(356) The Battle Over State Lines: Leveraging an Interstate Compact to Ensure Continuity of Care

Background: As a result of COVID-19 related precautions, states temporarily relaxed certain restrictions on telehealth services during the pandemic, including waiving licensing requirements so physicians could serve patients across state lines. However, many states ended these flexibilities in 2021. According to two online surveys fielded by the Cystic Fibrosis Foundation to accredited centers in 2020-2021, 65% of programs reported providing care to patients living in another state. Of these, 18.5% of programs reported that some of their out-of-state (OOS) patients were not able to access telehealth services due to licensure-related issues.[1] CF Foundation Compass fielded 20 calls from CF patients in 15 states requesting assistance in accessing their OOS care center, accounting for over 25% of all network adequacy inquiries received during that time. The Foundation recognized the need for policy change to improve access to OOS care for people with CF.

Methods: In 2021, we interviewed five CF care centers about their experiences with telehealth and OOS licensing. The administrative burden of applying for multiple state medical licenses was a key barrier to providing remote OOS care, and the Foundation identified the Interstate Medical Licensure Compact (IMLC) as one solution. The IMLC streamlines the licensing application process for physicians who want to practice in multiple states. From January 2021 to March 2022, the Foundation supported legislation in ten states to join the IMLC by sending letters with 31 care center director co-signers.



The Foundation also hosted a webinar in June 2021 to educate CF care centers about the IMLC as a way to pursue multiple medical licenses with one application. We shared follow-up information about the IMLC through Foundation COVID-19 digest emails.



More recently, the Foundation fielded a survey in March 2022 to all CF care centers to understand the current use of and barriers to telehealth for CF care teams. Data from this survey is forthcoming.

Results: Prior to the Foundation’s engagement in January 2021, 30 states and the District of Columbia were members of the IMLC. As of April 8, 2022, five additional states have passed legislation to join the IMLC, reflecting a 17% increase in state participation from January 2021 to March 2022. Within the 35 participating states at present, 126 CF care center programs will have the potential to utilize the IMLC . The Foundation has supported legislation in all six states with pending legislation to join the IMLC in 2022. Increased physician awareness of IMLC was evidenced by physician participation from 20 states in the webinar, as well as broad distribution of the recording via the COVID-19 digest to 288 CF programs in 49 states following the session.

Conclusions: While more states taking action to join the IMLC is an important step, challenges persist. Even in IMLC member states, CF providers express concerns about the cost and administrative burden of maintaining licenses in multiple states. Permanent regulations regarding the use of and reimbursement for telehealth remain uncertain. To better understand the current challenges and opportunities for telehealth and remote OOS care, the Foundation is supporting additional research and advocacy in this area.

Acknowledgements:

References: [1] Sawicki GS, Van Citters AD, Dieni O, Sabadosa KA, Willis A, Benitez D, Ong T, Dasenbrook EC. Financial impacts of the COVID-19 pandemic on CF care: lessons for the future. JCF 2021; 3:16-20. doi: 10.1016/j.jcf.2021.09.008.