Letter Supporting Provision in Senator John McCain’s Bill S. 2943
September 19, 2016
Chairman John McCain
Committee on Armed Services
Dear Chairman McCain:
The American Telemedicine Association strongly supports the provision in your bill S. 2943 (National Defense Authorization Act for Fiscal Year 2017) section 705(d) that allow TRICARE beneficiaries to be served by a state-licensed health professional using telemedicine, regardless of the location of the professional or the patient.
The Senate provision is good for patients and their providers.
Currently, all health professionals outside of the Military Health Service need to be licensed where they have a physical practice location as well as in the patient’s location at the time of service. This approach impedes efficient interstate use of telemedicine, it limits care to patients, drives up healthcare costs and limits patient choices.
For example, there are reported to be 30 million people that have a rare disease (defined as affected less than 200,000 in the U.S.) and few are located in a locality with at least one of the few highly specialized medical experts. An increasing number of areas of the country have shortages of certain specialists, such as psychiatry. Telehealth can be very usefully for giving people access and choice.
Just as a beneficiary can choose to travel to any available provider for health services, they should also have the ability to use the most qualified healthcare professional without being inconvenienced by unnecessary state barriers or travel. These barriers initiated by multiple state licensure authorities also cost health professionals and ultimately taxpayers hundreds of millions of dollars each year.
Telemedicine providers are paid based on their location, and not the patient’s. Such practice implies that clinical services occur where the professional is located. It seems simple and logical to also align the basis for licensure on the health professional’s location, not the patient’s.
This approach to mutual recognition of state licensure is currently endorsed and employed by nursing, psychology and physical therapy professionals nationally as well as with physicians treating active duty soldiers in the Military Health System. All TRICARE beneficiaries should be able to access health professionals in the same way as their uniformed colleagues without the cost and time constraints of obtaining multiple state licenses.
The Senate provision is supported by federal authority and experience.
The Senate provision is comparable to the authority that Congress gave, without opposition, 5 years ago for Defense Department personnel. Other federal agencies use arrangements where physicians can provide consultations with patients located in any federal facility, such as Veterans Affairs and Indian Health Service.
Just as the Founding Fathers chose to locate the Capitol in a special district where a state’s policies and politics would not apply, Federal agencies and programs can decide about the application of state laws and regulations. Congress is uniquely empowered by the Constitution to regulate interstate commerce.
Thank you Mr. Chairman for your leadership on improving service for TRICARE beneficiaries and reducing unnecessary administrative barriers for their caregivers.
Jonathan D. Linkous