[House Report 115-394]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-394
======================================================================
VETERANS E-HEALTH AND TELEMEDICINE SUPPORT ACT OF 2017
_______
November 7, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2123]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2123) to amend title 38, United States Code, to
improve the ability of health care professionals to treat
veterans through the use of telemedicine, and for other
purposes, having considered the same, report favorably thereon
without amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
Purpose and Summary
H.R. 2123, the ``Veterans E-Health and Telemedicine Support
Act of 2017,'' would authorize a licensed health care provider
of the Department of Veterans Affairs (VA) to practice
telemedicine at any location in any state, regardless of where
the provider or patient is located and whether or not the
patient or provider is located on federal government property.
Representative Glenn Thompson of Pennsylvania introduced H.R.
2123 on April 25, 2017.
Background and Need for Legislation
As a national, integrated health care system, the Veterans
Health Administration (VHA) has a responsibility to ensure that
veteran patients receive the same level of and access to care
no matter where the veteran patient is located.\1\ This is a
particular challenge for veteran patients residing in remote,
rural, or medically underserved areas far from VA medical
facilities and for veteran patients with mobility or other
issues that impact their ability to travel to VA medical
facilities to receive care.\2\
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\1\Authority of Health Care Providers to Practice Telehealth.
https://www.federalregister.gov/documents/2017/10/02/2017-20951/
authority-of-health-care-providers-to-practice-telehealth. Accessed
October 31, 2017.
\2\Ibid.
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Telemedicine refers to ``the use of telehealth technologies
to provide clinical care in circumstances where distance
separates those receiving services and those providing
services.''\3\ By allowing VA clinicians to provide ``the right
care in the right place at the right time,'' telemedicine is
critical to VA's ability to deliver health care to veteran
patients who could not otherwise access such care.\4\\5\
According to VA, ``[telemedicine] increases the accessibility
of VA health care, bringing VA medical services to locations
convenient for beneficiaries, including clinics in remote
communities and beneficiaries' homes.''\6\ In fiscal year 2016,
VA health care providers provided more than 2 million episodes
of care via telemedicine to more than 700,000 veteran patients,
approximately 12 percent of VA's total patient population.\7\
Veteran patients who have had experience with VA telemedicine
programs have demonstrated improved health outcomes, including
decreases in hospital admissions.\8\
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\3\VA Telehealth Services. https://www.telehealth.va.gov/ Accessed
October 30, 2017.
\4\Ibid.
\5\Authority of Health Care Providers to Practice Telehealth.
https://www.federalregister.gov/documents/2017/10/02/2017-20951/
authority-of-health-care-providers-to-practice-telehealth. Accessed
October 31, 2017.
\6\Ibid.
\7\Ibid.
\8\Ibid.
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However, the continued expansion of telemedicine across the
VA health care system is constrained by restrictions on the
ability of VA providers to practice telemedicine across state
lines without jeopardizing their state licensure and facing
potential penalties for the unauthorized practice of
medicine.\9\ VA claims that this disparity--between VA health
care practice and state medical licensure laws--has severely
inhibited the provision of telemedicine in VA and, therefore,
reduced the availability and accessibility of care for veteran
patients.\10\
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\9\Ibid.
\10\Ibid.
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In response to this, Secretary Shulkin announced on August
3, 2017, that VA would be amending regulations to allow VA
health care providers who are licensed, registered, or
certified in ``a state'' to practice in any state when they are
acting within the scope of their VA employment--regardless of
individual state licensure, registration, or certification
restrictions except for applicable state restrictions on the
authority to prescribe and administer controlled
substances.\11\ VA claims that this action would serve to
``authorize VA health care providers to furnish care,
consistent with their employment obligations, through
[telemedicine], without fear of adverse action by any
state.''\12\ Despite this rulemaking, Secretary Shulkin
testified during an October 24th Committee hearing that
legislation was needed to ``[provide] statutory protection and
[codify] VA's longstanding practice of allowing VA providers to
practice in any state as long as they are licensed in a
state.''\13\
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\11\Ibid.
\12\Ibid.
\13\United States Cong. House Committee on Veterans' Affairs.
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement from the Honorable David Shulkin M.D.,
Secretary of Veterans Affairs).
