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VA Issues Proposed Rule to Allow Home-Based Telemedicine for Veterans

October 3, 2017
by Heather Landi
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The U.S. Department of Veterans Affairs (VA) issued a proposed rule this week that would allow VA healthcare providers to provide medical care via telehealth across state lines and regardless of the location of the provider of the beneficiary.

The VA says the proposed rule would increase the availability of mental health, specialty and general clinical care for all VA beneficiaries. “Just as it is critical to ensure there are qualified health care providers on-site at all VA medical facilities, VA must ensure that all beneficiaries, specifically including beneficiaries in remote, rural or medically underserved areas, have the greatest possible access to mental health care, specialty care and general clinical care,” the proposed rule states. “Thus, VA has developed a telehealth program as a modern, beneficiary- and family-centered health care delivery model that leverages information and telecommunication technologies to connect beneficiaries with health care providers, irrespective of the state or location within a state where the health care provider or the beneficiary is physically located at the time the health care is provided.”

Further, VA officials stated, “By providing health care services by telehealth from one state to a beneficiary located in another state or within the same state, whether that beneficiary is located at a VA medical facility or in his or her own home, VA can use its limited health care resources most efficiently.”

VA will accept comments on the proposed rule through Nov. 1.

For fiscal year (FY) 2016, VA health care providers had 2.17 million telehealth episodes of health care (meaning a clinical encounter or a period of time in which care was monitored), which served over 702,000 veterans (approximately 12 percent of the total patient population), with 45 percent of those veterans living in rural communities. By increasing VA’s capabilities to provide telehealth services, VA would be able to expand these services, the agency said in the proposed rule.

While telehealth enhances VA’s capacity to deliver health care services to beneficiaries located in areas where health care providers may be unavailable or to beneficiaries who may be unable to travel to the nearest VA medical facility for care because of their medical conditions, the agency states that in order to protect VA health care providers from potential adverse actions by states, many VA medical centers (VAMC) are currently not expanding some critical telehealth services if the health care service is provided outside federal property, or across state lines.

In addition, many individual VA health care providers refuse to practice telehealth because of concerns over states taking action against the health care provider’s state license, state laws, or the shifting regulatory landscape that creates legal ambiguity and unacceptable state licensing risk, the VA stated in the proposed rule. “The current disparities between VA health care practice in telehealth and state laws have effectively stopped or inhibited VA’s expansion of telehealth services to certain locations, thereby reducing the availability and accessibility of care for beneficiaries,” the VA stated.

This proposed rulemaking would clarify that VA health care providers may exercise their authority to provide care through the use of telehealth, notwithstanding any state laws, rules, or licensure, registration, or certification requirements to the contrary. In so doing, VA would exercise federal preemption of state licensure, registration, and certification laws, rules, regulations, or requirements to the extent such state laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.

The VA notes in the proposed rule that the changes would improve VA’s ability to provide mental health services to veterans. Veterans who received mental health services through synchronous video telehealth in fiscal year 2016 saw a reduction in the number of acute psychiatric VA bed days of care by 39 percent, the VA reports.

Another benefit of expanding VA telehealth includes serving a recruitment incentive for VA healthcare providers and allowing VA to address recruitment shortages, the agency states. In Charleston, South Carolina, the South Carolina VAMC serves as one of the VA’s National TeleMental Health Hubs and provides mental health services to veterans across eight states with a team of 30 full-time healthcare provides.  The VA notes there are currently multiple vacancies for TeleMental Health psychiatrists at the Charleston Hub, and “in the past six months, applicants have only expressed interest in telework positions.”

The American Medical Association (AMA) released a statement supporting the expansion of clinically validated telehealth services within the VA, and stated that “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,” the AMA stated.


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