USA Trends and Developments Contributed by: Nadia de la Houssaye, Allison Bell, Emily Degan Vorhoff and Keiana Palmer, Jones Walker LLP
review of the state of the US digital health space may also be subject to change. Licensure: New Challenges to an Old System Prior to the COVID-19 pandemic, most states had strict limitations on the licensing of health- care professionals to practise telemedicine within their borders. Pandemic-era waivers from the Department of Health and Human Ser- vices (HHS) allowed for significant flexibility in telemedicine licensing requirements, though many of these waivers have only been extended through 30 September 2025. The Interstate Medical Licensure Compact (IMLC), which became operational in 2017 – in part as a result of the growth of telemedicine – continues to serve as an agreement among 40 states, the District of Columbia and the Territory of Guam. In these jurisdictions, physicians are licensed by 52 different medical and osteopathic boards. (Note that Michigan’s participation in the compact was repealed on 28 March 2025, and will go into effect 12 months from that date.) The compact enables physicians to qualify to prac- tice medicine in multiple states by completing just one application. Similar licensing compacts have gained momentum for audiologists, speech pathologists, occupational therapists and men- tal health counsellors. While the compact streamlines the application process, it does not eliminate the costs asso- ciated with obtaining and maintaining multi- ple state licences. Physicians must still pay between USD300 and USD700 for each state licence, which represents a significant financial burden for providers practising telemedicine at the national level. This is particularly challeng- ing as federal reimbursement rates decline and healthcare system administrative costs increase.
In December 2023, a lawsuit (Shannon MacDon- ald, MD, et al v Otto Sabando) was filed in the US District Court for the District of New Jersey. The plaintiffs argue that New Jersey licensure laws unfairly restrict the practice of specialised medicine across state lines. Although the case remains in its initial stages, the legal theories involved, including violations of the Commerce Clause of the US Constitution and the First and Fourteenth Amendments, have the potential, if successful, to reform state licensure law across the country. As state legislative and regulatory bodies grap- ple with these issues, providers must maintain vigilance in their compliance efforts, carefully tracking the evolving requirements on a state- by-state basis. CMS Policies and Reimbursement: Some, But Not All, Waivers Made Permanent Since the expiry of the federal Public Health Emergency (PHE) in May 2023, the HHS, the US Centers for Medicare and Medicaid Services (CMS) and the Drug Enforcement Agency (DEA) have extended a number of Medicare exemp- tions and policies. While some of these flexibili- ties are permanent, many remain temporary. The following is a list of some of the more relevant extensions. • Medicare patients can receive telehealth ser- vices for non-behavioural/mental health care in their home through 30 September 2025. • Medicare patients can permanently receive telehealth services for behavioural/mental health care in their home. • There are no geographic restrictions for origi- nating sites for Medicare non-behavioural/ mental telehealth services through 30 Sep- tember 2025.
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