II 

116TH CONGRESS 

2D SESSION S. 4421 

To provide temporary licensing reciprocity for telehealth and interstate health 

care treatment. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 4, 2020 

Mr. MURPHY (for himself and Mr. BLUNT) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To provide temporary licensing reciprocity for telehealth and 

interstate health care treatment. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Temporary Reciprocity 

5 to Ensure Access to Treatment Act’’ or the ‘‘TREAT 

6 Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) It is necessary to regulate, on a temporary 

10 and emergency basis, the provision of interstate 


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1 commerce as it pertains to treatment by medical 

2 professionals licensed in one State to patients in 

3 other States. 

4 (2) COVID–19, the disease caused by SARS– 

5 CoV–2, has created a national public health emer6 gency, as declared by the Secretary of Health and 

7 Human Services under section 319 of the Public 

8 Health Service Act (42 U.S.C. 247d) on January 

9 31, 2020, and by the President under the National 

10 Emergencies Act on March 13, 2020. 

11 (3) The COVID–19 pandemic has resulted in 

12 closing many businesses and nonprofit organizations, 

13 including colleges and universities, and large areas 

14 of the country remain under full or partial stay-at15 home orders, precluding the ability to seek routine 

16 or elective medical treatment and consultation. The 

17 closing of campus-based in-person learning at insti18 tutions of higher education has also meant that up 

19 to 1,000,000 students have returned to live with 

20 their families across State lines from where they 

21 may have been receiving medical care in the univer22 sity setting. Furthermore, in many rural areas, in23 person medical treatment is inaccessible. Even in 

24 urban areas, the pandemic has severely disrupted ac25 cess to medical care, requiring medical professionals 


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1 licensed in one State to provide treatment to pa2 tients residing nearby but across a State line and 

3 unable to visit the medical professional’s office in 

4 the State of licensure. 

5 (4) It is vital that hospitals, temporary surge or 

6 field facilities, skilled nursing facilities, and nursing 

7 homes in areas with high caseloads of COVID–19 

8 patients be able to have access to qualified medical 

9 professionals, including such professionals licensed 

10 in other States, without the delays that would be re11 quired for individualized licensing during a time 

12 when State agencies’ capacity to review and process 

13 licensing requests are limited by the pandemic. 

14 (5) The provision of services by medical profes15 sionals, including services provided at no cost and 

16 services provided to patients in a State other than 

17 the State or States in which the medical professional 

18 maintains an office for professional services, affects 

19 interstate commerce. When used to provide services 

20 to patients located in a State other than the State 

21 in which the medical professional is located, tele22 health services, as defined in section 3, utilize facili23 ties of interstate commerce. 

24 (6) The inability of patients to visit in-State 

25 health care providers during the current crisis subVerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421

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1 stantially affects interstate commerce. Economic ac2 tivity has been limited by public health authorities 

3 and other government officials to ‘‘flatten the curve’’ 

4 of infections and hospitalizations and thereby pre5 vent the health care system from becoming over6 whelmed. Maximizing the efficient and effective use 

7 of health care resources is therefore vital to reopen8 ing the economy. 

9 (7) Barriers to the efficient delivery of health 

10 care services will lead to a shortage of those services 

11 that substantially affect health care availability 

12 across State lines. Shortages in health care services 

13 in one State prompt interstate travel to obtain 

14 health care in other States, even though discour15 aging such travel, particularly among the sick, is 

16 vital to containing the contagion and reopening the 

17 national economy. 

18 SEC. 3. DEFINITIONS. 

19 In this Act: 

20 (1) the term ‘‘health care professional’’ means 

21 an individual who— 

22 (A) has a valid and unrestricted license or 

23 certification from, or is otherwise authorized by, 

24 a State, the District of Columbia, or a territory 


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1 or possession of the United States, for any 

2 health profession, including mental health; and 

3 (B) is not affirmatively excluded from 

4 practice in the licensing or certifying jurisdic5 tion or in any other jurisdiction; 

6 (2) the term ‘‘Secretary’’ means the Secretary 

7 of Health and Human Services; and 

8 (3) the term ‘‘telehealth services’’ means use of 

9 telecommunications and information technology (in10 cluding synchronous or asynchronous audio-visual, 

11 audio-only, or store and forward technology) to pro12 vide access to physical and mental health assess13 ment, diagnosis, treatment, intervention, consulta14 tion, supervision, and information across distance. 

15 SEC. 4. TEMPORARY AUTHORIZATION OF TELEHEALTH 

16 AND INTERSTATE TREATMENT. 

17 (a) IN GENERAL.—Notwithstanding any other provi18 sion of Federal or State law or regulation regarding the 

19 licensure or certification of health care providers or the 

20 provision of telehealth services, a health care professional 

21 may practice within the scope of the individual’s license, 

22 certification, or authorization described in section 3(1)(A), 

23 either in-person or through telehealth, in any State, the 

24 District of Columbia, or any territory or possession of the 

25 United States, or any other location designated by the 


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1 Secretary, based on the licensure, certification, or author2 ization such individual in any one State, the District of 

3 Columbia, or territory or possession of the United States. 

4 (b) SCOPE OF TELEHEALTH SERVICES.—Telehealth 

5 services authorized by this section include services pro6 vided to any patient regardless of whether the health care 

7 professional has a prior treatment relationship with the 

8 patient, provided that, if the health care professional does 

9 not have a prior treatment relationship with the patient, 

10 a new relationship may be established only via a written 

11 acknowledgment or synchronous technology. 

