Proposed Legislation Would Remove Telemedicine Licensing Barriers

Well-before the world had heard of COVID-19, the use of telemedicine was increasingly seen as a way to expand patient access to care and address a growing shortage of physicians, particularly in rural and underserved areas. As noted by the authors of an article in the American Journal of Managed Care, “The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists.”

But the pandemic and the lockdowns that followed in its wake dramatically changed the telehealth landscape for doctors, patients, and insurers. Now, legislation recently introduced in Congress seeks to address licensing barriers that have stood in the way of leveraging this technology to improve patient care.

The number of virtual visits exploded as such appointments became seen more as a matter of health and safety rather than convenience. While it is estimated that only two percent of all patient appointments pre-pandemic were via telemedicine, a whopping 61 percent of visits have been conducted virtually since then. Even when, hopefully in the near future, COVID-19 recedes into memory, experts anticipate that telemedicine will remain an increasingly utilized option.

Scores of Separate Licenses Currently Needed For Telemedicine Across State Lines

But the inability of physicians to provide remote care to patients in other states where they are not licensed is holding back telemedicine’s potential and unnecessarily denying patients access to quality healthcare. This is particularly problematic in areas where the healthcare system is currently overwhelmed by COVID-19 cases.

The problem is that, as of November 2019, 49 state medical boards, plus the medical boards of the District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine have a license in the state in which the patient is located.

Equal Access To Care Act

However, a bill introduced in Congress in July – The Equal Access To Care Act (EACA) – seeks to remove this roadblock. If enacted, the act would allow licensed practitioners to provide services via telehealth in any state from any location for up to 180 days after the end of the current public health emergency period. On July 23, the federal government extended that period for another 90 days.

Specifically, the EACA provides that a physician, practitioner, or other healthcare provider who is licensed to provide health care services in their primary state, and who provides such health care services in interstate commerce through electronic information or telecommunication technologies to a patient in another state, does not need to obtain a comparable license from the state where the patient is located in order to provide such services.

It is expected that EACA will receive rare bipartisan support in both chambers. If it does pass, it raises the question of what happens to telehealth licensing requirements after the pandemic emergency ends. Given that almost all stakeholders have come around on the use of and payment for virtual visits, one would think that a permanent solution is more likely than not.

Expanded Medicare Coverage For Telemedicine Also On The Table

In addition to removing licensing burdens, Congress is also considering legislation to expand Medicare coverage for telehealth services. The Telehealth Modernization Act was introduced on July 30th. If it becomes law, the act would remove geographic and originating site restrictions from Medicare coverage of telehealth services, ensure that telehealth services at federally qualified health centers (FQHCs) and rural health clinics (RHCs) are covered by Medicare, and give the Health and Human Services Secretary the authority to permanently expand the types of telehealth services covered by Medicare, among other changes.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Cognitive Decline Among Older Physicians Leading to Increased Screening

For every accomplished physician who dreams of retiring early, there is one who can’t imagine giving up the work that brings them so much personal and professional satisfaction and financial security. Every year, 20,000 American doctors turn 65, but only half of them retire by then. Thousands of physicians continue to practice well past their 70th, even 80th, birthdays. It is estimated that one in every eight practicing doctors in the U.S. is over 65, overseeing 50-70 million office visits and 11 million to 20 million hospitalizations each year.

One In Eight Doctors Over 70 Found to Have Significant Cognitive Deficits

With so many patients receiving care from physicians 65 and up, many hospitals and healthcare systems are also increasing their scrutiny of the cognitive abilities and faculties of these senior clinicians. Major institutions such as Scripps Health Care, Intermountain Healthcare, Stanford Hospitals and Clinics, and Penn Medicine have implemented mandatory cognitive screens for older practitioners.

At Yale New Haven Hospital, for example, all applicants 70 or older who seek reappointment to the medical staff are required to have an objective evaluation of cognitive function as part of the two-year reappointment process. What a recent round of that testing revealed was that one in eight doctors who participated in the screening had cognitive deficits that were likely to impair their ability to practice medicine independently.

Testing or No Testing, Cognitive Issues Raise Professional Licensing Concerns

The wisdom and efficacy of such testing programs is subject to debate, with many arguing that age-based screening is empirically unjustified or inherently discriminatory. Whether subject to required testing or not, however, all older physicians who continue to treat patients later in life will at some point face difficult questions about their abilities and the prudence of continuing to practice.

Confronting issues of cognitive decline, if not impairment, is no easy task, personally and professionally. But recognizing any such concerns is also an ethical imperative. Continuing to practice while suffering from cognitive impairment significant enough to raise concerns about patient safety can subject a physician of any age to disciplinary action and the loss of their license.

The Illinois Medical Practice Act (the “Act”), for example, makes it a basis for suspension or revocation of a license for a physician to practice if they have a:
• Mental illness or disability which results in the inability to practice under this Act with reasonable judgment, skill or safety.
• Physical illness, including, but not limited to, deterioration through the aging process… which results in a physician’s inability to practice under this Act with reasonable judgment, skill, and safety.

