Licensing and Credentialing of Telehealth Programs

Licensing and credentialing telehealth providers can pose challenges to expanding telehealth programs in rural communities. Licensing refers to the process of securing the authority to practice medicine within a state. Credentialing refers to the process of verifying the provider's license, education, insurance, and other information to ensure they meet the standards of practice required by the hospital or healthcare facility. Virtually all states require physicians providing telehealth services to be licensed in the state of the patient receiving care. Further, every site delivering telehealth services must fully credential the physician.

Licensing and credentialing are intended to protect patients by ensuring that telehealth providers are in compliance with state regulations and hospital policies. However, licensing and credentialing can be time-consuming administrative processes, and rural telehealth programs with limited resources may become burdened by renewing licenses for providers to practice in several states and hospitals. In addition, states require medical licenses to be renewed periodically, typically every one to two years.

Some states and associations are taking steps to increase the portability of clinical licenses. For example, the Federation of State Medical Boards offers the Federation Credentials Verification Service and the Uniform Application for Licensure, streamlines the application process for physicians and physician assistants. Several states also participate in interstate compacts for healthcare providers, which facilitate multi-state licensing. Some licensure compacts, such as the Nurse Licensure Compact, grant providers one multi-state license that allows eligible providers to practice in all participating states. Others, such as the Interstate Medical Licensure Compact, create an expedited pathway for licensure that makes it easier for providers to apply for multiple licenses. However, interstate licensure compacts do not cover every type of telehealth provider. For example, behavioral health counselors are not included in an interstate licensure compact.

Some states, including Alabama, Louisiana, Maine, Minnesota, New Mexico, Ohio, Oregon, and Texas, have also developed out-of-state telehealth licenses in order to facilitate the licensing process. Tennessee's Osteopathic Board also offers an out-of-state telemedicine license. These licenses enable providers to practice telehealth across state lines, though they are not licensed to provide in-person care. Rural communities may need to investigate state laws and policies to understand licensing requirements and exceptions.

Rural communities seeking to streamline the telehealth credentialing process should be aware of the credentialing by proxy method approved by the Centers for Medicare and Medicaid Services and The Joint Commission. Credentialing by proxy can help rural programs expand telehealth services by allowing community and Critical Access Hospitals (the originating sites of telehealth) to rely on the credentialing process of distant telehealth sites. The California Telehealth Resource Center offers a privileging and credentialing checklist that can help rural communities shape the written agreement between the originating and distant sites. Provider Bridge also offers a technology platform to streamline the licensure process, which may help rural communities to mobilize healthcare providers quickly during states of emergency.

Resources to Learn More

Credentialing Under Medicare and Accreditation Programs: Implications for Telehealth Practitioners
Document
Discusses credentialing by proxy standards set by The Joint Commission. Provides recommendations for further credentialing changes.
Author(s): Klutz, B.
Organization(s): Center for Connected Health Policy: The National Telehealth Policy Resource Center, Health Management Associates
Date: 3/2010

Multi-Discipline Licensure Resource Project
Website
Provides current information on emergency regulations and licensing for occupational and physical therapists, psychologists, and social workers. Resources include state-specific information related to licensure, telehealth, and COVID-19, as well as online and phone support.
Organization(s): Association of State and Provincial Psychology Boards (ASPPB)

Provider Bridge
Website
Connects healthcare professionals with state agencies and healthcare entities to increase access to care for patients in rural and underserved communities, and assists in mobilizing volunteer healthcare professionals during public health emergencies. Features COVID-19 resources including state-by-state telehealth information and links to help providers find answers to telehealth licensure questions.
Organization(s): Federation of State Medical Boards