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Letter: TRICARE Bill Could ‘Federalize’ Telehealth Doctors

The AAFP says a section of the new defense bill could place doctors using telehealth to treat the nation's armed servicemen and women above state licensure laws.

- A bill to boost telehealth services for the nation’s armed forces may clash with state efforts to regulate the technology.

The National Defense Authorization Act for FY 2017, now making its way through Congress, includes a telehealth benefit for the TRICARE program, but one version of the bill mandates that the originating location for certain telehealth services be the physician’s location. Several states and some federal programs have designated the patient’s location as the originating site.

This version of the bill has been approved by the Senate, while the House approved a version that did not include the originating site designation. Congress is now working on combining the two bills into one piece of legislation.

The discrepancy caught the attention of the American Academy of Family Physicians. In a Sept. 1 letter to Congressional leaders, AAFP Board Chairman Robert L. Wergin, MD, warned that the Senate version of the bill, S.2943, “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,” Wergin wrote. “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 isn’t the first time telehealth has hit a snag with the originating site. Legislators in Arkansas are now grappling with proposed telehealth regulations that would define the originating site as a hospital, clinic, doctor’s office or similar health facility. This would essentially prevent Arkansas residents from using telehealth services in their homes, or access telehealth via a mobile device at any place other than a provider’s location.

The TRICARE bill isn’t that restrictive, but it would affect how those physicians are regulated.

Under Section 705(d), it indicates that, “for purposes of reimbursement, licensure, professional liability and other purposes relating to the provision of telehealth services under this section, providers of such services shall be considered to be furnishing such services at their location and not at the location of the patient.”

As Wergin notes, this would enable a physician with one state license to use telehealth to treat TRICARE beneficiaries in any state, regardless of that state’s telehealth laws. This, he said, would “federalize medical licensure for physicians who treat America’s more than 8 million TRICARE beneficiaries.”

As an alternative, Wergin said the AAFP is urging states “to engage in reciprocity compacts for physician licensing,” primarily to assist physicians in getting a license in each state in which he or she wants to deliver care through telehealth. One such example is the Interstate Medical Licensure Compact created by the Federation of State Medical Boards, currently endorsed by 17 states.

Dig Deeper:

AAFP Criticizes CMS on Telemedicine Reimbursement Restrictions

DoD Expands Telemedicine Access for Military, Families

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