The COVID-19 pandemic has had a profound impact on the healthcare industry, causing significant disruptions and changes in the way healthcare professionals work. To address the influx of healthcare professionals needed to fight the pandemic, many states implemented emergency measures to ensure patients received the care they needed.

During the pandemic, emergency measures included creating emergency licensure applications or waiving certain licensure requirements. Some states expanded license reciprocity. Others waived licensure requirements for certain types of healthcare professionals, allowing them to practice without the usual licensing procedures. Additionally, some states waived the requirement for in-person visits before providing telehealth services. These measures allowed healthcare professionals to practice across state lines or in areas where their expertise was most needed, helping to provide essential healthcare services during a critical time.

However, as the situation improves, healthcare professionals and organizations need to prepare for the return to pre-pandemic licensing requirements. In this article, we will discuss the changes in licensing requirements during the pandemic, and how to prepare for the return to pre-pandemic licensing.

Pandemic Licensing Adaptations and Their Implications

During the COVID-19 pandemic, many states introduced temporary, emergency, or fast-tracked licensure or waived certain licensure requirements to address the urgent need for healthcare professionals. 

For instance, Massachusetts established an expedited “Emergency Temporary License Application” for physicians with an active, unrestricted medical license in another U.S. state, territory, or district. New York completely waived licensure requirements for specific physicians, while Delaware lifted the in-person patient visit prerequisite for telehealth services.

While state-based actions increased the availability of healthcare professionals, unified changes have made the healthcare community more adaptive to the rapidly changing situation:

Telehealth Parity Laws

During the pandemic, the Centers for Medicare & Medicaid Services (CMS) increased reimbursement rates for telehealth providers at non-facilities, which created payment parity between an in-person and a telehealth visit. This was done to encourage the use of telehealth and ensure patient access to care during the pandemic, particularly those who were at higher risk of infection or who had limited access to transportation or healthcare facilities. The increased reimbursement rates also helped healthcare providers who were experiencing financial strain due to decreased in-person visits.

The current reimbursement rates will only last through 2023. After that point, rates may revert to lower pre-pandemic levels.

Telehealth & RPM Copayment Waivers

The HHS Office of Inspector General (OIG) issued a policy statement that providers wouldn’t face administrative sanctions for reducing or waiving cost-sharing amounts for telehealth or remote patient monitoring (RPM) services for Medicare beneficiaries. This policy aimed to alleviate financial barriers to healthcare and ensure that patients could continue to receive care regardless of their financial situation. As a result, more patients were able to access these services and receive the care they needed.

RPM Services Limited to “Established Patients”

In an effort to expand access to care during the pandemic, CMS waived the requirement that RPM services could only be billed for established patients. This allowed providers to offer RPM services to new patients, who may have been unable to receive in-person care due to the pandemic.

However, it’s important to note that this waiver only applied during the PHE, and outside of this period, RPM services are still limited to established patients.

End of HIPAA-related Enforcement Discretion

To facilitate the use of telehealth and ensure patients had access to care during the pandemic, the HHS Office for Civil Rights (OCR) provided guidance that allowed healthcare providers to use non-HIPAA-compliant platforms for telehealth services without the risk of federal penalties, as long as they acted in good faith.

This guidance only applies to the duration of the PHE, and providers should be prepared to comply with HIPAA requirements once the PHE ends.

Returning to Pre-Pandemic Licensing Requirements: Navigating Permanent and Temporary Changes

As the COVID-19 pandemic subsides, some aspects of healthcare in the United States will revert to pre-pandemic norms, while others will continue in a modified form. Let’s delve into these changes more closely.

Permanent Changes in Telehealth Services

One permanent change is the ability of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide distant-site behavioral/mental telehealth services. Medicare patients can now receive these services at home, without geographic restrictions on originating sites. Additionally, audio-only communication platforms are now permitted for delivering these services.

Rural hospital emergency departments are now also recognized as originating sites for telehealth services, a significant development for patients with limited access to nearby healthcare facilities.

On February 24, 2023, the DEA proposed a rule allowing prescriptions for controlled substances via telehealth encounters in limited circumstances. While controlled substances can still only be prescribed after a provider examination, this rule change could provide more options for patients who need these medications but have limited access to in-person care.

Temporary Changes

The Consolidated Appropriations Act (CAA) of 2023 extended several telehealth flexibilities authorized during the COVID-19 Public Health Emergency (PHE) through December 31, 2024. Some continuing temporary changes include:

  • Healthcare providers eligible to bill Medicare can bill for telehealth services regardless of the patient’s or provider’s location, allowing patients to receive telehealth services at home.
  • Audio-only telehealth visits remain reimbursable, benefitting patients without access to video-conferencing technology.
  • The list of providers eligible to deliver telehealth services remains expanded to include physical therapists, occupational therapists, speech-language pathologists, and audiologists.
  • The acute hospital care at-home program can continue, providing hospital services to patients at home, including through telehealth.
  • Telehealth can be used to conduct recertification of eligibility for hospice care.
  • Patients with High Deductible Health Plans coupled with Health Savings Accounts can utilize first-dollar coverage for telehealth services without meeting their minimum deductible first.
  • FQHCs and RHCs can provide telehealth services to Medicare beneficiaries as distant site providers, rather than being limited to originating site providers.

What’s Coming to an End

First and foremost, the temporary nurse aide (TNA) waiver, which reduced training hours for nurse aides, will expire on May 11, 2023. This means that training and assessments will revert to their original requirements.