The Act also imposes reporting requirements on certain health care executives regarding “impaired” physicians, defined as those who lack the ability “to practice medicine with reasonable skill and safety due to physical or mental disabilities as evidenced by a written determination or written consent based on clinical evidence including deterioration through the aging process or loss of motor skill… of sufficient degree to diminish a person’s ability to deliver competent patient care.”

Doctors, for all their talents, are as vulnerable as anyone else to the inevitable effects of time and aging. While debate may continue as to the best way to identify and remediate instances of age-related cognitive or physical impairment, doctors who practice well into their golden years need to combine their clinical judgment with self-awareness when evaluating the wisdom of continuing to treat patients. Failing to do so puts both patients and professional licenses at risk.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Telemedicine and Physician Licensing: How the 19th Century is Holding Back the 21st

teleAdvancements in technology almost always outpace efforts by legislators and regulators to address the new realities, issues, and concerns that arise from such innovations. Laws that made sense even a short ten years ago can quickly become anachronistic, if not counterproductive.

Such is the dilemma facing physicians and healthcare providers who see telemedicine as a key way to address a growing physician shortage, especially in rural and other underserved areas. That shortage is expected to grow to 120,000 doctors by 2030, according to a 2018 report by the Association of American Medical Colleges.

51 Different Licenses

The problem is that while the internet knows no borders, medical licenses do. Increasingly, the inability of physicians to provide remote care to patients in other states where they are not licensed is holding back telemedicine’s potential and unnecessarily denying patients access to quality healthcare.

Physicians must be licensed in each state where their current and future patients are located, so a doctor wanting to counsel patients through telemedicine would need to obtain and stay compliant with licensing requirements in up to 51 jurisdictions governed by 51 different medical boards imposing 51 different standards, conditions, and rules.

The current state-based medical licensing regime traces its roots back to the 19th Century, and the system is clearly showing its age. While effective and robust licensing is still essential in ensuring quality of care, the lack of license reciprocity and portability between states is now more of a hindrance to providing such care than a help.

That is why already active efforts to change medical licensing to facilitate telemedicine continue to gain steam. The most successful of these efforts to date has been the Federation of State Medical Licensing Board’s (FSMB) work establishing the Interstate Medical Licensure Compact. Physicians in good standing can freely practice in any of the states participating in the compact so long as they possess a “full and unrestricted” license in their state of principal license (SPL). To date, only 24 states, including Illinois, have joined the compact.

A Uniform, Nationwide System

This still leaves too many doctors and too many patients locked out of telemedicine. As noted by the authors of a recent article in the American Journal of Managed Care, “The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists.”

That is why the FSMB and other telemedicine advocates have advanced several proposals to enhance license portability and reduce regulatory barriers to telemedicine. They all are based around a mutual recognition scheme whereby states honor each other’s medical licenses based on models that have been successfully used in Europe and Australia and by the Veterans Health Administration, US military, and US Public Health Service.

Adoption of a nationwide licensing scheme would be facilitated by establishing consistent standards for using and regulating telemedicine services, the sharing of malpractice, medical error, and license cancellation or suspension information between states, and other federal and state-level reforms.

Any efforts that would streamline the physician licensing process while at the same time increasing access to healthcare for those who need it most should be encouraged.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Illinois Recreational Marijuana Licensing: A High-Level Overview

dopeIllinois is expected to be one of the largest retail marijuana markets in the country, and plenty of budding pot entrepreneurs will want to get in on the action and meet consumer demand by opening adult use dispensaries. And if you’re going to legally sell weed to the masses, you’ll have to pass muster with the Illinois Department of Financial and Professional Regulation (IDFPR).

Under the Cannabis Regulation and Tax Act (the “Act”) signed into law earlier this year, IDFPR is charged with implementing and administrating multiple aspects of the state’s adult use marijuana program, including the licensing and oversight of dispensing organizations. Needless to say, IDFPR won’t be passing around dispensary licenses without ensuring that applicants meet the Act’s multitude of requirements and limitations on dispensary ownership and operations.

On a very high level, here is what you need to know before firing up your efforts to apply for a license to open a recreational marijuana dispensary in the Land of Lincoln:

When to Apply

Applications for Conditional Adult Use Dispensing Organization Licenses will be available no later than October 1, 2019, and will be due no later than January 1, 2020. These licenses are “conditional” in that they do not allow the licensee to purchase or sell marijuana until they have found a suitable location (which they must do within 180 days), passed an inspection by IDFPR, and paid the registration fee.

Once these requirements are met, the Department will award the licensee an Adult Use Dispensing Organization License, which authorizes the holder to legally obtain and sell cannabis pursuant to the Act.

Costs of Application and License

The costs involved in applying for and maintaining an adult use license depends on whether or not the applicant is a “Social Equity Applicant.” In an effort to promote and ensure socio-economic diversity and opportunity in the Illinois cannabis industry, the Act provides for reduced fees and other accommodations for applicants from economically disadvantaged areas in the state.

The application fee is $5,000 for Non-Social Equity applicants and $2,500 for Social Equity Applicants. The fee for maintaining a two-year license is $60,000 for Non-Social Equity licensees and $30,000 for Social Equity licensees.

