Telehealth expansion: Interstate licensure compacts benefit patients 

YouCompli Woman reviewing interstate licensure compacts for telehealth

Telehealth services and models have expanded rapidly during the pandemic. Healthcare employee burnout, the Great Resignation, and other factors are expected to further accelerate telehealth growth.  

Telehealth expansion has led to significant growth in the use of interstate licensure compacts. As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. 

Increasing use of interstate licensure compacts 

The National Council of State Boards of Nursing (NCSBN) recently published its annual report on interstate licensure. It noted 43 states and territories have enacted licensure compacts for nurses, physicians, physical therapists, emergency medical technicians, psychologists, speech therapists/audiologists, occupational therapists, and counselors. 

The Nurse Licensure Compact (NLC) is an interstate agreement allowing nurses to practice in multiple states with one multistate license issued from their home state. The compact enables nurses to provide nursing services to patients located in other NLC states via telehealth without obtaining additional licenses. The NCSBN says this approach allows for greater nurse mobility, public protection, and access to care.  

In addition, use of the Interstate Medical Licensure Compact (IMLC) grew by 47% in the past two years. The IMLC Commission noted “more than 8,000 licenses were issued through the compact from March 2020 to March 2021.” This is compared with nearly 4,000 licenses issued during the previous 12-month period.  

With more healthcare professionals practicing across state lines, patients have more choices. And healthcare compliance officers have processes and procedures to update.  

Interstate licensure compacts benefit patients 

For patients, one benefit of licensure compacts includes licensing boards being able to ensure that physicians maintain professional integrity and medical standards – regardless of where they practice. As more healthcare professionals obtain licensure under compacts, patients gain greater flexibility in making care decisions.  

For example, rural patients can participate in a telehealth visit with a specialist or provider at home. This saves patients the time and expense of driving long distances to see the same provider in a facility setting.   

Another positive is the increased use of remote monitoring devices, such as glucose monitors, blood pressure monitors, and heart monitors. Patients can receive state-of-the-art monitoring remotely, instead of as a hospital inpatient. In turn, healthcare costs decrease and patient compliance increases.  

A significant patient benefit with expanded telehealth is the inclusion of mental health services. Under the provisions of the Consolidated Appropriations Act of 2021, services for the diagnosis, evaluation, or treatment of mental health disorders may continue as telehealth services. Per the Centers for Medicaid & Medicare Services (CMS), the previous restrictions limiting telehealth mental health services to patients residing in rural areas no longer apply.  

Compliance considerations 

Compliance officers need to help their organizations keep up as healthcare delivery models change. Organizations will need to update everything from billing codes to human resources policies and procedures to information technology (IT) practices.  

For example, compliance officers should partner with Human Resources to make sure out-of-state licensed professionals have been educated in facility policies and procedures. They also need to ensure that professionals working under licensure compacts understand the nuances of the rules and laws in the state they are working. 

Compliance officers also need to work with the IT department to ensure that remote devices have been securely connected to the network. They also need to collaborate with the risk department on making sure proper medical professional liability insurance coverage has been obtained for these licensed professionals.  

Compliance officers should work with Revenue Cycle on two crucial issues:  

  • Ensuring that the organization stays abreast of the changes to the CMS list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth. 
  • Staying current on telehealth visit coverages and coding modifiers to decrease denials of patient charges.  

As your team manages your response to continuing regulatory changes, having a system to keep up with the moving parts can help. YouCompli can support your regulatory change management process. It provides regulatory analysis to help you know what changes are coming and decide whether they affect your institution. It also provides requirements, tasks, and deadlines, in clear business English, making it easier for you to manage changes and verify that you’ve taken the proper steps. 

Denise Atwood, RN, JD, CPHRM 
District Medical Group (DMG), Inc., Chief Risk Officer and Denise Atwood, PLLC 

Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.  

Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.  

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Nursing-shortage solutions come with licensure challenges  

Nursing-shortage solutions

The nursing shortage in the US was bad before the pandemic started. Now after the double whammy of a two-year pandemic and an aging population, it’s even worse. 

