White House Health Care Report Addresses Scope of Practice, Worker Mobility, and Telehealth

On December 3, 2018, the U.S. Department of Health and Human Services, Department of the Treasury, and the Department of Labor released a report entitled, Reforming America’s Healthcare System through Choice and Competition. The report follows a Presidential Executive Order directing the Administration to examine ways that the U.S. health care system can better provide cost-effective, high-quality care by promoting choice and competition.

In a section focusing on “Government Healthcare Policies and Their Effect on Competition,” the report summarizes how state licensing, scope of practice, and telehealth policies can impact provider supply and competition and makes recommendations for how the Administration can take steps to address them.

When discussing the impact of state scope of practice restrictions, the report acknowledges the important role states have in stipulating, “minimum education, training requirements, and certification, among other criteria, for those who seek to acquire or maintain a license” and recommends allowing “all healthcare providers to practice to the top of their license.” The report highlights how restriction of practice can contribute to limited access to care and increase the cost for services and recommends allowing non-physician provider to be paid directly for services they provide if there is evidence to support that they can do so safely and effectively. Advanced practiced registered nurses (APRNs) were used as an example of providers who are highly trained and are capable of providing safe and effective care comparably to physicians. The report recommends states to broaden the scope of practice, allowing all healthcare providers to practice to the top of their license. The report also recommends eliminating collaborative agreements that are not justified by legitimate concerns.

In addition to looking at state scope of practice laws and regulations, the report looks at the impact state licensing laws have on workforce mobility. The report highlights the issues that many providers face when attempting to obtain a license in another state, despite having national standards and a national exam. Interstate compacts and model laws are offered as a potential solution for states to improve license portability through reciprocity or expediting the licensure process. The report specifically cites the success of the Nurse Licensure Compact as an option to improve license portability. It also suggests that the federal government look at proposals to encourage states to adopt compacts, supporting greater mobility.

The report also references telehealth, noting that it has become a useful and important means of healthcare delivery, especially for those in underserved areas, and that it has the potential to reduce costs and improve health outcomes for patients. The report states that scope of practice and state licensing laws have sometimes created regulatory barriers to the delivery of telehealth services. To address these issues, the report recommends that states adopt interstate licensure compacts to make practicing across state lines easier.