Rule2025-19324
Health Care Professionals Practicing Via Telehealth
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Published
October 2, 2025
Effective
November 3, 2025
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) adopts as final, with changes, a proposed rule to amend its medical regulations that govern VA's health care professionals who practice health care via telehealth. This final rule implements the authorities of the VA MISSION Act of 2018 and the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021. This final rule enables VA to maximize health care resource utilization and provide safe and convenient national health care to veterans using telehealth. It also strengthens VA's role in supporting national and State responses to war, terrorism, national emergencies and natural disasters.
Full Text
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<title>Federal Register, Volume 90 Issue 189 (Thursday, October 2, 2025)</title>
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[Federal Register Volume 90, Number 189 (Thursday, October 2, 2025)]
[Rules and Regulations]
[Pages 47595-47604]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-19324]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
[Docket No. VA-2022-VHA-0020]
RIN 2900-AQ59
Health Care Professionals Practicing Via Telehealth
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with
changes, a proposed rule to amend its medical regulations that govern
VA's health care professionals who practice health care via telehealth.
This final rule implements the authorities of the VA MISSION Act of
2018 and the William M. (Mac) Thornberry National Defense Authorization
Act for Fiscal Year 2021. This final rule enables VA to maximize health
care resource utilization and provide safe and convenient national
health care to veterans using telehealth. It also strengthens VA's role
in supporting national and State responses to war, terrorism, national
emergencies and natural disasters.
DATES: This rule is effective November 3, 2025.
FOR FURTHER INFORMATION CONTACT: Dr. Kevin Galpin, Executive Director,
Telehealth Services, Office of Connected Care, Veterans Health
Administration, (404) 771-8794.
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register (FR) on August 23, 2022, VA proposed to revise its regulations
that govern a VA health care professional's practice via telehealth. 87
FR 51625. VA provided a 60-day comment period, which ended on October
24, 2022. We received a total of 18 comments, ten of which fully
supported the proposed rule. We thank the commenters for their comments
and do not further address them below. The remaining comments, some of
which were generally supportive of the rule, raised issues and concerns
that are grouped together by like topic and addressed below. We make
minor changes to the rule as described below.
[[Page 47596]]
Comments Related to Preemption of State Law
We received two comments regarding VA's preemption of conflicting
State laws. One commenter stated that VA is prohibited by the Tenth
Amendment of the Constitution from requiring States to issue or
continue licenses to health care professionals who do not meet State
licensing requirements, such as the requirement that the health care
professional's supervisor is providing in person supervision or the
requirement that the trainee be supervised by a health care
professional who is licensed in the same State as the trainee. The
commenter requested that VA clarify that it is not commandeering States
to license those employees who do not meet State requirements for a
license. We do not make any changes based on the comment.
The Tenth Amendment of the United States Constitution provides that
the powers not delegated to the United States by the Constitution, nor
prohibited by it to the States, are reserved to the States
respectively, or to the people. However, VA's authority to furnish
health care to veterans has not been reserved to the States or the
people. Under Article I, section 8, Congress has the power to ``provide
for the common Defence and general Welfare of the United States''; to
``raise and support Armies'', and to ``provide and maintain a Navy'';
and to ``make Rules for the Government and Regulation of the land and
naval Forces''. See Art. I, sec. 8, cls. 1, 12-14. Congress also has
power to ``make all Laws which shall be necessary and proper for
carrying into Execution the foregoing powers''. See Art. I, sec. 8,
cls. 18. Congress exercises its authority under some or all of these
clauses when enacting veterans' benefits. See, e.g., Torres v. Texas
Dep't of Pub. Safety, 597 U.S. 580 (2022). Exercising these powers,
Congress, under section 7301(b) of title 38, United States Code
(U.S.C.), established that the primary function of the Veterans Health
Administration (VHA) within VA is to provide a complete medical and
hospital service for the medical care and treatment of veterans.
