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Department of Veterans Affairs Aims to Trump State Telemedicine Rules

Correction: An earlier version of this post incorrectly noted that the American Medical Association opposed the rule. The post has been updated to include the AMA’s full statement expressing support for proposed rule. [October 10, 2017]

The U.S. Department of Veterans Affairs (“VA”) is taking a significant step towards expanding needed services to Veterans by proposing a rule to preempt state restrictions on telehealth.

Most states currently restrict providers (including VA employees) from treating patients that are located in that state if the provider is not licensed there. As a result, the VA has had difficulty getting a sufficient number of providers to furnish services via telemedicine for fear that they will face discipline from those states for the unlicensed practice of medicine.

The VA has a real need for expanding its telemedicine capabilities as many of its patients are located in rural and underserved areas. The VA’s top clinical priority is mental health, and having more robust telemedicine capabilities could help improve timeliness of treatment (a reputational sore spot for the VA).  The VA could also use telemedicine to reach more people in need that may not otherwise seek help.  The rule would allow the VA to more evenly distribute care by hiring providers in urban areas where there is larger pool and have them treat in rural areas (via telemedicine).

The American Medical Association (“AMA”) has expressed support for the proposed rule.  Jack Resneck Jr., M.D., Chair-elect of the AMA Board of Trustees, issued the following statement showing the AMA’s support:

“The AMA supports expansion of clinically validated telehealth services within the VA, and this decision ensures that important patient protections are in place for the delivery of high quality and reliable care.  The VA has a unique federally controlled healthcare system with essential safeguards to help ensure that both in-person and virtual beneficiary care meet and exceed the standard of care.  The AMA strongly supports that the proposed rule explicitly provides that this program’s multi-state licensure exception applies only to VA-employed providers and would not be expanded to 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 EHR and infrastructure capabilities.  We applaud the VA’s expansion of telehealth services in a manner that promotes quality and access.”

Not everyone is happy about the proposed rule, however. Some organizations oppose the rule as undermining each state’s ability to govern the practice of medicine within its borders.  The concern is that states would have no ability to regulate their citizens’ care under this new framework.

While this rule is limited only to VA patients and providers, the hope is that other federal agencies or even states will follow the VA’s lead. Given the importance of increasing access to care and the advances in the delivery of care via telemedicine, it might be time for states to reexamine their restrictive approach to professional licensure.

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Ryan Cuthbertson