Debate opens on bill to let out-of-state clinicians register to provide telehealth in Montana

Sen. Daniel Zolnikoff, sponsor of Senate Bill 438, told the Senate Business and Labor Committee the bill would allow patients in Montana to see out-of-state providers by telehealth through a simple registration process for clinicians who are licensed and in good standing in their home state.

A senior fellow with Cicero Action described the measure as a registration model used successfully in other states during and after COVID-19 and said the registration would require an attestation, a background screen and a fee set by the licensing board.

Proponents said the change would improve access to specialists and niche services for rural Montanans and allow patients to keep established relationships with out-of-state clinicians. Local chambers, NAMI Montana and AARP testified in favor, saying telehealth reduces costs and improves access in rural counties.

Department of Labor Commissioner Sarah Swanson strongly opposed the bill as written, telling the committee: "Registration is not licensing. They're not the same. A registration is not a license and a license is not a registration or a certificate." Swanson warned the bill would create a permanent separate administrative registry, add investigative and staffing burdens to boards, and could duplicate a package of licensing reforms the department developed during the interim. She said the department and stakeholders had previously agreed on a temporary 21‑day licensure exemption for short-term telehealth practice (House Bill 414) and urged the committee to study the registration approach further rather than enact a permanent, separate registry immediately.

Other opponents included the Montana Medical Association, some provider associations (occupational therapy, speech/hearing and physician assistants) and the Montana State Building and Construction Trades Council, which opposed the bill on principle as a pattern of allowing out‑of‑state practice with different requirements. Opponents flagged ambiguous definitions in the bill for which professions the registry would cover and said the bill’s venue provision would shift discipline actions into county district court instead of the department’s established administrative process.

Sponsor Zolnikoff said the registration model is already used in multiple states and that registration can be implemented without disrupting existing board authority; he urged the committee to permit expanded patient choice and access.

The committee recorded testimony for and against the bill; no final committee action was recorded in the transcript.