Furthermore, the increased flexibility for home-based care for Medicaid recipients during the pandemic will also end on May 11, 2023

As a result, states will need federal waivers to provide home care benefits, and Medicaid enrollees will have to meet specific requirements again to receive long-term care.

Finally, the liability immunity provided under the Public Readiness and Emergency Preparedness (PREP) Act will end on October 1, 2024. This includes hospital COVID-19 data reporting requirements, which will continue through April 30, 2024, unless the Health and Human Services Secretary establishes an earlier date.

Learn more about Provider Enrollment & Credentialing Timeframes

Remember State Medical Boards’ Rules

The above discussion pertains solely to federal regulations. Healthcare professionals and providers should also stay informed about any additional state medical boards’ requirements. Most states have already concluded their emergency standards, with many reverting to pre-pandemic rules regarding telehealth requirements and Medicaid payment stipulations. Meanwhile, other states have implemented permanent changes based on their experiences during the PHE. 

Providers should examine state regulations, consult with licensing agencies, and verify payer program standards moving forward.

Getting Ready for the Return to Pre-Pandemic Licensing

The Department of Health and Human Services (HHS) has released a guide to assist healthcare providers in preparing for the termination of temporary pandemic-related waivers and the reinstatement of pre-pandemic licensing standards. This guide contains useful fact sheets for various types of providers, such as physicians, hospitals, long-term care facilities, and laboratories.

The Centers for Medicare & Medicaid Services also encourages the healthcare system to brace for the return to pre-pandemic licensing standards. They’re requesting that providers begin phasing out flexibilities that are no longer critically needed and take action to adhere to the updated standards. This approach will help providers transition back to standard operations while maintaining high-quality patient care.

Essential Factors for Healthcare Professionals and Organizations

It’s vital that your organization is ready for the end of the PHE. If you haven’t begun preparing, take these steps immediately:

  • Examine the HHS guidance and state regulations to ensure you grasp the required changes.
  • Identify any practices or arrangements that must be altered to comply with the regulations.
  • Update your policies and practices, and train your staff on the changes.
  • Stay alert for any new legislation or agency action related to the applicable standards.

Acting now is crucial to avoid liability for noncompliance once the PHE concludes. Potential penalties include denial or repayment of reimbursement, False Claims Act liability, and more.

Another key aspect to consider is patient safety during the transition phase. Review your infection control protocols and make sure you’re equipped to manage any potential outbreaks that may arise as a result of returning to pre-pandemic operations.

Finally, remember to consider the impact of the transition on your workforce. Your staff might face increased stress and burnout during this period of change, so it’s important to offer them the support and resources needed to handle any challenges that may emerge.

Best Practices for Adapting to Pre-Pandemic Licensing Requirements

As healthcare professionals and organizations gear up for the conclusion of the Public Health Emergency (PHE), it’s vital to grasp the best practices for adjusting to pre-pandemic licensing requirements. Here are some key factors to bear in mind:

Understand and review pre-pandemic licensing requirements

It’s crucial to thoroughly examine and comprehend the pre-pandemic licensing requirements for your organization. This encompasses state regulations, accreditation standards, and any other relevant licensing requirements. Doing so will help you pinpoint any compliance gaps and devise a plan to address them.

Create a thorough plan for compliance

Once you’ve identified any compliance gaps, create a detailed plan to tackle them. This plan should involve updating policies and procedures, training staff, and implementing any necessary changes to practices or arrangements. Additionally, your plan should incorporate regular monitoring and auditing to ensure sustained compliance.

Communicate with staff and patients effectively

Clear communication is critical during the transition to pre-pandemic licensing requirements. Make sure to convey any changes to staff and patients, ensuring everyone is aware of new policies and procedures. This approach can help maintain compliance and enhance patient safety.

Prioritize patient safety

Patient safety should remain a top concern during the shift to pre-pandemic licensing requirements. This involves implementing best practices for infection prevention and control, guaranteeing proper documentation and record-keeping, and continuously monitoring and addressing potential safety issues.


  • What are the licensing changes that were implemented during the pandemic?
    During the pandemic, many licensing requirements were temporarily relaxed to help healthcare professionals and organizations cope with the increased demand for services. For example, some states allowed healthcare providers to practice across state lines, and certain telehealth regulations were loosened to make it easier for patients to receive care remotely.
  • When will healthcare professionals be required to return to pre-pandemic licensing requirements?
    The Centers for Medicare & Medicaid Services (CMS) has announced that healthcare professionals and organizations should prepare to return to pre-pandemic licensing requirements by May 11, 2023. Providers should review the HHS guidance and relevant state rules to confirm and comply with the revised standards.
  • What are the key considerations for healthcare professionals and organizations during the transition back to pre-pandemic licensing?
    It’s important to identify any practices or arrangements that need to be revised in order to comply with regulations, update policies and practices, and train staff on the changes. Healthcare professionals and organizations should also keep an eye out for any new legislation or agency action related to applicable standards. Failure to take these steps may expose your organization to liability for noncompliance once the PHE ends.
  • What are some strategies for adapting to pre-pandemic licensing requirements?
    To optimize licensing compliance and ensure patient safety during the transition, healthcare professionals and organizations should consider implementing best practices such as conducting self-audits, identifying areas of potential risk, and engaging with regulatory bodies to seek guidance and feedback. Additionally, ensuring open communication between staff and patients can help to mitigate any disruptions or confusion caused by the transition.
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