Generally, VA is allowed to employ medical professionals so long as
they are licensed ``in a State,'' see, e.g., 38 U.S.C. 7402(b)(1)(C),
rather than in every State in which they or their patients will be
located while providing care through VA. See also title 38, Code of
Federal Regulations (CFR) 17.419(b)(1)(i) (providing that a VA health
care professional may practice in any State ``irrespective of the State
where they hold a valid license, registration, certification or other
State qualification''). Specific to the provision of care through
telehealth, Congress explicitly provided that, notwithstanding any
provision of law regarding the licensure of health care professionals,
a VA health care professional may practice at any location in any
State, regardless of where the health care professional or the patient
is located, when using telehealth to provide treatment to an individual
under chapter 17. 38 U.S.C. 1730C(a). Section 1730C(d) further states
that this section supersedes any State law to the extent that the State
law is inconsistent with section 1730C, and that no State shall deny or
revoke a license, registration, or certification who otherwise meets
the qualifications of the State for holding such credential on the
basis of their practice of telehealth at VA. Therefore, the rule does
not encroach on any rights reserved to the States or to the people and
is not a violation of the Tenth Amendment to the U.S. Constitution both
because Congress has authority to enact laws regarding veterans'
benefits under Article I, section 8, and because Congress asserted
Federal supremacy under clause 2 of Article VI of the Constitution,
which provides that the Constitution, and the laws of the United States
made in pursuance thereof, are the supreme law of the land. In enacting
section 1730C, Congress exercised its authority under this clause
(commonly referred to as the supremacy clause) to preempt inconsistent
State law.
We clarify that through this rulemaking, we are not requiring or
commandeering a State to grant a license to those VA employees who do
not meet the State requirements to receive a license, registration,
certification, or other requirements. Rather, we are preempting any
provisions of State requirements as applied to VA health care
professionals to the extent that such provisions are inconsistent with
a VA health care professional's practice via telehealth. If a State
requirement is inconsistent with the VA employee's ability to carry out
their Federal duties, that State requirement will have no force or
effect on the VA employee when carrying out their VA duties. As
explained above, section 1730C(d)(2) confirms that no State shall deny
or revoke the license, registration, or certification of a covered
health care professional who otherwise meets the qualifications of the
State for holding the license, registration, or certification on the
basis that the covered health care professional has engaged or intends
to engage in telehealth at VA. However, the States will still determine
whether the health care professional otherwise meets the State
qualifications for holding the license, registration, or other
requirement.
We received one comment addressing limitations in the Controlled
Substances Act (CSA) and other applicable Federal law, regulation, and
policy as applied to VA, to include possible limitation by State law
through such authority. The commenter referenced practice guidelines
regarding the prescribing of buprenorphine, citing 86 FR 22439 (April
28, 2021), that ordinarily require prescribers to be licensed to treat
patients in the State in which the patient is located. As the commenter
acknowledged, the practice guidelines specifically exempt Federal
practitioners who are acting within the scope of their Federal
employment. We do not make a substantive change based on the comment
but make a non-substantive clarifying change to 38 CFR 17.417(b)(3) to
avoid any potential confusion regarding the authority of VA health care
professionals to prescribe controlled substances via telehealth and the
impact of State law as referenced by Federal authority.
State law that would conflict with VA health care professionals
prescribing via telehealth is not applicable to VA health care
professionals, but Federal standards regarding prescribing via
telemedicine are applicable. VA stated in proposed Sec. 17.417(b)(3)
that its health care professionals are subject to the CSA and other
``applicable Federal law, regulation, and policy,'' 87 FR 51631,
whereas the provision it is replacing (currently in Sec. 17.417(b)(1)
requires health care professionals to comply with ``the laws and
practice acts of the health care providers' State license,
registration, or certification'' in addition to applicable Federal law.
VA views the change as being authorized by, and consistent with, the
relevant statutory authority.
Specifically, the CSA creates a number of standards for a
prescription to be valid. See, e.g., 21 U.S.C. 829. Additional
standards are applicable to prescribing via ``telemedicine.'' See,
e.g., 21 U.S.C. 802(54) (authorizing prescribing a controlled substance
when the prescriber is, inter alia, communicating with the patient via
``a telecommunications system referred to in section 1395m(m) of title
42.''). These standards created by the CSA are among the applicable
Federal laws addressed in proposed 38 CFR 17.417(b)(3).
The CSA also references ``applicable . . . State laws'' into the
``practice of telemedicine.'' 21 U.S.C. 802(54). VA
[[Page 47597]]
health care professionals are specifically authorized to practice
medicine through telehealth notwithstanding State law. 38 U.S.C.
