Tag Archives: Multi-state licensing

State licensing issues affecting telemedicine practice among several states

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Historically, state licensing boards and organizations require health care professionals to become independently licensed by each state in which they chose to practice medicine.[i] Surely, there are metropolitan areas in our nation where several states make up a metropolitan area, particularly on the East Coast. The Chicago metropolitan area spans across state lines to include residents of Wisconsin, Illinois and Indiana, and notably, Michigan is not too far from the Chicago area and many people keep weekend lake homes there. Consider an oncologist who manages care and treatment of cancer patients, who has a lake house in New Buffalo, Michigan and a practice based in Chicago. What happens when telemedicine allows the doctor to use technology to monitor Chicago patients from his lake house in Michigan?

As technology and telemedicine offer health care professionals new options, there are new questions arising in professional licensing among the states.

Telemedicine is the use of mobile technology to perform certain routine health care services. Common applications of telemedicine include a physician with rural patients who require services that could be performed through the use of mobile technology, saving the patients the time and expense of travel to the doctor’s main office. Telemedicine also reduces the use of the office space and staff when patients are seeing the doctor from home.

Latoya Thomas, director of the State Policy Resource Center for the American Telemedicine Association commented in a recent article about the increased frequency in which states and organizations are addressing the concerns raised about the practice of telemedicine and developing appropriate laws and policies. Thomas stated, “It is something I think hospitals across the country are becoming familiar with if they haven’t already,” Thomas says, “and trying to figure out how they can comply with current standards but also prepare themselves for any new policies that might come down the pike in 2016.”

There are some “safe harbor” rules for telemedicine and states adopting policies and procedures for mobile healthcare practice.

In another scenario, an out of state patient who sees a physician in Illinois, for example, can conduct a surgical follow-up visit online; Indiana, Illinois and Ohio permit online physician follow-up with established patients[ii]. Another instance of allowed interstate telemedical practice not requiring the physician be licensed in the outlying state is the safe harbor rule of infrequent patient treatment. Minnesota has a telemedicine statute stating, “An out-of-state physician who holds a valid license to practice medicine in another state need not possess a Minnesota license-nor even register with the Minnesota Board-if she provides telemedicine services on an “irregular or infrequent basis,” which is defined as less than once per month or to fewer than ten patients annually.[iii]

There is not a uniform law directing the standard of interstate telemedical practice yet. There are Telemedicine Practice Guidelines, however, offered by the American Telemedicine Association. Some states do allow physicians in neighboring or other states to practice medicine in their state without being independently licensed, but where the out of state physician practices with the same standard of care required in the individual state.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Michael V. Favia and his associates and colleagues in health care law and litigation actively follow updates in mobile health care technology and the delivery of health care services. Favia works with clients not only with matters involving the practice of medicine directly, but also with the state licensing and regulation of health care professionals. When considering telemedicine, it is important to consult with the malpractice insurance provider and find out what policies control the location of the delivery of health care services.

Michael V. Favia & Associates are available to assist nurses and healthcare professionals with professional licensing matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] Healthcare Dive, State licensure issues challenging telemedicine borders, by Heather Caspi, Oct. 29, 2015

[ii] The National Law Review, The Out-of-State Practice of Telemedicine: Licensure Challenges and Opportunities, Oct. 21, 2015

[iii] See HNi above

Challenges for health care professionals reported in the National Practitioner Data Bank

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The National Practitioner Data Bank (NPDB) is a federal information collection program, a part of the U.S. Department of Health and Human Services, designed to ensure health care consumers receive quality health care, patient safety, and are protected from fraud and abuse in the health care industry. This information kept and shared with authorized users includes negative health care professional disciplinary information, malpractice awards, loss of license or exclusion from participating in Medicare or Medicaid. The benefit of information sharing is measured in the efficiency in which the state agencies licensed to use the data bank can catch potential threats to the public, preventing health care professionals from having trouble in one state and leaving for another to start over with a clean slate. There are challenges however, when a health care professional is licensed in several states and there is an occurrence in one state and all the other states are notified, potentially triggering a chain reaction of inquiries among licensing and regulatory agencies.

