By Carl Sims, CSG Policy Analyst
- The COVID-19 crisis has resulted in shortages of qualified, licensed health care and other related professions that are needed to support state and local responses.
- States have been enacting measures to modify existing licensing regulations that remove barriers that may prevent an individual to assist in response efforts.
- Many states have been granting temporary licensure for out-of-state professionals or those that are otherwise retired, still in training, or have lapsed licenses.
- Certain health care practitioners in some states are being granted expanded scopes of practice.
- Other states are removing barriers to allow for greater use of telemedicine services.
- States are also waiving or suspending certain requirements related to the maintenance or attainment of licenses where they might require physical travel, interactions or might otherwise be difficult to achieve during the crisis.
Addressing the Problem
Occupational licensing serves as a way for states to help ensure the protection of public health and safety where there exists the potential for physical, emotional or financial harm. Each state maintains the authority to structure the scope of practice, education and other training requirements necessary for an individual to be granted the right to practice a certain profession. However, given the independent of licensing regulations between states, licensure portability can be particularly difficult to achieve without other supporting policy provisions. Further, achieving and maintain licensure can require significant time and financial investments and thereby decrease the current availability of practitioners.
This issue has been compounded by the recent increased demand in health care related occupations, which are commonly licensed. Increasing the supply of an already spread thin workforce has been one of the primary challenges states are facing. Unlike other disasters which may be more localized, COVID-19 is affecting every state. Even though the severity of cases may vary across the country, states may not be able to safely send health care workers harder hit states in case their own situation may worsen.
How Are States Impacted?
The occupational licensing policy responses by states are centered on how states can meet their health care demands now and relieve regulatory burdens or requirements impacted by COVID-19. Therefore, many of the policy actions involve temporarily waiving, suspending, or modifying licensing requirements or granting temporary licenses during state declarations of emergency.
Action in the States
States have been primarily taking occupational licensing related action through executive orders. Many legislatures have either adjourned or been suspended due to the crisis, however, some had the opportunity to also pass supporting legislation. Other state responses have come from existing provisions and procedures in place such as through the Emergency Management Assistance Compact which provides a process for states to request and allow out-of-state licensed workers.
Below is a sample of state actions related to occupational licensing:
- Executive Order – Allows any person who holds a valid, unexpired license as a health care practitioner that is issued by another state to engage in the activities authorized under that license at a health care facility in Maryland.
- Executive Order – Allows any inactive practitioner, at a health care facility in Maryland, to engage in activities that would have been authorized under his/her inactive license without first reinstating his/her inactive license
- Executive Order – Extends expiration date of all licenses, registrations, and other authorizations for 30 days
- Executive Order – Allows unlicensed
non-nursing staff to perform basic nursing tasks including swabs/tests
- Executive Order – Allows physicians
and nurse practitioners to issue non-patient-specific regimens to those
authorized by law or exec. order to conduct swabs/tests; allows nurses to order
- Executive Order – Allows nurses, physicians
assistants, physicians, respiratory therapists, and midwives licensed in other
states to practice in the state without penalties.
- Executive Order – Allows physician
assistants, specialist assistants, nurse practitioners, professional nurses and
practical nurses to exceed their normal practice scope and to operate without a
- Executive Order – Allows
nursing/medical students to volunteer at medical centers without any formal
arrangement (and to collect educational credit for it); also allows grads of
foreign med schools with one year of postgrad training to provide patient care
- Executive Order – Allowing pharmacists/pharmacy technicians to practice remotely
- Executive Order – Triggers provisions relating to the Emergency Management Assistance Compact; grants full recognition to emergency licenses of practitioners from compact states.
- Executive Order – Declaration of emergency triggers statutory provision allowing licensed out-of-state medical professionals and retired Utah professionals to acquire temporary emergency licenses in Utah; application fees are also waived.
- H.742 –Creates fast tracks for out-of-state licensed healthcare and mental health professionals, retired healthcare and mental health professionals, and new graduates to join or return to the Vermont workforce.
- Executive Order – Suspends expiration dates of medical licenses; suspends requirements that boards of certification/registration conduct investigations within a certain timeframe.
- Executive Order – Allows licensed out-of-state nurses and doctors to practice in in the state (including telemedicine) without any further certification; suspends continuing education requirements; allows retired physicians to return to practice without having to re-certify.
- Executive Order – Eases requirements for issuance of temporary permits for medical students to practice respiratory care; waives medical license renewal fees for respiratory care practitioners
The COVID-19 state actions related to occupational licensing aim to increase the supply of qualified health care practitioners by removing certain barriers created by regulation. States are also taking action to ensure licensure requirements by non-health or other COVID-19 related response occupations are not adversely impacted by stay at home orders, travel restrictions or other interruptions to normal operations relative to the license.