State Outlook: Occupational Licensing Policies in the COVID-19 Era

As the COVID-19 pandemic began to spread quickly throughout the United States, it became readily apparent to state leaders that health care workforce capacities might be overwhelmed. Many states provisionally amended occupational licensure policies to reduce regulatory burdens and increase the capacity of hospitals. Non-health care occupations also were temporarily relieved of certain licensing requirements, especially those reliant on in-person services such as continuing education. All 50 states and Washington D.C. passed some licensure streamlining actions in 2020, typically through executive orders and administrative rule changes. These changes are analyzed in a recent policy report by The Council of State Governments (CSG) researchers: “Assessing COVID-19 Occupational Licensing Policy Actions”.

These recent efforts by states are part of a larger trend to improve labor market entry and interstate workforce mobility for licensed occupations. However, the COVID-19 public health emergency prompted states to specifically prioritize policies that modify scopes of practice and licensing requirements, expand telehealth services and temporarily license volunteer, out-of-state, retired and in-training practitioners. While many state actions were made for at least the duration of the public emergency, some states took further measures to make permanent policy changes particularly around telehealth.

  • In June, the Colorado legislature passed SB 20-212, which expands access to telehealth for Colorado residents by prohibiting insurers from requiring an established in-person practitioner/patient relationship or imposing location or additional licensure requirements, as well as preventing limitations on the use of Health Insurance Portability and Accountability Act (HIPAA)-compliant technologies to deliver telehealth. Colorado Governor Jared Polis had previously expanded access to telehealth temporarily through Executive Order 2020-020.
  • Ohio has approved two actions to make emergency rulings permanent. Governor Mike DeWine issued Executive Order 2020-29D, which permanently allows the following health care workers to practice telemedicine: home health and hospice aides, private Registered Nurses, hospice Licensed Practicing Nurses, dentists and mental health practitioners. This Executive Order requested the state’s medical board make the changes permanent, or else it would expire. Subsequently, Ohio’s State Medical Board issued AC 5160-1-18, which expanded definitions of telehealth, reduced restrictions on its use and allowed telehealth services to be paid for by Medicaid.
  • Idaho Governor Brad Little used executive action to change regulations to the practice of telehealth throughout the state. Governor Little previously has issued proclamations on April 2 and April 23  to suspend requirements and disciplinary provisions related to physicians’ use of telehealth. Governor Little made those actions permanent through Executive Order 2020-13 on June 22  and allowed out-of-state practitioners to provide telehealth services in Idaho, effective January 2021. The bill also gives state licensing agencies the ability to determine whether specific, temporary regulations are “deleterious to public health or safety,” and allows them to permanently suspend that regulation

As states continue to assess the on-going impacts of COVID-19 and ways to improve state resilience, more consideration will be given to permanent policy changes which improve licensure mobility and improve access to licensed services. Part of the reason only a few states have made these changes by statute is because many legislatures have not been in session during most of the pandemic. In preparation for the upcoming 2021 sessions, multiple bills throughout the United States have been pre-filed to relieve regulatory burdens related to COVID-19 occupational licensure policy concerns. Some examples:

  • In New Jersey:
    • S 279 would revise requirements and processes for temporary courtesy licenses and certificates issued by the State Board of Examiners, Board of Nursing and other professional and occupational licensing boards.
    • S 3175 would permit expedited licensure in mental health professions for certain out-of-state individuals during a state of emergency or public health emergency.
    • A 1100 would enter New Jersey into the Emergency Medical Services Personnel Licensure Interstate Compact.
  • In Kentucky, BR 245 would enter the state into the Psychology Interjurisdictional Compact and allow psychologists to hold one or more compact state licenses at a time.
  • In Minnesota, HF 29 would enter the state into the Psychology Interjurisdictional Compact.