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Defense Bill Expands Telehealth Services in TRICARE

The National Defense Authorization Act expands telehealth coverage for military personnel and veterans, while maintaining state licensure controls.

- A Defense bill that includes expanded telehealth access for active duty military personnel and veterans has been approved by Congress – minus controversial language that would have basically federalized telehealth doctors.

The National Defense Authorization Act for FY 2017, which makes telehealth services available under the U.S. Defense Department’s TRICARE program, sailed through both the House and Senate after the controversial language in the Senate bill was stripped out.

The initial Senate bill had mandated that the originating site for telehealth services – defined for such issues as licensure, reimbursement and liability – would be the physician’s location, rather than that of the patient.

That drew the ire of the American Academy of Family Physicians, the American Medical Association and several pro-telehealth groups, who pointed out that such a law would enable physicians treating military personnel and veterans to skip state licensing laws when treating patients via telehealth.

AAFP Board Chairman Robert L. Wergin, MD, had said the Senate version of the bill “portends a troubling scenario under which state licensing boards will lack the authority to discipline physicians who are practicing medicine within that state’s borders.”

“While this language would indeed ease barriers that hinder the free flow of telehealth services, it also would undermine the existing system of medical licensure, under which each state governs the practice of medicine within its borders,” he wrote in a Sept. 1 letter to Congressional leaders. “Allowing physicians with a single license to treat TRICARE beneficiaries in any state via telemedicine would create episodes of medical care that the state in which the patient resides cannot readily regulate, if at all.”

"This provision would deprive TRICARE beneficiaries of essential protections by fundamentally subverting and undermining existing state-based patient safety protections that are currently in force, and remove an essential mechanism used by states to ensure medical care provided to patients in their state meets acceptable standards of care," the AMA added in its letter to Congress, which was co-signed by about 50 medical societies and organizations.

The bill would also have gone against the Federation of State Medical Boards’ attempts to create a nationwide Interstate Medical Licensure Compact. The compact, now endorsed by 18 states (with Michigan moving toward a legislative vote) calls for an expedited licensure process for providers seeking to practice across state lines, while enabling each state to keep and enforce its specific licensure and administrative regulations.

“The medical profession has long advocated that state licensing boards and the Federation of State Medical Boards (FSMB) streamline and simplify the medical licensure process,” the AMA argued in its letter. “And, to that end, a workable solution is rapidly advancing through the FSMB’s Interstate Medical Licensure Compact.”

The final bill, which now awaits the President’s signature, treats telehealth on a par with in-person visits, though without deductibles or copayments. Providers will be able to seek reimbursement for telehealth services that provide health evaluations, diagnoses, treatment supervision and outcomes monitoring.

The Department of Veterans Affairs (VA) has long championed the use of telehealth. More than 690,000 veterans participated in more than 2 million virtual visits in fiscal year 2014, while VA surveys have shown an 85 percent satisfaction rate.

Earlier this year, the Department of Defense expanded the list of locations for military members receiving care to include the patient’s home, as well as any “other patient location deemed appropriate by the treating provider.”

“A ‘visit’ no longer necessarily requires that a patient physically see their provider in person,” Jonathan Woodson, MD, the Assistant Secretary of Defense for Health Affairs for the U.S. Department of Defense, announced in a memorandum issued in February. “Enrollees have the option of receiving care from their primary care provider through multiple means – in-person visits, secure messaging, telephone consults, nurse advice line, behavioral health visits within the medical home, clinical pharmacist consultations and telemedicine visits between patients and providers located at separate military treatment facilities.”

“This authorization will enhance our ability to provide telemedicine services and improve access to care for our beneficiaries,” Woodson wrote.

The order comes with four conditions:

  1. Providers must ensure that the patient is medically and psychologically capable of being treated via telemedicine, and that it be documented in the patient’s medical record;
  2. Home-based telemedicine must be conducted via a Department of Defense-approved platform that conforms with HIPAA;
  3. Provider and patient must agree on a backup communication plan should the telemedicine link fail; and
  4. The Department of Health Affairs, working with the Military Health System’s Telehealth Working Group, “will provide guidance regarding implementation of telehealth at a patient’s location, to include coding practices and reporting requirements.”

Dig Deeper:

Telehealth Reimbursement and Its Interstate Licensure Problem

Potential for Healthcare Kiosks in Improving Care Delivery

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