12 (c) INITIATION OF TELEHEALTH SERVICES.—Before 

13 providing telehealth services authorized by this section, the 

14 health care professional shall— 

15 (1) verify the identification of the patient re16 ceiving health services; 

17 (2) obtain oral or written acknowledgment from 

18 the patient (or legal representative of the patient) to 

19 perform telehealth services, and if such acknowledg20 ment is oral, make a record of such acknowledg21 ment; and 

22 (3) obtain or confirm an alternative method of 

23 contacting the patient in case of a technological fail24 ure. 


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1 (d) WRITTEN NOTICE OF PROVISION OF SERV2 ICES.—As soon as practicable, but not later than 30 days 

3 after first providing services pursuant to this section in 

4 a jurisdiction other than the jurisdiction in which a health 

5 care professional is licensed, certified, or otherwise author6 ized, such health care professional shall provide written 

7 notice to the applicable licensing, certifying, or authorizing 

8 authority in the jurisdiction in which the health care pro9 fessional provided such services. Such notice shall include 

10 the health care professional’s— 

11 (1) name; 

12 (2) email address; 

13 (3) phone number; 

14 (4) State of primary license, certification, or 

15 authorization; and 

16 (5) license, certification, or authorization type, 

17 and applicable number or identifying information 

18 with respect to such license, certification, or author19 ization. 

20 (e) CLARIFICATION.—Nothing in this section author21 izes a health care professional to— 

22 (1) practice beyond the scope of practice au23 thorized by any State, District of Columbia, terri24 torial, or local authority in the jurisdiction in which 


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1 the health care professional holds a license, certifi2 cation, or authorization described in section 3(1)(A); 

3 (2) provide any service or subset of services 

4 prohibited by any such authority in the jurisdiction 

5 in which the patient receiving services is located; 

6 (3) provide any service or subset of services in 

7 a manner prohibited by any such authority the juris8 diction in which the patient receiving services is lo9 cated; or 

10 (4) provide any service or subset of services in 

11 a manner other than the manner prescribed by any 

12 such authority in the jurisdiction in which the pa13 tient receiving services is located. 

14 (f) INVESTIGATIVE AND DISCIPLINARY AUTHOR15 ITY.—A health care professional providing services pursu16 ant to the authority under this section shall be subject 

17 to investigation and disciplinary action by the licensing, 

18 certifying, or authorizing authorities in the jurisdiction in 

19 which the patient receiving services is located. The juris20 diction in which the patient receiving services is located 

21 shall have the authority to preclude the health care pro22 vider from practicing further in its jurisdiction, whether 

23 such practice is authorized by the laws of such jurisdiction 

24 or the authority granted under this section, and shall re25 port any such preclusion to the licensing authority in the 


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1 jurisdiction in which the health care provider is licensed, 

2 certified, or authorized. 

3 (g) MULTIPLE JURISDICTION LICENSURE.—Notwith4 standing any other provision of this section, a health care 

5 professional shall be subject to the requirements of the 

6 jurisdiction of licensure if the professional is licensed in 

7 the State, the District of Columbia, or territory or posses8 sion where the patient is located. 

9 (h) INTERSTATE LICENSURE COMPACTS.—If a 

10 health care professional is licensed in multiple jurisdic11 tions through an interstate licensure compact, with respect 

12 to services provided to a patient located in a jurisdiction 

13 covered by such compact, the health care professional shall 

14 be subject to the requirements of the compact and not this 

15 section. 

16 SEC. 5. APPLICATION. 

17 This Act shall apply— 

18 (1) during the period beginning on the date of 

19 enactment of this Act and ending on the date that 

20 is at least 180 days (as determined by the Sec21 retary) after the end of the public health emergency 

22 declared by the Secretary of Health and Human 

23 Services under section 319 of the Public Health 

24 Service Act (42 U.S.C. 247d) on January 31, 2020, 

25 with respect to COVID–19; and 


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1 (2) subject to a declaration by the Secretary of 

2 Health and Human Services invoking such applica3 tion— 

4 (A) during a period in which there is in ef5 fect both— 

6 (i)(I) a major disaster with respect to 

7 not less than 12 States, declared by the 

8 President pursuant to section 401 of the 

9 Robert T. Stafford Disaster Relief and 

10 Emergency Assistance Act (42 U.S.C. 

11 5170) or emergency declared by the Presi12 dent under section 501 of the Robert T. 

13 Stafford Disaster Relief and Emergency 

14 Assistance Act (42 U.S.C. 5191); or 

15 (II) a national emergency declared by 

16 the President under the National Emer17 gencies Act (50 U.S.C. 1601 et seq.); and 

18 (ii) a public health emergency de19 clared by the Secretary of Health and 

20 Human Services under section 319 of the 

21 Public Health Service Act (42 U.S.C. 

22 247d); and 

23 (B) for at least 180 days after the disaster 

24 or emergency period under subclause (I) or (II) 


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1 of subparagraph (a)(I) ends, as determined by 

2 the Secretary of Health and Human Services. 

Æ 


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