The House of Representatives on Tuesday passed a bill that would allow the US Department of Veterans Affairs (VA) doctors to treat patients remotely across state lines, using telehealth technology. A similar measure is pending in the Senate.
Last month, the VA proposed a new regulation that would accomplish the same goal. However, Congressional action is required to authorize the department to issue that regulation. A 30-day comment period on the VA proposal recently expired, but no final rule has been released yet.
The House bill, the Veterans E-Health and Telemedicine Support Act of 2017, was introduced last April by Reps. Glenn Thompson (R-PA) and Julia Brownley (D-CA). The measure would:
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Create a VA state licensure exemption to allow VA-credentialed healthcare professionals to work across state borders to perform telemedicine without having to obtain a new license in that state.
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Expand the definition of exempt healthcare professionals to include VA doctors.
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Remove the location requirement to allow for care regardless of where the healthcare professional or patient is located.
Like the proposed VA regulation, the House legislation would not allow VA-contracted private physicians to treat patients remotely in states where they are not licensed. It also does not expand the scope of practice beyond what is allowed in a VA provider’s state of licensure.
A number of veterans associations and patients’ rights organizations have endorsed the bill. So has the American Medical Association (AMA), the American Psychological Association, the American Psychiatric Association, and the American College of Radiology.
In an earlier statement regarding the VA’s proposed regulation, Jack Resneck Jr, MD, chair-elect of the AMA board of trustees, said the AMA supported the provision by VA doctors of telehealth services across state lines. However, he said, the AMA did not want this regulation expanded to include “contracted physicians or providers who are not directly controlled and supervised by the VA and would not necessarily have the same training, staff support, shared access to a beneficiary’s [electronic health records] and infrastructure capabilities.”
Other medical associations have been mostly silent, with the exception of the American Academy of Family Physicians (AAFP). In an October 31 letter to the VA, the AAFP offered qualified support for the proposed rule. While the association has historically opposed federal preemption of state restrictions on licensure, it said, in this narrow case such preemption “could possibly serve the public interest and is perhaps not too inappropriate.” The AAFP cautioned that its support was contingent on the regulation being confined to VA-employed physicians and providers.
The VA rolled out its new telehealth program at an August press conference that included remarks by VA Secretary David Shulkin, MD, and President Donald Trump. The centerpiece of the program is a new virtual visit service called VA Video Connect that allows any VA physician to conduct a telehealth visit with any veteran anywhere in the country, either on a mobile device or on a computer.
In that news conference, Dr Shulkin noted that last year 700,000 veterans used VA telehealth services, which are now available for more than 50 medical and dental specialties.
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