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Therefore, section 2 of the bill would exercise preemption
of state licensure, registration, and certification laws,
rules, and regulations or requirements to the extent such state
laws conflict with the ability of VA providers to engage in the
practice of telehealth while acting within the state of their
VA employment and authorize a VA licensed health care provider
to practice telemedicine at any location in any state,
regardless of where the provider or patient is located and
whether or not the patient or provider is on federal government
property. The Committee believes that the continued expansion
of telemedicine across the VA healthcare system will aid
veterans in receiving timely, quality care from VA and in
achieving improved health outcomes. Further, the Committee
concurs with the American Medical Association that providing VA
healthcare providers the authority to practice telemedicine
across state lines would, ``address the significant and unique
need to expand access to health care services for veterans
being treated within the VA system while also ensuring that
important patient protections remain in place, including the
direct oversight, accountability, training, and quality control
specific to VA-employed physicians and other health care
professionals.''\14\ Section 2 of the bill would also require
VA to submit a report to Congress on the Department's
telemedicine programs, which would allow the effectiveness of
VA telemedicine to be better understood.
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\14\United States Cong. House Committee on Veterans' Affairs.
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement for the record from the American
Medical Association).
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Hearings
There were no Subcommittee hearings held on H.R. 2123.
On October 24, 2017, the full Committee conducted a
legislative hearing on a number of bills including H.R. 2123.
The following witnesses testified:
The Honorable Jim Banks, U.S. House of
Representatives, 3rd District, Indiana; The Honorable
Mike Gallagher, U.S. House of Representatives, 8th
District, Wisconsin; The Honorable John R. Carter, U.S.
House of Representatives, 31st District, Texas; The
Honorable Glenn Thompson, U.S. House of
Representatives, 5th District, Pennsylvania; The
Honorable Neal P. Dunn, U.S. House of Representatives,
2nd District, Florida; The Honorable Andy Barr, U.S.
House of Representatives, 6th District, Kentucky; The
Honorable David J. Shulkin, M.D., Secretary, U.S.
Department of Veterans Affairs, who was accompanied by
Carolyn Clancy M.D., the Executive in Charge of the
Veterans Health Administration, and Laurie Zephyrin
M.D., MPH, MBA, the Acting Deputy Under Secretary for
Health for Community Care for the Veterans Health
Administration; Adrian M. Atizado, Deputy National
Legislative Director, Disabled American Veterans;
Roscoe G. Butler, Deputy Director for Health Care,
Veterans Affairs and Rehabilitation Division, The
American Legion; and, Kayda Keleher, Associate
Director, National Legislative Service, Veterans of
Foreign Wars of the United States.
Statements for the record were submitted by:
American Federation of Government Employees, AFL-CIO;
American Health Care Association; American Medical
Association; AMVETS; Concerned Veterans of America;
Fleet Reserve Association; Got Your 6; Health IT Now;
Iraq and Afghanistan Veterans of America; Military
Officers Association of America; Military Order of the
Purple Heart; National Alliance on Mental Illness;
National Guard Association of the United States; Nurses
Organization of Veterans Affairs/Association of VA
Psychologist Leaders/Association of VA Social Workers/
Veterans Healthcare Action Campaign; Paralyzed Veterans
of America; Reserve Officers Association; University of
Pittsburgh; Vietnam Veterans of America; the Wounded
Warrior Project; The American Congress of Obstetrics
and Gynecologists; the University of California,
Riverside School of Medicine; the American Society of
Transplant Surgeons; and, the National Indian Health
Board.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 2123.
Committee Consideration
On November 2, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 2123 to be
reported favorably to the House of Representatives by voice
vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 2123
reported to the House. A motion by Representative Tim Walz of
Minnesota, Ranking Member of the Committee on Veterans'
Affairs, to report H.R. 2123 favorably to the House of
Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to increase the provision of
telemedicine to veteran patients by authorizing VA providers to
practice telemedicine across state lines.
New Budget Authority, Entitlement Authority, and Tax Expenditures
With respect to the requirement with respect to clause
3(c)(2) of rule XIII of the Rules of the House of
Representatives, the Committee has requested but not received
from the Director of the Congressional Budget Office an
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues.
Earmarks and Tax and Tariff Benefits
H.R. 2123 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
this bill. However, clause 3(d)(3)(B) of that Rule provides
that this requirement does not apply when the Committee has
included in its report a timely submitted cost estimate of the
bill prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974. The Committee has requested but not received a cost
estimate for this bill from the Director of the Congressional
Budget Office. The Committee believes, according to a
preliminary score from the Congressional Budget Office, that
enactment of H.R. 2123 would have minimal discretionary costs
over a five year period.