Number of Available Licenses

IDFPR may grant up to 75 adult-use dispensary licenses by May 1, 2020, and up to 110 licenses by December 21, 2021. But the law imposes limitations on the number of licenses IDFPR may issue for each of the 17 Bureau of Labor Statistics (BLS) Regions in Illinois based on that region’s percentage of the state population. The number of available licenses per BLS region is:

  • Bloomington: 1
  • Cape Girardeau: 1
  • Carbondale-Marion 1
  • Champaign-Urbana: 1
  • Chicago-Naperville-Elgin: 47
  • Danville: 1
  • Davenport-Moline-Rock Island: 1
  • Decatur: 1
  • Kankakee: 1
  • Peoria: 3
  • Rockford: 2
  • Louis: 4
  • Springfield: 1
  • Northwest Illinois Nonmetropolitan Area: 3
  • West Central Illinois Nonmetropolitan Area: 3
  • East Central Illinois Nonmetropolitan Area: 2
  • South Illinois Nonmetropolitan Area: 2

Criteria for Choosing Winning Applicants

There will be a heck of a lot more than 75 applicants for these 75 licenses, so IDFPR will use a point system based on numerous factors to determine who will receive licenses. Those who score highest on the following 250-point scale will be the most likely to be opening dispensary doors next year:

  • Suitability of Employee Training Plan (15 points)
  • Security and Record-Keeping (65 points)
  • Business Plan, Financials, Operating Plan, and Floor Plan (65 points)
  • Knowledge and Experience in Cannabis or Related Fields (30 points)
  • Status as a Social Equity Applicant (50 points)
  • Labor and Employment Practices (5 points)
  • Environmental Plan (5 points)
  • Illinois Owner (5 points)
  • Status as a Veteran (5 points)
  • Diversity Plan (5 points)

Ownership Requirements

Not every aspiring dispensary owner will be eligible to receive a license. In addition to being 21 or older, “principal officers” of the business (pretty much anyone with any ownership stake or management authority) must not have been “convicted of an offense that would impair the person’s ability to engage in the practice of owning a dispensary.” IDFPR will use several criteria when evaluating the impact of a principal officer’s previous conviction on their application.

These are just some of the issues involved in applying for and obtaining an adult use cannabis dispensary license in Illinois. While IDFPR may be the body granting licenses, applicants will also have to deal with local governments which will have a big say in whether and where a dispensary can set up shop.

If you are considering entering the legal cannabis industry in Illinois and have questions about the IDFPR application process and criteria, please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Will You No Longer Need a License to Do Your Job? States Meeting to Discuss Big Changes to Licensing Rules

hurdlesThe Illinois Department of Financial and Professional Regulation (IDFPR) is responsible for reviewing license applications in 235 separate categories covered by 61 different professional license acts. It licenses and regulates over 1 million professionals and firms throughout Illinois. But those numbers may shrink significantly, professional licensing may no longer be required for many professions, and it may get easier to get licensed in other states depending on the outcome of a multi-state conference of regulators to be held in December.

Should Tour Guides Need Licenses?

Illinois is one of 11 states participating in the Tucson, Arizona meeting, which was called to address what many consider to be the over-regulation of too many professions and occupations. According to the National Conference of State Legislatures (NCSL), which is a co-sponsor of the conference, the number of jobs requiring an occupational license, or government approval to practice a profession, has grown from about 1-in-20 to more than 1-in-4 over the past 60 years.

While no one takes issue with the need to license and regulate medical professionals, accountants, engineers, and the like, do tour guides really need to be licensed, as is actually required in some states (though not in Illinois)?

Economists and others have argued that professional licensing requirements for many occupations present unnecessary barriers that keep many people from entering those jobs while not significantly adding to consumer protection.

A 2015 study by the Brookings Institution found there were “far more cases” in which licensing reduced employment than ones where it improved the quality and safety of services. The restrictions have resulted in 2.8 million fewer jobs nationally and raised consumer costs by $203 billion annually, the study found.

Removing the Barriers to Moving

Additionally, since each state has their own licensing requirements and regulatory regimes, it can be exceedingly difficult and confusing when licensed professionals move to another state and want to continue their career. One state may require more hours of continuing education than another, for example, and simply transferring a license from one state to another can be an administrative nightmare.

The NCSL notes that that having to navigate 50 different licensing systems is particularly hard for military spouses and others who have to move frequently. At the conference, participants will attempt to find solutions that can bring uniformity and minimize the hurdles involved in relocating.

It remains to be seen what will come of this December conference. But there is no question that reforms to the professional licensing scheme here in Illinois and elsewhere would be a welcome development. Hopefully, Illinois regulators will address the unfairness of the professional license disciplinary process next.

Louis Fine: Chicago Professional License Defense Attorney

As a former Chief Prosecuting Attorney and administrative law judge for IDFPR, I have seen the serious consequences that an adverse enforcement decision can have on professionals who suddenly find their future in disarray. I understand how and why the Department decides to pursue investigations, how it handles negotiations, and how to approach formal proceedings in a way that gives my clients the best possible chance of a positive and expeditious outcome.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. Together, we will get you back to your clients and your career.