The Enhanced Nurse Licensure Compact (eNLC) has been implemented as of January 19, 2018. This means that any nurse living in an eNLC state can apply for a multistate license and practice in any of the participating states without maintaining individual state licenses. There are currently 29 states opted into the compact but more are expected to follow.

What is the eNLC?

In 1997, Boards of Nursing (BONs) developed the Nurse Licensure Compact (NLC), which enabled nurses to have a license in their state of residency and practice in other NLC states. Overseen by the National Council of State Boards of Nursing (NCSBN), the NLC was implemented in 2000 and approved by 24 states by 2010. Then it hit a speed bump.

Among other things, state legislatures wanted a criminal background check on all NLC licensed nurses. So, in 2015, BONs executive officers unveiled the Enhanced Nursing Licensure Compact (eNLC) with 11 uniform licensure agreements including a background check requirement.

By June 20, 2017, 26 states, which was the number of states needed to implement the program, had approved eNLC legislation. Currently, there are 29 member states, and eight more have pending eNLC legislation on their rosters.

The Beginning of a Healthcare Revolution

The eNLC is the first multistate licensing agreement in the healthcare industry that covers the majority of the United States. Nurses living in eNLC states no longer have to pay additional license fees and complete multiple lengthy application processes in order to practice in other eNLC states. They also don’t have to maintain these additional licenses (which requires renewal every two years).

Greater Mobility

The implementation of eNLC means that nurses living on state borders can easily practice in a neighboring state. Military spouses moving every few years can find a new job more quickly. This new mobility is especially important for traveling nurses who take care of our most vulnerable—home care nurses, hospice nurses, and caseworkers. And in the event of an emergency in an eNLC state, nurses across the country can volunteer their services.

Improved Telemedicine Experiences

One of the most exciting benefits of the eNLC is that it comes right when telemedicine is reaching its stride. For telemedicine to flourish, healthcare providers need the ability to work across state borders, and the implementation of the eNLC is a first big step in that direction.

Patients who don’t live near limited healthcare providers will now have access to the expertise of nurses across the country. Growing telemedicine practices will have a larger network of top quality medical expertise, and patients will in turn have a greater choice of healthcare providers.

As more states adopt eNLC, the healthcare industry will be closer to meeting the growing challenges of a more mobile—both physically and virtually—patient community by expanding job opportunities for nurses and healthcare opportunities for the public.

But this is only the first step. The creation of eNLC and its adoption by the majority of the United States has paved the way for other medical associations to create similar multistate license agreements, so in the coming years, healthcare in the United States will be easier to access and easier to provide.


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The Telehealth services industry has a new victory over a former foe—reimbursement barriers. The 2017 KLAS and CHIME research survey reports that half of the participating health organizations stated that reimbursement was a limitation and a barrier for their Telehealth programs. The latest groundbreaking legislation has removed that barrier.

After a five-hour government shutdown, President Trump signed a $400 billion budget deal into law on February 9, 2018. The budget deal expands the Telehealth reimbursement under the (CHRONIC) Care Act. This recent legislation will increase electronic interaction between healthcare providers and patients—providing more access to video conferencing and remote technology.

Senator Brian Schatz commented about the new law on his Twitter account: “Tucked into the bill signed are the most significant changes ever made to Medicare law to use Telehealth. It will increase access and quality of care, and reduce costs using tech that’s already available.”

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act opened doors for healthcare providers by lifting outdated restrictions that limited Medicare reimbursements for telehealth. Although the signed bill expands telehealth provisions specifically for the Medicare demographic, advocates say that it could impact future legislation. reports, “New data that will come out of expanded coverage in the Medicare Advantage program could be an important driver in furthering telehealth coverage across Medicare.”

What is Telehealth?

According to the Federal Health Resources and Services Administration (HRSA), “Telehealth is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care.” The Center for Connected Health Policy (CCHP) also defines telehealth as “the wide range of diagnosis and management, education, and other related fields of health care.”

Telehealth Technologies

The CCHP lists the different telehealth technologies below:

  • Live video: A two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.
  • Remote patient monitoring (RPM): The personal health and medical data collected from an individual in one location via electronic communication technologies, which is transmitted to a provider in a different location for use in care and related support.
  • Mobile health (mHealth): Healthcare and public health practice and education supported by mobile communication devices such as cell phones and tablet computers. Applications can range from targeted text messages that promote healthy behavior to wide-scale alerts about disease outbreaks, to name a few examples.
  • Store-and-forward: An asynchronous conversation when a patient sends a specialist or doctor X-rays, scanned documents or test results.

What are the Benefits of the Telehealth Expansion?

  • Reduced healthcare costs and increased efficiency.
  • Improved quality of care and accessibility for long-distance patients.
  • Allows health IT staff to be more responsive to patients.
  • Overall increased satisfaction due to reduced patient wait times with fast and easy remote communication.
  • Increased patient engagement through the use of modern technology.
  • Results in lower readmission rates and/or shorter hospital stays.

Considering the wide range of benefits from the telehealth expansion, it has received bipartisan support in Congress from both the Democratic and Republican party. As usual, both political parties have differences but have come together to provide Americans with better healthcare options.

“The budget deal doesn’t have everything Democrats want; it doesn’t have everything the Republicans want, but it has what the American people need,” Sen. Chuck Schumer, said in a statement.

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