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Federal Government Allows States to Loosen License Requirements

Mar 18, 2020
The Trusted Team

Think you can practice anywhere in an emergency? It’s still a state decision.

Yesterday morning (Wednesday, March 18th), Vice President Mike Pence announced that Health and Human Services (HHS) are preparing to suspend federal regulations that prevent medical professionals (nurses and doctors alike) from practicing across state lines given the current pandemic (i.e. removing the need to have state-specific or compact state licensure).

That said, as announced last Friday, states will need to apply directly with the Centers for Medicare & Medicaid Services (CMS) for a licensure waiver, and there will remain processes in place within each state to ensure proper licensure and the safety of the public. Following President Trump's signing of National Public Emergency (NPE), state governors will be able to sign an 1135 waiver that will allow their state to accept medical practitioners with licenses from other states.

When the President declared a national emergency on March 13th, the HHS Secretary was also granted “the power to waive certain federal licensing requirements so that doctors from other states can provide services in states with the greatest need.” 

In other words, “requirements that physicians and other health care professionals be licensed in the State in which they provide such services, if they have equivalent licensing in another State and are not affirmatively excluded from practice in that State or in any State a part of which is included in the emergency area.” 

This currently extends to “physician[s] or other health care practitioner[s] or professional[s].”

The CMS shared a press release clarifying this decision. The main takeaway: this is not a “de facto” one-license model that is immediately available; but rather, states that have declared a state of emergency can apply to the CMS for a state licensing waiver. 

This will allow “providers with an active license in good standing from any state to service patients in their state and be reimbursed for those services by Medicare and Medicaid,” with the primary objective being to increase telehealth capabilities, and the secondary one being to increase numbers of local, in-person medical personnel. 

What These Licensure Changes Mean for You

If you are a practicing physician, registered nurse, or other medical professional currently licensed in one state, given the current conditions dictated by the government’s response to the COVID-19 pandemic, you may have the opportunity to practice within any other state in need of additional medical personnel, as long as said state has applied to the CMS for a licensing waiver.

These changes apply primarily to telehealth initiatives (meaning you are able to perform remote services from your home state to any other state) but are also extended to in-person support.

For nurses specifically, this means that whether you currently possess a single-state or multi-state (compact) license, you will -- for the time being -- be fast-tracked through the state licensure process in any state that is included in the “emergency area” (currently the whole United States). This pertains to both telehealth functions as well as travel nursing roles.

How States Have Responded so Far

So far, according to the NCSBN, at least 33 states have submitted to the CMS to waive certain medical provider licensing requirements. You can see the status of all states below (*Upd. 3/26):

Alabama

  • Submitted 1135 waiver; Licensed nurses can work in Alabama without a state-specific license for a period of 30 days after the Governor declares a state disaster

Alaska

Arizona

  • Submitted 1135 waiver; "temporary waiver of professional licensure requirements necessary[...] to address the state of emergency."

Arkansas

  • Implemented an expedited licensing process (single-state and valid for three months)

California

  • Submitted 1135 waiver; Any state license is welcome but must be registered by the facility (requires 2-4 business days)
  • BON Verification Link

Colorado

  • Any compact license (multi or single-state) accepted
  • BON Verification Link

Connecticut

Delaware

  • Submitted 1135 waiver; Licensed nurses can work in Delaware without a state-specific license

Florida

  • Submitted 1135 waiver; Any valid license from any state will be accepted
  • BON Verification Link

Georgia

  • Submitted 1135 waiver; Any valid APRN, RN, or LPN license from any state will be accepted

Hawaii

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Idaho

  • Submitted 1135 waiver; Any valid license from any state will be accepted
  • Expedited online process
  • BON Verification Link

Illinois

Indiana

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Iowa

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Kansas

  • Offering exemption: "An exempt license shall be granted only to a registered professional or practical nurse who meets these requirements: (1) Is not regularly engaged in nursing practice inKansas, but volunteers nursing services or is a charitable health care provider..."