1730C(a). VA does not view a conflict as existing between the two
provisions. See Morton v. Mancari, 417 U.S. 535 (1974) (discussing the
preference for reading statutes to co-exist if possible). Rather,
section 1730C identifies a group of State laws--those that conflict
with a covered health care professional's practice of health care
through telehealth that are not appliable to VA health care
professionals in their VA role--without specifically excluding State
laws that interfere with prescribing controlled substances through
telemedicine, whereas the CSA in section 802(54) identifies that health
care professionals must generally comply with those State laws
applicable to them. Section 1730C(d)(2) explicitly prohibits a State
from denying or revoking the license, registration, or certification of
a covered VA health care professional based on their practice of
telehealth at VA.
Therefore, we conclude that it is possible to give effect to both
21 U.S.C. 802(54) and 38 U.S.C. 1730C, with the latter establishing
that State laws interfering with VA health care professionals
prescribing controlled substances are not applicable to VA health care
professionals under the former. To the extent a conflict exists between
the two statutes, we conclude that section 1730C(d) is the specific
rule addressing State law as applied to the practice of telehealth by
VA health care professionals and would control the general rule of 21
U.S.C. 802(54). See, e.g., Morales v. Trans World Airlines, Inc., 504
U.S. 374, 384 (1992) (``[I]t is a commonplace of statutory construction
that the specific governs the general.''). Moreover, 38 U.S.C. 1730C
was enacted (in 2018) after 21 U.S.C. 802(54) (in 2008). To the extent
there is a conflict, the canon of interpretation that the later statute
will generally prevail over a conflicting earlier statute would also
support VA's interpretation. Indeed, to do otherwise would effectively
render 38 U.S.C. 1730C(d) surplusage with regard to prescribing via
telemedicine, an interpretation that is not generally favored. See,
e.g., Montclair v. Ramsdell, 107 U.S. 147, 152 (1883).
VA does not view section 1730C(e) as requiring a different result.
Section 1730C(e) states a rule of construction that nothing in section
1730C may ``be construed to remove, limit, or otherwise affect any
obligation of a covered health care professional under the [CSA]'').
State law is superseded by section 1730C(a) (``notwithstanding any
provision of law regarding the licensure of health care
professionals'') to the extent it is inconsistent with a VA health care
professional's practice of medicine through telehealth, with section
1730C(d) making clear that State may take no action against a VA health
care professional's license based on a professional providing or
intending to provide treatment through telehealth as part of their VA
practice. Section 1730C(d)(1). In this context, such State laws are not
``applicable . . . State law'' under 21 U.S.C. 802(54) and create no
``obligation'' for VA health care professionals to follow conflicting
State laws. 38 U.S.C. 1730C(e). Therefore, VA concludes that section
1730C(e) incorporates the Federal standards of the CSA, but not more.
VA also notes that Congressional recognition of the unique nature of
VA's Nationwide practice by removing some State-level requirements
regarding prescribing is not unprecedented. For instance, in the CSA,
Congress exempted VA health care professionals from some State
requirements even before section 1730C was enacted. See, e.g., 21
U.S.C. 802(54)(A)(ii)(III)(bb)(AA) (exempting VA health care
professionals from the requirement of being ``registered . . . in the
State in which the patient is located'' when prescribing via telehealth
if the patient is being treated by, and physically located in, a
hospital or clinic registered under 21 U.S.C. 823(g)).
This addition also supports VA's ``Fourth Mission'' to improve the
Nation's preparedness for response to war, terrorism, national
emergencies, and natural disasters by developing plans and taking
actions to ensure continued service to veterans, as well as to support
national, State, and local emergency management, public health, safety
and homeland security efforts. VA's Fourth Mission is authorized under
three separate authorities 38 U.S.C. 1784, 1784A, and 1785. Section
1784 authorizes VA to furnish hospital care or medical services as a
humanitarian service in emergency cases. Under section 1784A, in the
case of a VA hospital that has an emergency department, if any
individual comes to the hospital or the campus of the hospital and a
request is made on behalf of the individual for examination or
treatment for a medical condition, the hospital must provide for an
appropriate medical screening examination within the capability of the
emergency department, including ancillary services routinely available
to the emergency department, to determine whether or not an emergency
medical condition exists. Lastly, under section 1785, VA may, during
and immediately following a disaster or emergency, furnish hospital
care and medical services to individuals responding to, involved in, or
otherwise affected by that disaster or emergency. In conjunction with
other Federal entities, such as the Department of Health and Human
Services (HHS) and the Department of Defense, VA serves as an asset to
the nation during disasters and emergencies. As a foundational part of
Federal emergency management efforts through the National Response
Framework, VA leads the effort for meeting veterans' needs and has
expanded authority to assist service members or civilians. Telehealth
and the ability to prescribe controlled substances in these situations
are important capabilities to support VA's Fourth Mission. This
rulemaking will ensure VA health care providers are able to practice
according to Federal standards when prescribing controlled substances
during emergencies to help support VA's Fourth Mission.
