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In a potentially game-changing win for physical therapists (PTs), physical therapist assistants (PTAs), and many other health care providers, the US Department of Veterans Affairs (VA) is following through on a proposal to dramatically expand the use of telehealth services across state lines for VA beneficiaries in all US jurisdictions The change, strongly supported by APTA, would also allow these services to be conducted in nonfederal sites, including the homes of VA patients.

As noted in its final rule released on May 10, VA took this sweeping action because interstate barriers were limiting VA's ability to fulfill its federal mandate.

"In an effort to furnish care to all beneficiaries and use its resources most efficiently, VA needs to operate its telehealth program with health care providers who will provide services via telehealth to beneficiaries in states in which they are not located, licensed, registered, certified or otherwise authorized by the state," VA writes in its rule. "Without this rulemaking, doing so may jeopardize these providers' credentials…because of conflicts between VA's need to provide telehealth across the VA system and some states' laws or requirements for licensure, registration, certification, that restrict the practice of telehealth."

In addition to providing comments in strong support of this change when it was proposed in October 2017, APTA met with VA representatives to advocate for the expanded use of PT and PTA services provided via telehealth.

"Our combined efforts with APTA have helped to create a change that will make a huge difference in the lives of VA patients," said Mark Havran, PT, DPT, president of the Federal Physical Therapy Section. "The patients who will benefit from this new rule are some of VA's most in-need, with many living far from provider facilities or experiencing mobility issues that make travel difficult. Now PTs and PTAs will be better able to provide the services those patients require."

Some important things to understand about the new rule:

The rule doesn't expand authority or scopes of practice.
VA providers must continue to abide by federal law and the practice acts of the provider's state of licensure.

The rule applies only to VA-employed providers—not to contracted providers such as providers in the Veterans Choice program.
The limitation to VA-employed providers was necessary to create protections from any actions that might be taken by state professional licensing boards.

Copays for telehealth services will go away.
Congress authorized VA to waive copay requirements for telehealth services, which VA did.

The rule doesn't go into effect immediately.
The changes will go into effect 30 days after publication in the Federal Register, which hasn't happened yet. Don't expect that publication until sometime in December at the earliest.

The rule won't solve all the issues with telehealth service delivery.
VA acknowledges that the change addresses only 1 challenge to telehealth services, and has resolved to continue to work on technical elements that interfere with effective delivery, including patients' and providers' access to technology.

Telehealth services currently are allowed in the VA system, but only if both the provider and patient live in the same state. Additionally, many VA medical centers restrict telehealth activities to federal property—for both the patient and the provider. The new rule would make it possible for the facilities to lift those restrictions.

"This rule is a significant step forward in the recognition of therapy services provided through telehealth," said Justin Moore, PT, DPT, CEO of APTA. "APTA was happy to support this change, because we believe VA's vision and leadership in this important component of health care will help to shape the future of patient access."

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