Kentucky

  • Any valid license from any state will be accepted

Louisiana

  • Submitted 1135 waiver; Temporary licensing and credentialing for healthcare providers willing to assist from out of state

Maine

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Maryland

  • Submitted 1135 waiver; Any valid license from any state will be accepted
  • BON Verification Link

Massachusetts

  • Expedited online process of "reciprocal licensure" (requires 1 business day)
  • BON Verification Link

Michigan

  • Any valid license from any state will be accepted

Minnesota

Mississippi

  • Telehealth amendments: "Out-of-state APRNs may utilize telehealth when treating patients in Mississippi without the necessity of securing a license to practice in the state..."

Missouri

  • Expedited licensure applications: anyone who graduated nursing school after December 16, 2019 but has not yet taken the NCLEX (has not been denied licensure) can practice as a graduate nurse pending the results of their first licensing exams or 180 days (whichever comes first)

Montana

  • Any valid license from any state will be accepted

Nebraska

Nevada

New Hampshire

  • Any valid license from any state will be accepted
  • Expedited online process
  • BON Verification Link

New Jersey

  • Submitted 1135 waiver; Any valid single-state license from any state will be accepted (at least for telehealth and telehealth medicine purposes)
  • Partially implemented nurse licensure compact: nurses holding compact licenses will currently find their licenses valid in New Jersey
  • Any valid multi-state license from any state will be accepted

New Mexico

  • Submitted 1135 waiver; Any valid license from any state will be accepted and will not need a New Mexico license until upwards of 30 days thereafter
  • Any travel nurse entering New Mexico for assignment must self-quarantine for 14 days before showing up to work
  • BON Verification Link

New York

  • Any valid/active license from any state will be accepted, does not need to register with the New York Board of Nursing
  • BON Verification Link

North Carolina

  • Any valid license from any state will be accepted
  • BON Verification Link

North Dakota

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Ohio

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Oklahoma

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Oregon

  • Any valid license from any state will be accepted

Pennsylvania

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Rhode Island

  • Submitted 1135 waiver; Any valid license from any state will be accepted (permits 90-day license to practice that can be extended once)

South Carolina

  • Submitted 1135 waiver; Any valid license from any state will be accepted
  • Expedited online process (requires 1 business day)
  • BON Verification Link

South Dakota

  • Any valid license from any state will be accepted (and honored for 90 days)

Tennessee

  • Submitted 1135 waiver; Any valid license from any state will be accepted
  • BON Verification Link

Texas

  • Submitted 1135 waiver; Any valid license from any state will be accepted, nurses must be submitted using this process via the Texas Board of Nursing
  • BON Verification Link

Utah

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Vermont

  • Submitted 1135 waiver; Any valid license from any state will be accepted (licensure lasts 90 days and can be renewed until the state of emergency is over)

Virginia

  • Submitted 1135 waiver; Government waives requirements of fees, CEUs, and reactivation of licenses for APRNs, RNs, and LPNs

Washington

  • Any valid license from any state can submit, nurse needs to acquire WA license before starting; expedited licensure process direct through the Washington Board of Nursing
  • BON Verification Link

West Virginia

Wisconsin

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Wyoming

  • Submitted 1135 waiver; Any valid license from any state will be accepted

Washington, D.C.

  • Submitted 1135 waiver; Licensed nurses can work in D.C. without a state-specific license

Guam

  • Submitted 1135 waiver; Licensed nurses can work in Guam without a state-specific license

Northern Mariana Islands

Puerto Rico

Virgin Islands

America Samoa

*We'll be adding more information for each state as it becomes available.

Additionally, Texas, Maryland, and South Carolina have granted temporary out-of-state licensure to applied and submitted healthcare professionals; while Colorado has enacted an extension of the Enhanced Nurse Compact Licensure, allowing out-of-state nurses in good standing to work locally in Colorado; and, Massachusetts, as well as Washington, have announced an expedited, single-day licensure process. 

Arizona, Pennsylvania, and Montana extended various iterations of out-of-state licensure to help assimilate workers with "occupational licensure" (inclusive of physicians, nurses, and OTs) back in 2019, ahead of recent events.

If you would like help moving through any of these modified processes, you can sign up in only a few minutes to speak with a Nurse Advocate today.