Information collection and sharing is not new, but it is a more streamlined process today.

The United States Congress created the National Practitioner Data Bank with the intent to improve the quality of health care services while protecting the public from fraud and abuse. In 2010, when Congress voted to approve the Affordable Care Act, the NPDB was combined with the Healthcare Integrity and Protection Data Bank (HIPDB), which was originally established in 1996 in the Health Insurance Portability and Accountability Act (HIPAA). HIPDB was established to combat health care fraud and abuse, and served to collect and share information the way the NPDB does today.[i]

Reports to the National Practitioner Data Bank are “records of actions taken by authorized organizations regarding health care practitioners, entities, providers, and suppliers who do not meet professional standards.[ii]” An authorized report can include information concerning settlements and payment in medical malpractice cases in addition to negative action by health care organizations or state licensing boards in connection with the delivery of health care services, meaning a reprimand, loss of privileges, suspension, revocation and so forth. Medical malpractice reports are a concern of any licensed health care professional whose decision in whether to settle or continue defending against a complaint for medical malpractice due to concerns that paying a settlement will jeopardize the doctor’s status in the NPDB.

Licensure in multiple states can be a concern for health care professionals with reports on the NPDB.

If a health care professional settles a medical malpractice case, and they are licensed in multiple states, there could be state inquiries arising out of all the states in which the individual holds a medical license. It is possible that in the licensing agency, in the state where the medical malpractice case took place, is aware, investigates and elects not to discipline the health care professional. It is also possible that a neighboring state agency, also becoming aware of the malpractice cases through the NPDB, investigates and takes adverse action against the health care professional, such as suspending the individual’s license. That suspension could be the trigger for a domino-type effect in all the states in which a health care professional is licensed to practice their craft.

Health care professionals defend against claims and complaints to avoid reports on the NPDB.

Attorneys and consultants such as Michael V. Favia and the Illinois Professional Licensing Consultants work with health care professionals who face concerns about long-term impacts of actions that could damage their reputation and ability to earn income when reports are made to the NPBD. When negative information is reported through the NPDB, it can cost a health care professional significant time and money to protect their license to practice and make a living. Knowing the benefits and liabilities arising out of the NPDB is important, and health care professionals should be keenly aware of the NPDB and how it is used in the health care industry among the states.

Michael V. Favia & Associates offices are conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] National Practitioner Data Bank website, HIPDB Archive.

[ii] National Practitioner Data Bank website, Reporting to the NPDB

Illinois adopts multi-state licensing compact, streamlines procedures, benefits telemedicine practice

“The Compact represents a national solution built upon, and reinforcing, a system of state-based regulation proven to protect patients and ensure the safe delivery of health care. ”

“The Compact represents a national solution built upon, and reinforcing, a system of state-based regulation proven to protect patients and ensure the safe delivery of health care.”

Becoming licensed to practice healthcare in multiple Midwestern states just became much easier as Gov. Bruce Rauner approved the cross-state licensure compact for telemedicine. Illinois is the 11th state to adopt The Interstate Medical Licensure Compact (“Compact”)[i]. “The Compact represents a national solution built upon, and reinforcing, a system of state-based regulation proven to protect patients and ensure the safe delivery of health care.[ii]

Whether the impetus is living and working near state borders or practicing telemedicine, the Compact opens the door to more opportunities.

In certain areas of the country, like the Chicago area, it is common for healthcare professionals to live in one state and work in another. With the increase in popularity and acceptance, mobile healthcare, also known as telemedicine, there are many opportunities to grow a practice and serve more patients with the new technology making miles of roads and borders irrelevant to healthcare choices. The Compact not only opens the door to telemedicine practice within the Compact states, full medical practice rights are conferred upon qualifying doctors who participate and pay administrative fees.

