The Veterans Affairs Department has issued an interim final rule to make it easier for VA clinicians to practice across state lines, even when it conflicts with state requirements.
The rule is designed to "preempt" state requirements that could be used to sanction VA clinicians for doing so, according to the rule published in the Federal Register Thursday.
It affirms a "long-standing" policy that allows VA clinicians to practice in states they're not licensed in, so long as they're working within the scope and requirements of their VA employment. As of January, an estimated 14% of the VA's 182,100 licensed healthcare professionals do not hold a state license, registration or certification in the same state as their main VA medical facility.
That flexibility has been helpful amid the COVID-19 pandemic, as it's allowed the VA to move clinicians into hotspots or areas with staffing shortages.
Hospitals in COVID-19 hotspots have had to bring on supplemental staff and sometimes even call on retired doctors to address staffing shortages. CMS in April unveiled flexibilities to allow providers to practice across state lines, in the hopes they would free up additional provider capacity during the pandemic.
The VA rule's designed to provide protections for their clinicians, so that states can't sanction them even if they're practicing outside the scope of state requirements, according to the agency.
"It is critical VA healthcare professionals are able to deliver services in regions other than where they may be licensed, registered, certified or limited by a state requirement," VA Secretary Robert Wilkie said in a statement. "Whether we are assisting states dealing with natural disasters or even more so now with their pandemic response, VA is working diligently to get the appropriate, qualified staff to those communities in need as quickly as possible."
The VA also anticipates needing to deploy clinicians from other VA medical facilities to those going live on the department's new electronic health record system, as part of an effort to offset expected productivity dips as clinicians adjust to the new EHR.
In the wake of the COVID-19 pandemic, healthcare experts and policymakers have suggested that it's time to start thinking about reforming licensure at the federal level for the private sector, in large part because it would make it easier for clinicians to treat patients via telehealth without having to question which state a patient is located in.
Even before COVID-19, there had been growing interest in interstate licensing compacts; however, some labor unions had argued that granting interstate licenses cedes control.
The VA already in 2018 finalized a rule that allowed VA physicians and nurses to administer care to veterans via telehealth across state borders; the new rule focuses on in-person care.
The new rule also gives the VA authority to establish national standards of practice that its clinicians have to follow. The VA will set those standards through sub-regulatory guidance.
The VA in its latest rule describes state requirements that inhibit its clinicians from practicing across the U.S. as "requirements that unduly interfere with their practice."
"Several VA healthcare professionals have already had actions proposed or taken against them by various states while practicing healthcare within the scope of their VA employment," the rule reads. The VA in the rule cites one such example: a VA psychologist licensed in California but employed to provide supervision of a trainee at a VA medical center in Tennessee.
That arrangement violated California psychology licensing laws; in response, the state's psychology licensing board proposed sanctions and fines of $1,000, according to the VA.
The VA's rule, as an interim final rule, went into effect immediately upon publication in the Federal Register, skipping the notice and proposal process.
Public comments on the interim final rule are due Jan. 11, 2021.
