Telemedicine Flexibilities, Including Permission to Cross State Lines, Should Continue After COVID-19

June 8, 2021

In January 2020, the Department of Health and Human Services (HHS) declared COVID-19 a public health emergency (PHE), which sparked immediate regulatory relief and swift changes to telemedicine policy across federal and state governments and spurred an increase in the use of telemedicine in cancer care. Prior to the pandemic, providers cited improved documentation, better continuity of care, enhanced communication between provider and patient, greater treatment compliance, and the potential availability of data for scientific evaluation. Cancer patients also reported high satisfaction with telemedicine. As COVID-19 infections increased, and the PHE was officially announced, many practices turned to telemedicine for the first time.

However, most of the regulatory flexibilities and telemedicine policies implemented under the PHE are temporary. If these changes are reversed after the PHE is lifted, patient access to telemedicine may be jeopardized by technological and reimbursement barriers to telemedicine, as well as state-based licensure processes. In fact, the National Academy of Medicine identified the current framework for cross-state licensure, which requires a physician obtain multiple licenses to practice medicine in multiple states, as a persistent barrier to telemedicine in the United States. 

In response, the American Society of Clinical Oncology (ASCO) issued a new position statement outlining the issues that telemedicine cross-state licensure presents for the cancer care community, in addition to ASCO’s recommendations to continue the practice during the COVID-19 pandemic and beyond.

Specific recommendations include:

  • CMS should maintain flexibilities to ensure telemedicine is available to more practitioners and patients.
  • Every state should participate in the Interstate Medical Licensure Compact (IMLC). In states that do not participate, lawmakers should enact legislation to encourage them to join. ASCO will work with state medical associations and state and regional oncology societies to support these efforts. 
  • State and federal policies permitting telemedicine to cross state lines should include a provision requiring that the doctor-patient relationship be established prior to provision of any telemedicine service.
  • Medical liability providers should include telemedicine and data security related risks in their policies. Prior to the delivery of any telemedicine service, physicians should verify that their medical liability insurance includes comprehensive coverage for telemedicine services, including telemedicine across states in which they practice.
  • The Federal Trade Commission should monitor telehealth practice patterns and prevent unfair methods of competition as well as unfair or deceptive acts or practices.

In July 2020, ASCO developed its ASCO Interim Position Statement: Telemedicine in Cancer Care to signal its positions on the policy issues that emerged during the PHE and to recommend specific actions for applying telemedicine in cancer care. In December of that year, ASCO published Learning from the COVID-19 Experience to Achieve Affordable and Equitable Care and Clinical Research: The American Society of Clinical Oncology Road to Recovery Report, which provided recommendations on the immediate and short-term steps that could be taken to protect the safety of patients and health care staff as communities across the country begin gradually easing pandemic-related restrictions. The report recommended that ASCO develop a public policy position regarding cross-state licensure, coverage, and certification of providers using telemedicine. This latest position statement aims to fulfill that recommendation.

Read the full statement.

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