We considered whether our proposed rule made this point
sufficiently clear to allow the public to meaningfully comment on the
issue and conclude that the issue was sufficiently explained. In the
preamble to the proposed rule VA now seeks to finalize, we explicitly
addressed Executive Order 13132, which ``provides the requirements for
preemption of State law when it is implicated in rulemaking.'' 87 FR
51627-51631. We further explained that VA health care professional's
practice of health care via telehealth ``is subject to the limitations
imposed by the Controlled Substances Act [. . .] and implementing
regulations [. . .] on the authority to prescribe or administer
controlled substances, as well as any other limitations on the
provision of VA care set forth in applicable Federal law, regulation,
and policy.'' 87 FR 51625, 51626. See also id. at 51631 (proposed 38
CFR 17.417(b)(3)). This statement and corresponding regulatory text
were intended to clarify that VA health care professionals are not
excluded from Federal authority by 38 U.S.C. 1730C or the proposed
rule, neither of which reference State law or suggest that the
preemption of conflicting State laws does not extend to those State
laws that are inconsistent with Federal standards regarding the
prescription of controlled substances through telehealth.
We again note that this statement meaningfully departs from the
existing regulation, which predates section 1730C. VA's initial efforts
to preempt State law addressing the practice of telehealth prior to
1730C were not intended to exempt VA health care professionals from all
State-law requirements. Specifically, VA engaged
[[Page 47598]]
in rulemaking in October 2017, publishing a proposed rule entitled
Authority of Health Care Providers to Practice Telehealth. 82 FR 45756
(October 2, 2017). While conflicting State law was generally preempted
(``this proposed rule would preempt certain State laws'', and
``conflicting State and local laws, rules, regulations, and
requirements related to health care providers' practice would have no
force or effect when practicing telehealth''), see id. at 45759, VA
also stated that the rulemaking did not affect VA's existing
requirement that all VA health care providers ``adhere to restrictions
imposed by their State license, registration, or certification
regarding the professional's authority to prescribe and administer
controlled substances.'' Id. at 45758.
VA consulted with State officials before proposing the rule in
2017, with at least one response suggesting some varying
interpretations about the scope of VA's rule to preempt State-law
requirements interfering with VA's practice of telehealth as including
controlled substances. Id. at 45760 (stating Florida's requirement that
patients receive an in-person examination each time a physician issues
a certification for medical marijuana would not apply to VA
practitioners practicing telehealth, but VA would maintain the
restrictions imposed by Federal law and policy regarding the
prescription of controlled substances). See generally id. at 45759-60
(for a more fulsome discussion of the generally favorable input VA
received from State agencies and National Associations for State
practice groups).
In 2018, VA's rule was promulgated, 83 FR 21897 (May 11, 2018), and
VA again clarified that this section ``does not otherwise grant health
care providers additional authorities that go beyond what is required
or authorized by Federal law and regulations or as defined in the laws
and practice acts of the health care providers' State license,
registration, or certification.'' Authority of Health Care Providers to
Practice Telehealth, 83 FR 21897, 21898 (May 11, 2018). The version of
38 CFR 17.417(b)(1) that will be replaced is clear, therefore, both in
plain language and regulatory history in directing compliance with
prescribing requirements from a practitioner's State of licensure, save
where there is a conflict with Federal duties or requirements.
Shortly after VA codified Sec. 17.417 in regulation, 38 U.S.C.
