The American College of Radiology (ACR) is lobbying against a provision within the Senate’s version of the National Defense Authorization Act (NDAA) that preempts state laws governing medical licensure, medical practice, professional liability and reimbursement pertaining to health care services delivered via telemedicine within the TRICARE system.
TRICARE provides health coverage for U.S. Armed Forces personnel, military retirees and their dependents. The NDAA is an annual piece of legislation primarily dedicated to authorizing the federal government to spend money for war operations and military base operations.
Section 705(d) of S. 2943, the NDAA for fiscal year (FY) 2017, seeks to change the definition for the practice of medicine as it relates to telemedicine as occurring at the location of the physician, rather than the patient. The Senate Armed Services Committee unanimously passed an initial version of the NDAA on May 18.The legislation later sailed through the full Senate by a vote of 85-13 on June 14.
The controversial telemedicine state licensure provisions, however, were not included in separate NDAA legislation, specifically H.R. 4904, the NDDA for FY2017, passed by the House on May 18 by a vote of 277-147.
In order to rectify a multitude of differences between the two bills outside of the telemedicine issue, the House and Senate voted in early July to convene a formal conference committee in September. The conference committee will officially commence following the conclusion of the Democratic and Republican national conventions and summer district work period.
The ACR is concentrating its lobbying efforts on the conferees appointed to the NDAA conference committee, which includes all senators, who serve on the Armed Services Committee, and a select bipartisan group of House members. Preliminary conversations have been positive, and the ACR hopes that its lobbying efforts will ultimately result in the removal of the controversial telemedicine provisions from S. 2943.
Numerous other medical organizations, including the American Medical Association (AMA) and American Osteopathic Association (AOA), as well as the Federation of State Medical Boards (FSMB), are working with the ACR to retain existing state licensure processes and federal telemedicine regulations. In fact, the AMA, AOA and FSMB recently sent a joint letter to the chairman and ranking members of the House and Senate Armed Services Committees to express support for the current system of state licensure and opposition to the inclusion of Section 705(d) within the final NDAA.
Telemedicine is broadly defined as the use of technology, such as video conferencing or wearable monitoring devices, by physicians to treat or assess patients not physically present for an in-person examination. Its application continues to generate growing support from select members of Congress and government agencies. Since the American health care system is increasingly characterized by an insufficient number of physicians to treat a growing population, policymakers view telemedicine as an important way to ensure all patients, especially individuals in rural areas, can gain access to high quality care.
Despite telemedicine’s potential, proponents of this policy consistently bemoan the combination of state licensure laws and federal regulations that confine access to telemedicine services primarily to rural areas as unnecessary impediments to its growth. In particular, the Senate Armed Services Committee included changes to existing state licensure requirements in S. 2943 to grant greater access to health care services for TRICARE beneficiaries located in remote areas.
ACR is supportive of telemedicine, in principle, and the College has worked diligently to develop a licensure policy that reflects the interest of our members. The ACR’s 2012 Technical Standard for Electronic Practice of Medical Imaging included a requirement that radiologists be familiar with the licensure requirements for providing teleradiology services at both the transmitting and receiving sites, as well as obtain licensure, as appropriate. Under current law, this standard would typically involve radiologists obtaining state licenses in the transmitting state, but not necessarily the receiving site.
The ACR believes the existing system of state licensure or even recent alternatives, such as the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact, serve as important quality safeguards for patients. The College also supports existing federal restrictions on the types of services and specific localities where individuals can receive care via telemedicine because health care delivered by a local physician who understands the nuances of a specific patient population is superior to care delivered remotely via telemedicine.
ACR members are encouraged to monitor the Advocacy in Action newsletter for the latest updates on the NDAA conference committee.