Ongoing Projects

A newly launched telepsychiatry program in North Carolina is resulting in patients spending less time waiting in hospital emergency rooms for mental health services and decreasing their likelihood of returning for treatment.  The program, which started January 1, 2014, is a joint initiative between the Governor’s office, the Department of Health and Human Services, and East Carolina University.  28 of the 100 counties in North Carolina do not have a single psychiatrist, which is creating a statewide shortage for mental health services.  As a result the state is electronically connecting patients with a psychiatrist via a secured two-way video connection.

Indiana became the first state to join the State Authorization Reciprocity Agreement (SARA) this week.  SARA was developed as a joint effort between the Presidents’ Forum, the Council of State Governments, the Commission on Regulation of Postsecondary Distance Education, and the four regional higher education compacts – the Midwestern Higher Education Compact (MHEC), the New England Board of Higher Education (NEBHE), the Southern Regional Education Board (SREB), and the Western Interstate Commission for Higher Education (WICHE). 

A blog written by Robert Kocher that appeared in Health Affairs earlier this week endorses the idea of interstate physician licensing agreements as a way to improve access to health care.  Kocher currently serves on the advisory board of the Harvard Medical School Health Care Policy Department and previously worked in the Obama Administration as Special Assistant to the President for Healthcare and Economic Policy.   In his posting he notes that the current physician licensing system limits a physician’s ability to practice across state lines, which in turn has stifled the growth of telemedicine and has also resulted in problems such as specialist shortages in rural and underserved areas. 

Florida Senate Bill 7028, entitled an act relating to telemedicine, would allow the state licensing board and the Florida Department of Health to explore a telemedicine compact for the purposes of increasing access to health care.  The bill was introduced this session and will first be considered by the Committee on Health Policy. 

A report from the California Legislative Analyst’s Office endorsed the State Authorization Reciprocity Agreement (SARA) as a way for states and institutions to more effectively address the challenges of offering distance education programs across state borders.  The report, which is entitled Oversight of Private Colleges in California, concluded the following with respect to SARA:

A letter dated January 9, 2014 and signed by 16 US Senators commended efforts to develop an Interstate Medical Licensing Compact.  The bi-partisan group of Senators, which was led by Senator John Thune (R-S.D.) and Senator Mike Enzi (R-Wyo.), applauded the Federation of State Medical Boards and the Interstate Medical Licensure Compact Taskforce for beginning work on a medical licensing compact.  CSG, through the National Center for Interstate Compacts, is providing technical assistance to the Taskforce. 

When it comes to solving problems, states increasingly are turning to a mechanism that dates back to America’s colonial past—the interstate compact. Compacts are one of the few tools specifically granted to states by the U.S. Constitution. They provide states a sophisticated administrative mechanism, allowing interstate collaboration to resolve complex policy challenges.

Compacts, which are governed by the tenets of contract law, provide states an enforceable, sustainable and durable tool capable of ensuring permanent change...

Crady deGolian, Director of CSG's National Center for Interstate Compacts, outlines the top 5 compacts to watch in 2014, including those dealing with the siting of electricity transmission lines,  interstate reciprocity regarding online education, and several compacts related to licensing, including EMS licensing, medical licensing, and physical therapy and telepsychology licensing compacts. 

The cost of health care in the United States has grown an average of 2.4 percent faster than the gross domestic product since 1970; it now represents 18 percent of the total GDP, according to the Kaiser Family Foundation. One challenge contributing significantly to these costs is access to health care in hard-to-serve locations. Problems accessing care is especially common in rural areas. According to the American Academy of Family Physicians, 21 percent of the U.S. population lives in rural areas, but only 11 percent of medical specialists practice in those areas. This results in a significant segment of the population that is frequently underserved. One possible solution is a series of medical licensing compacts intended to reduce existing barriers to the process of gaining licensure in multiple states.

The siting of interstate transmission lines has long-been a problem that has vexed both states and the federal government.  With the expected growth in electricity demand, coupled with the need to bring renewable energy to market and the necessity to enhance and secure the nation’s energy infrastructure, the need for added transmission capacity has never been more apparent.  However federal needs and state interests frequently do not align, leading to an underdeveloped and over-stressed electricity transmission system.