Telehealth Across State Lines

Telehealth licensingJust last week, the U.S. Veterans Administration (VA) announced a much-anticipated licensing rule that allows telehealth across state lines for specified practitioners serving VA patients. The new telehealth interstate practice rule now permits telehealth to be integrated nationwide as a routine part of patient care at the VA. This precedent sets the bar for legislation to relax interjurisdictional barriers for telehealth across state lines.

Until last Thursday, VA patients could only receive care via telehealth by going to one of  700+ community clinics that are equipped with video-conferencing and/or other telehealth technologies. By visiting these technology- equipped offices, practitioners at a different site could treat clients/patients who visited these clinics. Licensing regulations prohibited these clients/patients from being treated outside of a state where their treating professional held a license. Given the wide range of issues that often need immediate care, specialty care, or more convenient care to accommodate the preferences of the client/patient as well as the availability of adequately trained clinicians, the issue of telehealth across state lines has been a serious barrier to the utilization of 21st Century healthcare technology in the direct delivery of care.

The new rule (PDF), titled, Authority of Health Care Providers to Practice Telehealth states:

SUMMARY: The Department of Veterans Affairs (VA) is amending its medical regulations by standardizing the delivery of care by VA health care providers through telehealth. This rule ensures that VA health care providers can offer the same level of care to all beneficiaries, irrespective of the State or location in a State of the VA health care provider or the beneficiary. This final rule achieves important Federal interests by increasing the availability of mental health, specialty, and general clinical care for all beneficiaries.

Published in the Federal Register on Friday, this new telehealth rule finalizes last year’s landmark proposal to override state licensing restrictions so clinicians can treat veterans anywhere in the country. Outlined last August by former Secretary David Shulkin, M.D., alongside President Donald Trump, the rule is a critical piece of the VA’s Anywhere to Anywhere telehealth initiative.

Which  Clinicians Can Practice Telehealth Across State Lines

Allowing telehealth across state lines, this landmark rule only applies to VA-appointed providers. It excludes clinicians who provide care through VA Choice program or other health plans and insurances. More specifically, the rule does not apply to clinicians serving clients/patients with other payment arrangements, such as through telehealth employers, private pay, coaching, etc. As the most notable telehealth rule change passed in the history of telehealth, it is a bellwether for the massive changes that have been underway for more than a decade to allow clinicians to deliver the care that is needed by not only veterans, but a wide variety of underserved groups and their locations.

However, two other bills have passed the House and Senate that, if reconciled and signed by the president, would codify similar changes to serve increasingly expanding client/patient populations in an increasing variety of settings. The current VA rule then, New Telehealth Interstate Licensing Rule Offers Service to the Home Via A Smartphone Apps and More

While services to date have required that the veteran go to a technology-equipped professional office setting to receive telehealth-mediated treatment, this new law will also allow patients to be treated in their own homes. This change is particularly relevant to telemental and telebehavioral health, as the agency plans to use its 10 telemental health hubs to provide in-home services to patients around the country. This game-changing telehealth licensing rule will be closely watched for outcomes of various types to be collected to support yet more sweeping licensing changes across all healthcare arenas in the private and public sectors.

Already, some VA providers have been using the increasing functionality of the Anywhere to Anywhere program, using virtual visits to enhance phone appointments or schedule follow-up care through a new mobile app. The app allows patients to schedule and connect with clinicians using their smartphones. It is anticipated that utilization will significantly increase due to these wide-scale changes to accessibility of services.

Workforce Development for Telehealth: Professional Training

With the potential for such sweeping changes to impact workforce management, workforce development issues are also surfacing. It comes as no surprise then, that as part of this initiative, clinicians at the VA are being encouraged to consider telehealth training as part of the skillset needed for 21st Century healthcare service delivery.