The traditional path to multi-state licensure is time consuming and may be more of a burden than a benefit to healthcare professionals who want to practice in states other than their home state. Within the states adopting the Compact, a healthcare professional must meet nine eligibility requirements and pay the administrative fee, approximately $260, for each state within which cross-state licensure is sought. Since the criteria are pre-established, the entire process is streamlined under the Compact.

Compact eligibility requirements[iii]:

  • Possess a full and unrestricted license to practice medicine in a Compact state
  • Possess specialty certification or be in possession of a time unlimited specialty certificate
  • Have no discipline on any state medical license
  • Have no discipline related to controlled substances
  • Not be under investigation by any licensing or law enforcement agency
  • Have passed the USMLE or COMLEX within 3 attempts
  • Have successfully completed a graduate medical education (GME) program
  • Physicians who are ineligible for the expedited licensure process facilitated by the Compact would still be able to seek additional licenses in those states where they desire to practice, using traditional licensure processes.

Watch a video: Federation of State Medical Boards Roundtable Webinar, “Interstate Medical Licensure Compact Update”

Many of the Midwestern and interior states have either adopted or are in the legislative process of adopting the Compact. Illinois neighbors in Iowa have adopted the Compact, it is pending in Wisconsin. Indiana has yet to move forward. Healthcare administration professionals suggest more states will sign on to the Compact and adopt it into state law within the next 12 to 18 months.

Michael V. Favia & Associates are available to assist nurses and healthcare professionals with professional licensing matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] Illinois General Assembly, HB 3680 Interstate Medical Licensure.

[ii] The Interstate Medical Licensure Compact website with interactive map of legislative status.

[iii] The Interstate Medical Licensure Compact eligibility requirements and frequently asked questions.

New web-based professional licensing service to save doctors time and money in all 50 U.S. states

Courtesy: MedLicense.com

Courtesy: MedLicense.com

The process of applying for medical licensing and credentials can be significant and there are many busy physicians who either do not have time, or whose time is more valuably spent serving patients great healthcare. Whether a doctor is planning to move to a new state or intends to be licensed in several or all the U.S. states, there is a market demand for assistance with licensing procedures and the follow-up needed in the application process. Nowadays telemedicine is becoming increasingly popular for doctors and their patients who are comfortable conducting certain visits through mobile technologies. Every state in which a telemedicine doctor wishes to practice (even virtually) will have its own requirements for licensure.

MedLicense.com is a service to collect and process your applications in the licensing process.

The service MedLicense.com offers is relatively straightforward. When a doctor signs to for the service they consult with a MedLicense.com representative who interviews the doctor and collects resumes and CVs to determine whether the doctor meets state requirements for education, training and examinations. So long as a doctor meets the minimum thresholds for licensing, MedLicense.com can help doctors apply in all the 50 U.S. states.  In the process, this service provides feedback and follow-up during the period between application submissions and the issuance of the requested license or credential.

The MedLicense.com website[i] boasts more than 20,000 physician users and that those users save time and money. There is an active military service member discounted rate of $429 per state for qualified applicants.

In addition to applications for physician licenses in every U.S. state, MedLicense.com offers additional services not limited to insurance, hospital and physician credentialing. Additional services also include registration for the Medicare program and licenses for telemedicine practice.

In certain cases, an experienced professional licensing consultant and attorney is recommended.

Especially with the advance of mobile healthcare technologies like telemedicine, many more doctors are applying for licenses in multiple states. Meanwhile, the National Practitioner Data Bank[ii] collects shared information among states and healthcare professionals. This information can include incidents of discipline, medical malpractice settlements and other information used in the regulation and oversight of licensed healthcare professionals.

Entries in the National Practitioner Data Bank that might not have triggered adverse action in one state, could possibly lead to an inquiry or limitation on the ability to secure additional licenses. For these reasons, any doctor with potential downstream license inquiries should consult with an experienced attorney on professional licensing concerns.

About our firm:

Michael V. Favia & Associates are available to assist with analysis and advice on a difficult IDFPR matter. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] www.MedLicense.com

[ii] http://www.npdb.hrsa.gov/