The American Nursing Association estimates that this year will see more than 100,000 unfilled nursing jobs, “more than any other profession.” 

Hospitals have traditionally brought in “nurse travelers” from outside their service areas and their states to comply with state staffing requirements. In 2000, the Nursing Licensure Compact permitted nurses licensed in one participating state to practice in other participating states. In 2018 the Enhanced Nursing Licensure Compact (eNLC) added some requirements, such as state and federal fingerprint-based criminal background checks.  

With Vermont having started implementation February 1, 36½ states and territories are eNLC participants. Ohio has joined but won’t implement participation until January 2023.  Pennsylvania and the US Virgin Islands have joined but have not yet set implementation dates. The half is Guam, which recognizes eNLC licenses but whose nurses won’t be able to apply for one until later this year. 

Interstate licensing considerations for traveling nurses 

Nurse burnouts, quits, and anticipated retirements (500,000 RNs this year) have only added to the need for hiring travelers to fill the gaps. But before you do, there are potential pitfalls to watch out for:   

  • Does your state belong to the eNLC? Does the nurse’s home state? If not, what are the licensure requirements for nurses with out-of-state licenses? 
  • If your state has passed eNLC legislation, have they implemented it yet? If not, have they set a date for doing so? 
  • If eNLC legislation is pending in your state, what’s its status? 
  • Do you have a process in place for checking and verifying out-of-state licenses? 
  • If your state is not an eNLC participant, what are its regulations regarding out-of-state licensure? 
  • What if nurses you hired as travelers join your contracted staff and move to your state? Have you a process for making sure they updated their licenses from multi-state to your state? Are the in-state licenses current? If not, you’ll have been providing patient care services without a license.  

The expanding availability of out-of-state nurses can be hugely helpful for solving short-term nursing shortages. An audit of your practices against current regulations and compacts is a great first step in determining where and how to use traveling nurses in a compliant way. 

Do you have a system in place to manage regulatory changes? Having a solution that researches and analyzes regulatory changes, translates them into model procedures, and has a top healthcare law firm validate them can really pay. Read more about YouCompli’s regulatory monitoring process or schedule a demo.  

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Please share your insight and support the Coronavirus Response Fund for Nurses

YouCompli is conducting research on how healthcare Compliance functions support the overall wellbeing of their organizations. As a seasoned healthcare compliance professional, your input will be invaluable in helping shape YouCompli’s inaugural report on the ways Compliance helps lessen organizational risk with exceptional regulatory change management. 

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The survey contains six multiple choice questions and some optional demographic information. It typically takes less than five minutes to complete. For every survey response received by March 7, 2022, we will donate $10 to the American Nurses Foundation’s Coronavirus Response Fund for Nurses. (So be sure to encourage your compliance colleagues to fill it out, too!) 

We will release the survey results at the 2022 HCCA Compliance Institute, where we are presenting the panel discussion, Reducing Healthcare Risk with Strong Reg Change Management. If you’d like to receive the survey results report, all you have to do is let us know in the survey. 

Thank you for providing your data and perspective. The YouCompli team appreciates your time and looks forward to sharing rich industry insight later this spring. 

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Compliance officers reflect on COVID pivots and preparing for the end of the public health emergency

Featured speakers: Craig Bennett, Vice President and Chief Compliance Officer, Boston Medical Center; Rachel Lerner, Esq., General Counsel & Chief Compliance Officer, Director, Center for the Prevention of Elder Abuse and Neglect, Hebrew SeniorLife; Maria Palumbo, Chief Compliance & Privacy Officer, Lawrence General Hospital. Moderated by Larry Vernaglia 

Bennett, Lerner and Palumbo addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. (Read a summary.) This recap of their remarks looks at how their Compliance teams responded to COVID and have continued to partner with their organizations to manage regulatory change. It also looks at regulatory changes they are planning for in 2022. To access the full session recording, please contact the Massachusetts Health and Hospital Association.  