Budget Authority and Congressional Budget Office Cost Estimate
With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause (3)(c)(3) of rule XIII of the Rules
of the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has requested
but not received a cost estimate for this bill from the
Director of Congressional Budget Office. The Committee has
requested but not received from the Director of the
Congressional Budget Office a statement as to whether this bill
contains any new budget authority, spending authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
Federal Mandates Statement
With respect to the requirements of Section 423 of the
Congressional Budget and Impoundment Control Act (as amended by
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether the provisions of the reported bill include unfunded
mandates.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
2123.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 2123 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 2123 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017),
the Committee finds that no provision of H.R. 2123 establishes
or reauthorizes a program of the Federal Government known to be
duplicative of another Federal program, a program that was
included in any report from the Government Accountability
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most
recent Catalog of Federal Domestic Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 2123 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide the short title for
H.R. 2123, as the ``Veterans E-Health and Telemedicine Support
Act of 2017'' or ``the VETS Act of 2017''.
Section 2. Licensure of health care professionals of the Department of
Veterans Affairs providing treatment via telemedicine
Section 2(a) of the bill would amend chapter 17 of title 38
U.S.C. by inserting after section 1730A a new section 1730B.
Licensure of health care professionals providing treatment via
telemedicine. The new section 1730B(a) would, notwithstanding
any provision of law regarding the licensure of health care
professionals, authorize a covered health professional to
practice the health care profession of the health care
professional at any location in any State, regardless of where
the covered health care professional or patient is located, if
the covered health care professional is using telemedicine to
provide treatment to an individual under this chapter. The new
section 1730B(b) would require the new section 1730(a) to apply
to a covered health care professional providing treatment to a
patient regardless of whether the covered health care
professional or patient is located in a facility owned by the
Federal government during such treatment. The new section
1730B(c) would state that nothing in this section may be
construed to remove, limit, or otherwise affect any obligation
of a covered health care professional under the Controlled
Substances Act (21 U.S.C. 801 et seq.). The new section
1730B(d) would define a ``covered health care professional'' as
a health care professional who: (1) is a VA employee appointed
under sections 7306, 7401, 7405, 7406, or 7408 of title 38
U.S.C. or title 5 U.S.C.; (2) is authorized by VA to provide
health care under this chapter; (3) is required to adhere to
all quality standards relating to the provision of telemedicine
in accordance with applicable VA policies; and (4) has an
active, current, full, and unrestricted license, registration,
or certification in a State to practice the health care
profession of the health care professional.
Section 2(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38 U.S.C. by inserting
after the item relating to section 1730A the following new
item: ``1730B. Licensure of health care professionals providing
treatment via telemedicine.''.
Section 2(c) of the bill would require VA, after than one
year after date of enactment of this Act, to submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the effectiveness of the use of
telemedicine by VA to include an assessment of: veterans
satisfaction with the telemedicine furnished by VA; the
satisfaction of health care providers in providing telemedicine
furnished by VA; the effect of telemedicine on the ability of
veterans to access health care from VA and from non-VA health
care providers, the frequency of veterans use of telemedicine,
the productivity of health care providers, wait times for an
appointment for receipt of health care from VA, and, the
reduction--if any--in the use by veterans of in-person services
at VA facilities and non-VA facilities; the types of
appointments for the receipt of VA telemedicine that were
provided during the one-year period preceding the submittal of
the report; the number of appointments for the receipt of
telemedicine furnished by VA that were requested during such
period, disaggregated by Veterans Integrated Service Network
(VISN); and, VA savings (including travel costs)--if any--of
furnishing health care through telemedicine during such period.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
1730B. Licensure of health care professionals providing treatment via
telemedicine.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1730B. Licensure of health care professionals providing treatment
via telemedicine
(a) In General.--Notwithstanding any provision of law
regarding the licensure of health care professionals, a covered
health care professional may practice the health care
profession of the health care professional at any location in
any State, regardless of where the covered health care
professional or the patient is located, if the covered health
care professional is using telemedicine to provide treatment to
an individual under this chapter.
(b) Property of Federal Government.--Subsection (a) shall
apply to a covered health care professional providing treatment
to a patient regardless of whether the covered health care
professional or patient is located in a facility owned by the
Federal Government during such treatment.
(c) Construction.--Nothing in this section may be construed
to remove, limit, or otherwise affect any obligation of a
covered health care professional under the Controlled
Substances Act (21 U.S.C. 801 et seq.).
(d) Covered Health Care Professional Defined.--In this
section, the term ``covered health care professional'' means a
health care professional who--
(1) is an employee of the Department appointed under
the authority under sections 7306, 7401, 7405, 7406, or
7408 of this title, or title 5;
(2) is authorized by the Secretary to provide health
care under this chapter;
(3) is required to adhere to all quality standards
relating to the provision of telemedicine in accordance
with applicable policies of the Department; and
(4) has an active, current, full, and unrestricted
license, registration, or certification in a State to
practice the health care profession of the health care
professional.
* * * * * * *
[all]