:
According to American Telemedicine Association author Jon Linkous and ATA CEO states, “the Administration and Congress are looking at ways to eliminate red tape and allow patients to access doctors and specialists in other states without having to go through the delays, complications and costs of getting duplicate state medical licenses.” (“LinkousThink: White House Announcements, Regulations and Telemedicine“, Aug. 2011)

Other models or alternatives to state licensure

The Telemedicine Report to Congress, prepared by a federal Interagency Joint Working Group on Telemedicine, recently identified in its report the following alternatives to state licensure:

Consulting–With a consulting exception, a physician who is unlicensed in a particular state can practice medicine in that state at the behest and in consultation with a referring physician. The scope of these exceptions varies from state to state. Most consultation exceptions prohibit the out-of-state physician from opening an office or receiving calls in the state. Consultation exceptions to the licensure laws were enacted in most states before the advent of telemedicine. Although they may be well-suited to some telemedicine situations, it is unlikely these exceptions were intended to apply to regular, ongoing telemedicine links.
Endorsement–State boards can grant licenses to health professionals licensed in other states that have equivalent standards. For example, health professionals must apply for a license by endorsement from each state in which they seek to practice. States may require additional qualifications or documentation before endorsing a license issued by another state. Endorsement allows states to retain their traditional power to set and enforce standards that best meet the needs of the local population.
Mutual–Mutual recognition is a system in which the licensing authorities voluntarily enter into an agreement to legally accept the policies and processes (licensure) of a licensee’s home state. This approach has been adopted by the European Community and Australia to enable the cross-border practice of medicine. It also been successfully utilized by the Veterans Administration, U.S. Military Branches, Indian Health Service and Public Health Service. Licensure based on mutual recognition is comprised of three components: a home state, a host state, and a harmonization of standards for licensure and professional conduct deemed essential to the health care system. The health professional secures a license in his/her home state and is not required to obtain additional licenses to practice in other states.
Reciprocity–Reciprocity denotes the relationship between two states when each state gives the subjects of the other, certain privileges, on the condition that its own subjects shall enjoy similar privileges at the hands of the latter state. A licensure system based on reciprocity would require the authorities of each state to negotiate and enter agreements to recognize licenses issued by the other state without a further review of individual credentials. These negotiations could be conducted on a bilateral or multilateral basis. A license valid in one state would give privileges to practice in other states with which the home state has agreements.
Registration–Under a registration system, a health professional licensed in one state would inform the authorities of other states that he/she wished to practice part-time therein. By so registering, the clinician would submit to the legal authority and jurisdiction requirements imposed upon those licensed in the host state, but they would be held accountable for breaches of professional conduct in any state in which they are registered. California has passed legislation that would authorize registration but has not yet implemented it.
Limited Licensure–A limited licensure system would be a modification of the current system. Health professionals would be required to obtain a license from each state in which they practiced. However, the physician would have the option of obtaining a limited license that allows the delivery of a specific scope of health services under particular circumstances. This system would limit the scope of practice rather than the time period for practice as is currently the case. The health professional would be required to maintain a full and unrestricted license in at least one state.
National Licensure–A national licensure system could be implemented at the state or national level. A license would be issued based on a standardized set of criteria for the practice of healthcare throughout the U.S. Administration at the national level could be left to a national professional organization.
A national licensure system implemented at the state level would require states to voluntarily incorporate the national standards into their laws. In such a system, the states would be unable to impose significant additional standards. Health professionals would still be required to obtain a license from every jurisdiction in which they practiced, but a common set of criteria would greatly facilitate the administrative process. States could, however, possibly retain some flexibility in the administrative process.

Where do I find out information about my state or other states I want to operate in?

Contact the state’s medical board for specific requirements for practicing medicine in the state whether physically or via telemedicine equipment. State medical board contact information can be found at the Federation of  State Medical Boards website and via their state medical board directory.

Contact information for states within the SCTRC region are shown:

Arkansas State Medical Board
1401 West Capitol Avenue, Suite 340, Little Rock, AR 72201
(501) 296-1802 / Fax:(501) 603-3555
www.armedicalboard.org

Louisiana State Board of Medical Examiners
P.O. Box 30250
New Orleans, LA 70190-0250
(street address: 630 Camp St., 70130)
(504) 568-6820 / Fax:(504) 568-8893
www.lsbme.louisiana.gov

Mississippi State Board of Medical Licensure
1867 Crane Ridge Drive, Suite 200B
Jackson, MS 39216
(601) 987-3079 / Fax:(601) 987-4159
www.msbml.state.ms.us

Tennessee Board of Osteopathic Examination
 227 French Landing, Suite 300
Heritage Place MetroCenter
Nashville, TN 37243
(800) 778-4123 / Fax:(615) 253-4484
http://health.state.tn.us

Other Links

  • Fixlicensure.org
    A petition to change the licensure rules for telemedicine. For more information and to sign the petition, follow this link:
    http://www.fixlicensure.org/