Initial COVID response

The panel reflected on their organizations’ initial response to COVID. “All of us had to pivot on a dime,” said Bennett. “We hadn’t had an opportunity to plan for it. Instead, we worked daily that first quarter to make sure we were as compliant as we could possibly be.” He was part of a team that looked at various waivers, platform security, privacy and other issues affected by the public health emergency to provide care safely.  

Lerner had a similar experience. “We immediately convened interdisciplinary committee so we could make changes quickly. Telehealth was really new territory for us, and we had to look at our outpatient medical practice, and home- and community-based care,” she said. “Tracking COVID 19 waivers was a team sport between Legal and Compliance. We broke down some silos, and that may be one good lasting benefit of this experience.”  

Palumbo and her colleagues focused on creating templates and consistency for documentation to make things as straightforward as possible for clinicians. That included having them track their patient contact time in minutes rather than defaulting to 20-minute increments. “We’re auditing these processes now to be sure we’re prepared when it gets looked at externally.”  

Accessibility concerns and solutions

Palumbo illustrated how healthcare organizations had to respond to the specific needs of their communities. “Our population tends not to have computers or printers at home,” she said. It wasn’t enough to deliver COVID test results to the portal, because people needed printed results to return to work or school. Without a printer, they were stuck. “We were like the take-out line at a restaurant – we not only have to contract with the state to provide nine-lane testing, we also have a multiline drive up for picking up your covid test results because people need that hard paper.”  

Building a culture of compliance

Bennett reflected on the tremendous amount of change and adaptation healthcare staff managed over the past two years. “I have to commend all hospital staff in being able to pivot and not missing a beat,” he said. His organization paused or reprioritized certain issues, but they maintained a focus on complying with regulations. That meant checking in with people regularly. That helped him assess whether people were getting the support and resources they needed related to their work. He expects to continue looking for ways to support staff. “We’ll continue to try to add flexibility to meet the needs of our staff and the needs of our patients and organization.” 

Palumbo, too, is working to meet people where they are at. She recently “camped out in the cafeteria,” she said. “I couldn’t believe the results: About 350 people came to talk to me, including residents, physicians, surgeons, nurses, case managers, and housekeeping staff.” They asked about patient privacy and other compliance issues. “So much came up during COVID but we didn’t stop to work through everything or stop to talk to each other. I’ll try to do that at least once a quarter.”  

New compliance issues

Palumbo walked through some upcoming regulatory changes she’s watching. This included the Medicare Final Physician Fee Schedule and noted that the Appropriate Use Criteria changes are delayed until the January first that follows the end of the pandemic. She encouraged everyone to understand the documentation requirements for using nurse practitioners for some portion of care as well as the changes to billing for surgeon and ICU provider time.  

New rules also allow audio-only telehealth visits for behavioral health as long as the patient wants it and the physician documents it properly.  

Balancing privacy, efficiency, safety, and cybersecurity

Lerner continues to address privacy concerns related to COVID testing and contact tracing. “We were working so hard to limit the spread of the disease in our senior living facilities,” she said. “It was hard to navigate contact tracing and privacy.” Now she is addressing cybersecurity insurance requirements, for her own organization and making sure vendors have sufficient insurance. “Moving to remote workforces and telehealth, the cybersecurity exposure is higher than it’s ever been,” she said. “For instance, people working from home might want to print documents, but we have to keep them from printing PHI at home or mailing things insecurely when someone can’t come pick it up.”  

Managing regulatory change

Lerner said she spends a lot of time looking at regulatory changes to understand their implications to her organization. “It can take us a long time to decide ‘does this apply to us?’ And then figure out what to do with it. Then we have to figure out what to do with that information in bits and pieces. It is certainly a complex, ever-changing universe on that front.” She spoke of Compliance’s key role in knitting together all that information to help the organization act on it and integrate it into daily processes.  

YouCompli sponsored MHA’s 2021 Healthcare Legal Compliance Forum. We provide a complete solution to help healthcare compliance organizations manage regulatory change. Find out more about YouCompli.  

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