1730C was enacted. MISSION Act of 2018, Public Law 115-182, sec. 151(a)
(June 6, 2018). VA views section 1730C as a clear expansion of VA's
authority to provide health care through telehealth. Congress made
clear that VA health care professionals ``may practice'' their ``health
care profession . . . at any location in any State, regardless of
where'' the practitioner or patient were located when the practitioner
was practicing via telehealth. 38 U.S.C. 1730C(a). State laws are
superseded ``to the extent that such provision of State law [is]
inconsistent,'' including that no State may ``deny or revoke the
license, registration, or certification of a'' VA practitioner ``on the
basis that the covered health care professional has engaged or intends
to engage in activity covered by subsection (a).'' Id. at section
1730(d). While Congress made clear that VA health care professionals
are subject to the provisions of the CSA in section 1730(e), it does
not subject providers to the ``laws and practice acts of the health
care providers' State license, registration, or certification'', unlike
the VA regulation that was in effect. 38 CFR 17.417(b)(1). Following
the enactment of the VA MISSION Act of 2018, VA published the proposed
rule it now seeks to finalize. 87 FR 51625 (August 23, 2022). In the
preamble to this proposed rule, VA stated that this proposed rulemaking
would state that VA health care providers' practice of medicine via
telehealth ``is subject to the limitations imposed by the Controlled
Substances Act [. . .] and implementing regulations [. . .] on the
authority to prescribe or administer controlled substances, as well as
any other limitations on the provision of VA care set forth in
applicable Federal law, regulation, and policy.'' Id. at 51626. VA
removed the current requirement for compliance with State-level
restrictions in the providers' State of licensure, registration, or
certification, echoing 38 U.S.C. 1730C, but did not address the change
beyond the discussion above and the regulatory text stating that
providers are subject to the CSA and ``other limitations on the
provision of VA care set forth in applicable Federal law, regulation
and policy.'' Id. at 51631 (proposed 38 CFR 17.417(b)(3)).
We explicitly address here and in updated Sec. 17.417(b)(3) and
clarify that this rulemaking supersedes any conflicting State
requirements regarding the practice of telehealth, including such State
or local laws, rules, regulations, and requirements related to the
prescribing of controlled substances. This preemption applies both to
the State's enforcement of these laws and to the CSA, to the extent the
CSA could be read to reference State-level authority. See, e.g., 21
U.S.C. 802(54) (defining ``practice of telemedicine'' as meaning ``in
accordance with applicable Federal and State laws''). Conflicting
State-level restrictions on the practice of telehealth are not
applicable to VA health care professionals while those professionals
are acting in the scope of their VA employment and practicing through
telehealth, including to the extent that a State might otherwise take
action regarding the license, registration, or certification of the
provider. 38 U.S.C. 1730C(a), (d).
As articulated in our proposed rule, VA does not read section 1730C
as removing requirements for prescribing via telehealth in the CSA or
as set forth in other Federal law and policy. Section 1730C(e).
Therefore, to the extent a Federal actor with authority to prescribe
Federal standards, such as the U.S Department of Justice (including the
Drug Enforcement Administration) or the Department of Health and Human
Services, promulgate guidance binding on VA regarding the practice of
telehealth, we view such authority as binding on VA health care
professionals in their Federal practice. Additionally, any VA specific
policies on prescribing controlled substances, i.e., checking the
Prescription Drug Monitoring Program, how many days of medication VA
health care professional may prescribe, etc., must be followed. VA has
a robust system in place for prescribing controlled substances and, as
an integrated health system, has better substance use disorder service
(SUDS) outcomes. These outcomes are achieved via VA's SUDS continuum of
care, which provides standard outpatient services, intensive outpatient
programs, opioid replacement therapies, residential rehabilitation and
acute hospital services. VA has been proactive in developing
initiatives and tools to ensure VA employed health care professionals
deliver safe, high-quality care to veterans within its integrated
health care system, be it through in-person or virtual care. By way of
example, VA highlights its Opioid Safety Initiative (OSI), implemented
Nationwide in 2013, which facilitates the safe, effective prescribing
of opioid containing controlled substances in alignment with evidence-
based practice.
Key outcomes from this initiative demonstrate its effectiveness.
Between fourth quarter of Fiscal Year (FY) 2012 and fourth quarter of
FY 2024, VA's achievements include:
<bullet> A 68% reduction in patients receiving opioids (874,897 to
282,346 patients);
<bullet> A 90% reduction in patients receiving opioids and
benzodiazepines together (162,444 to 15,446 patients);
[[Page 47599]]
<bullet> An 82% reduction in patients with high dosage opioid
therapy (greater than or equal to 90 Morphine Equivalent Daily Dose)
(76,466 to 13,453 patients);
<bullet> A 73% reduction in patients on long-term opioid therapy
(569,027 to 155,945 patients);
<bullet> A 53% increase in patients on long term opioid therapies
with urine drug screen (UDS) (from 32% to 85%); and
<bullet> An 83% reduction in new patients on long-term opioid
therapy (58,417 to 10,005 patients). (VHA internal OSI dashboard data).
