VA’s Effort to Expand Telemedicine Across All States Moves Forward

By Sandra Basu

WASHINGTON—The House voted in favor of a bill giving VA authority to allow its licensed healthcare providers to practice telemedicine in any state, regardless of whether the patient or provider is located on federal government property.

The Veterans E-Health and Telemedicine Act of 2017 was passed by the House last month. A companion bill, S. 925, was awaiting action in the Senate. Under current law, rules bar VA providers from providing telehealth services across state lines unless both the veteran and the doctor are located in federal facilities. The bill would take away those restrictions.

“The expansion of telemedicine programs within VA has been hampered by restrictions on the ability of VA providers to practice telemedicine across state lines without jeopardizing their state licensure,” Rep. Phil Roe, MD, chairman of the House Committee Chairman on Veterans Affairs said during a recent hearing in which his committee voted to advance the bill.

In August, President Donald Trump and VA Secretary David Shulkin MD announced three initiatives to expand access to healthcare for veterans. VA photo

In passing the bill, Roe said the House committee would be “leading the country” in how telehealth is done.

“We are going to have to figure this out for Medicare because much more healthcare is going to be provided in this manner,” he pointed out.

The bill follows a VA announcement over the summer about plans to expand telehealth services by initiating a new regulation that would allow VA providers to treat patients via telehealth, regardless of location.

During that announcement VA Secretary David Shulkin, MD, said the change in regulations would mean that “were going to be able to use VA providers in cities where there are a lot of doctors and be able to use those doctors to help our veterans in rural areas where there aren’t many healthcare professionals.”

In October, the agency followed that announcement by publishing a proposed rule in the Federal Register to alter the regulation so “that VA healthcare providers may exercise their authority to provide care through the use of telehealth, notwithstanding any state laws, rules, licensure, registration, or certification requirements to the contrary.”

The proposed rule noted that “many individual VA healthcare providers refuse to practice telehealth because of concerns over states taking action against the healthcare provider’s state license, state laws, or the shifting regulatory landscape that creates legal ambiguity and unacceptable state licensing risk,” adding, “In an effort to furnish care to all beneficiaries and use its resources most efficiently, VA needs to operate its telehealth program with health care providers who will provide services via telehealth to beneficiaries in states in which they are not licensed, registered, certified, or located, or where they are not authorized to furnish care using telehealth. Currently, doing so may jeopardize these providers’ credentials, including fines and imprisonment for unauthorized practice of medicine.”

Several groups voiced their opinion on the proposed regulation.

“We believe that extending telehealth services to veterans who may currently lack adequate access to local VA facilities is an important step toward improving both care and access for our nation’s veterans,” the American Medical Informatics Association stated in a letter.

Federal Trade Commission officials wrote in a letter that the “rulemaking may spur innovation among other healthcare providers and thereby promote competition and improve access to care, which will benefit consumers so long as providers are held to the appropriate standard of care for the services they are providing remotely.”

Additionally, the FTC explained that the “proposed rule may afford a valuable opportunity to gather data and provide additional evidence for the VA and outside policymakers to assess the effects of telehealth expansion, thus benefitting VA patients and health care consumers generally.”

The American Academy of Family Physicians’ endorsement was more limited. AAFP Board Chair John Meigs Jr., MD, said in a letter to VA that “since this proposal is limited to a special situation within the VA and to support veterans’ access to health services, the AAFP offers qualified support for this proposed expansion of clinically validated telehealth services.”

“While the AAFP has historically opposed federal or legislative actions superseding state restrictions on licensure, and instead support FSMB licensure compact participation, we nevertheless believe that in this narrow case of the VA, federal preemption of state licensure could possibly serve the public interest and is perhaps not too inappropriate,” Meigs wrote.

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