October 27, 2017

House VA Committee Explores Telemedicine Legislation

Potential legislative changes to existing requirements surrounding medical licensure and the delivery of telemedicine by physicians within the Department of Veterans Affairs was a focal point of a hearing in the House Committee on Veterans Affairs.
Potential legislative changes to existing requirements surrounding medical licensure and the delivery of telemedicine by physicians within the Department of Veterans Affairs (VA) was a focal point of an Oct. 24 hearing in the House Committee on Veterans Affairs.

Rep. Glenn “GT” Thompson (R-VA) made a guest appearance before the House VA Committee to urge his colleagues to support H.R. 2123, the Veterans E-Health and Telemedicine Support (VETS) Act of 2017. Rep. Julia Brownley (D-CA), ranking member of the VA Health Subcommittee and chief Democrat sponsor of H.R. 2123, echoed Thompson’s comments.

Currently, the VA applies different medical licensure requirements depending upon whether the physician or other type of provider is delivering in-person care or telemedicine services. Fully employed VA physicians and providers are permitted to deliver in-person care across state lines, regardless of where the patients or health professionals are located, so long as they possess one valid state medical license. This same licensure reciprocity concept, however, is not applicable to telemedicine services or the use of technology that permits real-time, two-way communications for patient treatment. Telephone communication is not traditionally included in the definition of telehealth.

In contrast to in-person care, fully employed VA physicians are explicitly prohibited from engaging in telemedicine unless they have a valid license in the state where the patient resides as well. Although the VA waives the multistate license requirement when the veteran and treating physician are both in a federal facility, the restriction still can present an undue burden to the patient and erodes the underlying concept of telemedicine.

The VETS Act seeks to permit physicians and other providers who meet the definition of “covered health care professionals” to administer services via telehealth with a single medical license, regardless of where the physician or patient resides. The legislation also requires the VA Secretary to deliver a report to the House and Senate Committees on Veterans Affairs outlining the overarching effectiveness of telehealth services.

H.R. 2123, however, does not affect medical licensure requirements for contracted physicians or other health care professionals who provide telemedicine services and are not fully employed by the VA. As a result, physicians practicing outside of the VA system, including contractors, will continue to be required to obtain licenses in the place where they physically reside, as well as in the state where the patient is located, in order to provide both in-person and telemedicine services. Retention of the traditional medical licensure system for physicians who seek to provide health care services, including telemedicine, outside of the VA is of the utmost importance to preserving patient safety, especially in the case of medical error. The American College of Radiology (ACR), which is closely monitoring H.R. 2123, recognizes the VA faces unique circumstances pertaining to licensure and telemedicine. A companion bill, S. 925, has also been introduced by Sens. Joni Ernst (R-IA) and Mazie Hirono (D-HI). Federal lawmakers are expected to pass a bill to authorize additional funding for the VA Choice program before the December recess. Created following the enactment of the Veterans Access, Choice, and Accountability Act of 2014, the VA Choice program is designed to alleviate excessive wait times that plagued veterans seeking care from the VA.

ACR members should look to Advocacy in Action eNews for the latest developments pertaining to Congressional efforts to include H.R. 2123/S. 925 in potential forthcoming legislation to reauthorize the VA Choice program.