Furthermore, VA mandates that all veterans have their care reviewed
by an interdisciplinary team of health care professionals with
expertise spanning pain, mental health, addiction, pharmacy and
rehabilitation when the veteran:
<bullet> Is prescribed or has recently discontinued use of opioid
analgesic medications and is identified as very high risk for overdose
events, suicide events, or death through the VA's Stratification Tool
for Opioid Risk Mitigation (STORM); or
<bullet> Has recently suffered from a non-fatal overdose.
Note: STORM estimates the risk of overdose or suicide events or
death for all patients and has been incorporated in a decision
support tool to support population management and individual patient
risk review.
In a randomized program evaluation, this mandate was associated
with a 22 percent reduction in all-cause mortality in the next 4 months
among the very high-risk veterans targeted by this prevention
program.\1\ With VA's integrated health system and robust system in
place for prescribing controlled substances, veterans who receive VA
health care have better health outcomes than non-enrolled veterans, and
VA hospitals have dramatically outperformed non-VA hospitals in overall
quality ratings and patient satisfaction ratings.\2\
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\1\ See Strombotne KL, Legler A, Minegishi T, Trafton JA, Oliva
EM, Lewis ET, Sohoni P, Garrido MM, Pizer SD, Frakt AB. Effect of a
Predictive Analytics-Targeted Program in Patients on Opioids: A
Stepped-Wedge Cluster Randomized Controlled Trial. J Gen Intern Med.
2022 May 2:1-7. doi: 10.1007/s11606-022-07617-y. Epub ahead of
print. PMID: 35501628; PMCID: PMC9060407.
\2\ <a href="https://www.va.gov/wilmington-health-care/news-releases/400000-veterans-enrolled-in-va-health-care-over-past-365-days-30-increase-over-last-year/">https://www.va.gov/wilmington-health-care/news-releases/400000-veterans-enrolled-in-va-health-care-over-past-365-days-30-increase-over-last-year/</a> and Eric A. Apaydin, et al. Veterans Health
Administration (VA) vs. Non-VA Healthcare Quality: A Systematic
Review. Journal of Internal Medicine, 38 (2023).
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We also note that, in the FY 2024 budget request, VA included a
legislative proposal addressing prescribing via telehealth. We view
this request as complementary to the interpretation of 38 U.S.C. 1730C
and 21 U.S.C. 802(54) articulated above. While State law is not
applicable to VA health care professionals insofar as it is
inconsistent with those professionals prescribing via telehealth, our
legislative proposal provides further clarity regarding standards for
quality and safety that VA would need to follow and establish in
partnership with the Attorney General. Our legislative proposal
provides additional clarity on VA's standards for prescribing via
telehealth when doing so would be inconsistent with a State law that
would be preempted by 38 U.S.C. 1730C.
We note that, in order to practice telehealth pursuant to section
1730C(b), a VA health care professional must have an active, current,
full, and unrestricted license, registration, or certification in a
State to practice the health care profession of the health care
professional or, with respect to a health care profession listed
undersection 7402(b), have qualifications for such profession as set
forth by the Secretary. Trainees and postgraduate employees may only
participate in telehealth with clinical supervision, which must be by
an employee who is licensed, registered, or certified by a State or who
otherwise meets qualifications as defined by the Secretary. See 87 FR
51629. In addition, all health care professionals that require a
certification, registration, or other State requirement must maintain
their credentials as outlined by VA's qualification standards in VA
Handbook 5005, Staffing. VA health care professionals must still follow
State laws, unless there is a conflict with Federal duties or
requirements, and that pursuant to section 1730C(b)(1)(C), VA health
care professionals are still ``required to adhere to all standards for
quality relating to the provision of health care in accordance with
applicable policies of the Department.'' We are amending 38 CFR
17.417(b)(4) by adding a new paragraph (b)(4)(viii) to add a new
example of a situation where there would be a conflict between the
health care professional's State license and Federal duties or
requirements. This new paragraph states that an example of where a
health care professional's VA practice of telehealth may be
inconsistent or conflict with a State law or State license,
registration, or certification requirements related to telehealth
include when the beneficiary is receiving a controlled substance
medication in a State other than the health care professional's State
of licensure, registration, or certification. While several of the
existing examples in Sec. 17.417(b)(4) are relevant to prescribing
controlled substances, VA believes a specific example adds clarity.
