Government and Regulations

VA Proposes New Telehealth Rule

Rule would ease state-based licensure limitations that restrict the use of telehealth across state lines.


Not willing to wait for a pending legislative fix, the VA has proposed a new rule that would allow expanding telehealth offerings across state lines. The Authority of Health Care Providers to Practice Telehealth rule was proposed on October 2, 2017 and comments will remain open through November 1, 2017.

“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,” the rule states. “Telehealth increases the accessibility of VA health care, bringing VA medical services to locations convenient for beneficiaries, including clinics in remote communities and beneficiaries' homes. 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.”

The VA has long recognized the importance of telehealth for delivering health care to rural veterans who live far from VAMCs and community-based outpatient clinics. Providing specialty care can be especially challenging, given the dearth of specialists in many rural locations. In addition, many veterans live in a different state than the closest VAMC, creating health care delivery challenges.

The legal standing of telehealth is unclear. Currently, VA requires that health care providers (HCPs) are licensed in the same state as the patient location at time of health care delivery. VA Secretary David J. Shulkin, MD, has called for new legislation clarifying that VA HCPs do have authority to care for patients located in a different state. However, the new rule cites previously granted legislative authority. “In an effort to furnish care to all beneficiaries and use its resources most efficiently,” the rule states, “VA needs to operate its telehealth program with health care providers who will provide services via telehealth to beneficiaries in States in which they are not licensed.”

To date, the rule has received relatively few comments, and none dispute the VA interpretation of its legal authority to change telehealth rules. A few commenters have raised concerns over the quality use of telehealth care, especially for mental health care. Most comments, however, supported the expansion of telehealth to increase access to care for veterans.

House Resolution 2123, the VETS Act of 2017, also contains similar provisions that would streamline interstate telehealth. However, that bill has yet to receive a vote in the House Veterans Affairs committee.

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