As lawmakers work to expand telehealth services for members of the military, the AAFP is cautioning against letting the effort undermine the system of state medical licensure.
In a Sept. 1 letter(2 page PDF) to the chairs and ranking members of the Senate and House armed services committees, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., applauded the addition of a telehealth benefit to the TRICARE program in the National Defense Authorization Act(www.congress.gov). But he pointed out that a particular section of the bill that has passed the Senate conflicts with state laws.
Specifically, the legislation declares that for licensure, payment, liability and other such purposes, telehealth services would be considered to have been furnished at the physician's location, not the patient's. This language directly conflicts with state laws that specify that when a physician provides care for a patient in a different state, the patient's location is considered the location of care.
The House has passed a version of the bill that does not include the telehealth language, and the chambers are now resolving differences in their respective bills. The legislation is expected to be finalized by the end of September.
Although overall, the AAFP supports expansion of telehealth services, Wergin wrote that in this instance, the Senate's language would change the longstanding rule that the patient's location determines which laws apply.
"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," Wergin wrote.
Instead, he said the Interstate Medical Licensure Compact, an agreement adopted by 17 states, would better ease the burden of seeking licensure in more than one state.
"The AAFP encourages states to engage in reciprocity compacts for physician licensing -- specifically for the purpose of promoting the free flow of telehealth services -- and views this as the more appropriate method to ease the barriers to telehealth erected by state licensure, while ensuring patient safety and physician accountability," Wergin wrote.
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