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Will telemedicine restrictions lighten in the face of the pandemic? Can a licensed practitioner treat anyone from anywhere?

Chris Kresser: Next question from Sandy, “Will telemedicine restrictions lighten in the face of the pandemic? Can a licensed practitioner treat anyone from anywhere?”

Let me talk about this a little bit because I’m very deep in the weeds on this because of our new project that we’re launching. The summer Adapt Clinic is tentative, and it may or may not end up being that way, but some of you might have heard we’re launching a 100 percent telemedicine-based Functional Medicine, nutrition, and health coaching business in July, so I’ve done a ton of research into this. I’ve spoken to several healthcare attorneys, talked to various medical licensing boards, etc., and here’s my current summary or understanding. Unusually, the federal government has actually moved much more quickly than state governments in that case, and so what’s happened there is the CMS [Centers for Medicare and Medicaid Services] and also the VA [U.S. Department of Veterans Affairs] [have] made two big changes. Number 1, they’ve enabled reimbursement for telehealth, [which] wasn’t the case before, at least for CMS Medicare. Number 2, they are allowing any doctors and other practitioners like PAs [physician assistants] and NPs [nurse practitioners] to practice across state lines. Those provisions, however, apply only to Medicare and if you’re working in the VA. They do not apply to private medicine outside of Medicare. That is regulated on a state-by-state basis, as I’m sure you know, and even though the HHS [U.S. Department of Health and Human Services] has come out and said, hey, we really think it’s a good idea to relax licensing in states right now so people can get more access to care, they have no legislative authority to change that; it’s just a recommendation. Some states have acted on it, for example, Florida, which again, is ironic because Florida has historically been very conservative in this way, but Florida has relaxed their restrictions and said if you’re an MD or an NP or PA or whatever and you live outside of Florida, you can consult with residents of Florida via telemedicine even without getting a telemedicine license in Florida because Florida is one of the states that offers a separate telemedicine license for physicians that does not require them to get fully licensed in Florida, but then there are cases of other states who have made no changes. So it’s a real patchwork right now and it would take full-time personnel to figure out [in] every state what changes have been made or not been made, and then, of course, there is a question of how did those changes only apply to COVID-related care, [and] what defines COVID-related care because you can make a pretty strong case and most things right now are related ([if] someone has diabetes and you’re helping them reduce their blood sugar, isn’t that COVID-related care because diabetes is one of the biggest risk factors for hospitalization?), and then there’s a question of how long these changes will be in place. Is it going to be temporary, just during the COVID crisis, how do you define when the crisis finishes, won’t that be regional, etc., so it’s kind of a mess; that’s the legal situation. I can tell you that there are plenty of doctors. I’ve seen emails and posts from doctors who are just going ahead, who’ve interpreted the Medicare guidelines to suggest that even if they’re practicing outside of Medicare, in private medicine, those rules apply to them. I don’t think that is actually accurate legally, but as one of the attorneys that I talked to said, which is unusual for an attorney to say, but he basically said there’s very low appetite by [the] state to be prosecuting this stuff right now or even paying attention to it. They have a lot on their plate and this is the least of their concerns, especially if you’re not prescribing controlled substances and you’re just consulting with patients and maybe prescribing thyroid hormone or rifaximin for SIBO or something like that, you’re very low priority on their list. I’m not advising you to do that; this is not legal advice and that’s probably not legal in many states, but some clinicians who maybe have a little bit higher risk tolerance and deem that the risk of that [is] very low are going ahead and doing it, so that’s kind of my best synopsis. If you have any follow-up questions, please feel free to ask them.

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