May 17, 2018

House Passes VA Bill Covering Telehealth Licensing

Bipartisan legislation passed by the House of Representatives on May 16 includes provisions supported by the American College of Radiology (ACR) permitting fully employed physicians within the Department of Veteran’s Affairs (VA) to administer services via telehealth with a single medical license, regardless of where the patient resides. Similar authority was included in a Final Rule (Authority of Health Care Providers to Practice Telehealth) published in the May 11, 2018 Federal Register.

In addition to telehealth licensure reforms, S. 2372, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks [VA MISSION] Act, provides additional resources for the crucial VA Choice Program, which Acting VA Secretary Robert Wilkie expects to run out of money by May 31. Prompted by the struggle of veterans to obtain timely medical appointments at VA hospitals across the nation, the Choice program generally permits veterans, who experience excessive wait times, to receive care outside the VA system. The Senate will likely use fast-track procedural motions to pass the VA MISSION Act in coming weeks. As a strong supporter of VA Choice, President Trump has indicated he will sign S. 2372 into law once passed by Congress.

Currently, the VA applies different medical licensure requirements depending upon whether the physician or other type of medical provider delivers in-person care or telemedicine services. Fully employed VA physicians and other fully employed VA providers can administer in-person care across state lines, regardless of where the patient or health professional is located, if they possess one valid state medical license.

The same reciprocity concept does not apply to telemedicine services, however. Under current law, fully employed VA physicians or providers not contracted with the VA are prohibited from offering telehealth services unless they are licensed in the state where they are located and the state where the patient resides. The law also permits the multistate licensure requirement to be waived so long as the veteran and physician are both located in a federal facility, such as a VA medical center. The VA Mission Act would allow the department’s fully employed physician staff to conduct telemedicine if they’re located in federal or non-federal facilities.

The telehealth licensure provisions in S. 2372 are virtually identical to terms in H.R. 2123/S. 925, the VETS Act, introduced by Reps. Glenn Thompson (R-PA) and Julia Brownley (D-CA) in the House and Sens. Joni Ernst (R-IA) and Mazie Hirono (D-HI) in the Senate.

The ACR supports this stand-alone bill because it strikes an effective balance between facilitating greater access to telemedicine for veterans and preserving most of the current system of state-based medical licenses for physicians practicing outside of the VA. The VETS Act legislation also mandates the VA to produce a report about a year following the date of its enactment to outline the overarching successes of expanding telemedicine services within the department for fully employed physicians. S. 2372 includes the same report requirements.

The ACR worked diligently with the American Medical Association and Federation of State Medical Boards to ensure changes to telemedicine licensure requirements do not adversely impact patient access to quality, advanced imaging services or subject radiologists to commoditization. The College is pleased that the bill language originally included in the VETS Act was ultimately added to S. 2372.

ACR members are encouraged to monitor Advocacy in Action eNews for the latest developments on the VA MISSION Act as it moves on to the Senate for consideration.