Navigating Multi-State Practice: An Overview of Telehealth Licensing Compacts (IMLC, PSYPACT, ASWB)

The landscape of healthcare delivery is rapidly evolving, with telehealth playing an increasingly central role. A significant barrier to the widespread adoption and expansion of telehealth has traditionally been the state-by-state professional licensing requirements, which necessitate practitioners obtaining individual licenses in every state where they wish to practice. To address this challenge, several interstate licensing compacts have emerged, aiming to streamline the multi-state licensure process for various healthcare professions. These compacts are critical for healthcare businesses looking to expand their reach across state lines.

What Are Interstate Licensing Compacts?

Interstate licensing compacts are statutory agreements between states that allow licensed professionals to practice in member states without obtaining a full, separate license in each state. While the specific mechanisms vary, the general principle is to create an expedited pathway for licensure or to grant privileges to practice in compact member states based on a primary license from one compact member state. This significantly reduces the administrative burden and time associated with multi-state practice.

Interstate Medical Licensure Compact (IMLC)

The Interstate Medical Licensure Compact (IMLC) is designed to facilitate the expedited licensure of physicians across state lines. Established in 2017, the IMLC allows eligible physicians to apply for licenses in multiple compact member states through a single application process. The physician must hold a full, unrestricted medical license in a compact member state that serves as their State of Principal License (SPL). The IMLC Commission then verifies the physician's eligibility and qualifications, and upon approval, issues a Letter of Qualification, which the physician can use to obtain expedited licenses from other compact member states. The IMLC aims to enhance patient access to care, especially in underserved areas and through telehealth.

Source: Interstate Medical Licensure Compact Commission Source Published At: Ongoing updates, last reviewed February 2024

Psychology Interjurisdictional Compact (PSYPACT)

The Psychology Interjurisdictional Compact (PSYPACT) addresses the need for psychologists to practice telepsychology and conduct temporary in-person, face-to-face practice across state boundaries. PSYPACT became operational in 2020 and allows licensed psychologists in good standing from a PSYPACT-participating state to practice telepsychology in other PSYPACT states or to conduct temporary in-person practice for up to 30 days in a calendar year in other PSYPACT states, without needing to obtain a separate license in each state. This is achieved through an Authority to Practice Interjurisdictional Telepsychology (APIT) or a Temporary Authorization to Practice (TAP) mobility number.

Source: PSYPACT Commission Source Published At: Ongoing updates, last reviewed February 2024

ASWB Social Work Mobility (ASWB Compact)

The Association of Social Work Boards (ASWB) Social Work Compact is the newest of these initiatives, aiming to create an interstate compact for social work licensure mobility. This compact, once fully enacted and operational in a sufficient number of states, will allow licensed social workers to practice in participating states without needing to obtain a new license in each state. The goal is to enhance client access to social work services, particularly through telehealth, and to facilitate the mobility of social workers. As of early 2024, several states have enacted the compact legislation, and the ASWB is actively working towards its full implementation.

Source: ASWB Social Work Compact Source Published At: Ongoing updates, last reviewed February 2024

Impact on Multi-State Practice and Telehealth Expansion

These compacts represent a fundamental shift in how healthcare professionals can deliver services across state lines, particularly for telehealth. Before compacts, a physician, psychologist, or social worker wishing to serve patients in multiple states had to navigate the unique licensing requirements of each state, a process that could be time-consuming, costly, and complex. This often limited the ability of healthcare businesses to scale their telehealth operations effectively.

With the advent of these compacts:

• Expedited Licensure: Professionals can obtain licenses or practice authorizations in multiple compact states much faster than through traditional routes. This reduces the time to market for telehealth services.
• Increased Access to Care: Patients in states participating in compacts gain access to a broader pool of specialists, especially in areas with provider shortages or for specialized telehealth services.
• Reduced Administrative Burden: Healthcare businesses and practitioners experience less administrative overhead associated with managing multiple state licenses.
• Enhanced Practitioner Mobility: Compacts facilitate the ability of practitioners to move between states or to provide services to patients who may reside in different states, which is common in telehealth.

Key Considerations for Healthcare Businesses

While compacts offer significant advantages, healthcare businesses must understand their nuances and limitations:

1. State Participation: Not all states are members of every compact. Businesses must verify the current list of participating states for each compact relevant to their practitioners. Expansion into non-compact states still requires traditional licensure.
2. Eligibility Criteria: Each compact has specific eligibility requirements for practitioners (e.g., unrestricted license, no disciplinary actions, passing specific exams). Businesses must ensure their practitioners meet these criteria.
3. Scope of Practice: While compacts facilitate licensure, practitioners are still bound by the scope of practice and all other laws and regulations of the state where the patient is located. This is a critical distinction. For example, prescribing rules, telehealth-specific informed consent, and supervision requirements can vary significantly by state, even for compact-licensed professionals.
4. Jurisdiction of Boards: The compacts do not supersede the authority of state licensing boards. Each state board retains its disciplinary authority over practitioners practicing within its borders, even if licensed through a compact.
5. Ongoing Compliance: Businesses must have robust systems to track practitioner licenses, compact statuses, and ensure ongoing compliance with the practice acts of all states where services are rendered. This includes understanding state-specific telehealth regulations, patient privacy laws, and billing requirements.
6. Professional Liability: Practitioners operating under compacts should ensure their professional liability insurance covers practice in all states where they provide services.

Conclusion

Interstate licensing compacts like the IMLC, PSYPACT, and the ASWB Social Work Compact are transformative developments for multi-state healthcare practice and telehealth. They offer a more efficient and streamlined path for qualified professionals to deliver care across state lines, ultimately benefiting both providers and patients. For telehealth brands, medspas, dental practices, chiropractic offices, and other healthcare businesses, leveraging these compacts can be a strategic advantage for expansion and increased patient access. However, successful implementation requires a thorough understanding of each compact's specific rules, careful attention to state-specific regulations in the patient's location, and a commitment to ongoing compliance and regulatory monitoring.