Another commenter raised concerns about the lack of public and
State consultation prior to the promulgation of the rule. In
particular, the commenter stated that promulgating health care
professional practice rules at the Federal level rather than the State
level reduces opportunities for public participation and limits public
accountability, as the public can impact State laws and regulations
governing licensed health care professionals as well as State
regulating bodies. The commenter further explained that the State
consultation process used for this rule was insufficient, as VA did not
consult with individual State boards of nursing. We do not make any
changes to the rule based on this comment.
As an initial matter, VA reiterates that Congress enacted 38 U.S.C.
1730C to specifically authorize VA to establish rules related to
telehealth on a Federal level for VA health care professionals that
would explicitly preempt State requirements that are inconsistent with
VA's requirements. VA further believes that appropriate opportunities
for public and State participation were available for this rule. VA
provided a 60-day comment period on the proposed rule, which afforded
the public, including State officials and individual State boards, the
opportunity to submit comments on the rule. We also consulted with
appropriate State officials, including the National Council of State
Boards of Nursing, prior to the publication of the proposed rule in
compliance with sections 4(d) and (e) and section 6(c) of Executive
Order 13132, as that was the most practicable form of consultation. In
addition, VA will continue to work closely with State licensing boards
to make certain that VA health care professionals continue to meet the
standards of clinical practice, which will ensure patient safety.
Comments Related to Employee Protections and State Licensing
We received several comments regarding how VA will protect VA
health care professionals if a State pursues an adverse action against
such professional for practicing via telehealth. While we do not
consider any of these comments within the scope of the rule because
they all concern internal VA processes, we will address the concerns to
provide clarity and transparency. We do not make any changes based on
these comments.
One commenter raised concerns that the rule does not explain how
current and former VA employees should report
[[Page 47600]]
to VA State action that is being taken against their license based on
activities undertaken within the scope of VA employment. While we do
not consider any of this comment within the scope of the rule because
it concerns internal VA processes, we will address the concern to
provide clarity and transparency, as further described below. We do not
make any changes based on this comment.
Multiple commenters raised concerns about how and whether VA would
support or represent VA employees who have adverse actions taken
against them for practicing via telehealth inconsistent with their
State requirements. One commenter specifically raised concerns about
how VA would protect postgraduate health care employees, health
professions trainees, and those providing clinical supervision. Another
commenter suggested that VA commit to assisting its employees from
State action while another raised concerns about whether VA will devote
resources, financial or otherwise, to employees in such instances. One
of the commenters recommended that VA implement programs and procedures
to protect employees who are acting within the scope of the rule. While
we do not consider any of this comment within the scope of the rule
because it concerns internal VA processes, we will address the concern
to provide clarity and transparency. We do not make any changes based
on this comment.
We emphasize that VA is committed to providing representation to
all VA health care professionals who have any State action proposed or
taken against them for practicing consistent with their Federal duties.
VA health care professionals who carry out their Federal duties must be
allowed to do so free from the threat of liability. The Supremacy
Clause of the U.S. Constitution bars States and State officials from
penalizing government personnel for performing their Federal functions,
whether through State criminal prosecution, license revocation
proceedings, or civil litigation unless authorized by Federal law.
Subject to the requirements and procedures set forth in 28 CFR
50.15(a), Department of Justice representation is available to Federal
employees in civil, criminal, and professional licensure proceedings
where they face personal exposure for actions performed within the
scope of their Federal duties. This includes representation of any
postgraduate health care employees, health professional trainees, and
those providing clinical supervision, as long as they meet the
definition of health care professional in 38 CFR 17.417(a)(2). We note
that such defense does not extend to situations where a State Board may
be taking appropriate disciplinary action against a VA health care
professional when their behavior or clinical practice substantially
fails to meet generally accepted standards of clinical practice as to
raise reasonable concern for the safety of patients or if the VA health
care professional is practicing outside of the scope of their VA
employment. This is consistent with VA's current practice.
Although VA is committed to protecting its health care
professionals were any State to propose or take action against them, VA
does not anticipate that many, if any, actions will be taken against
its professionals for practicing via telehealth within the scope of
their Federal duties. As previously explained, 38 U.S.C. 1730C(d)
explicitly provides that the provisions of this section shall supersede
any provisions of the law of any State to the extent that such
provision of State law are inconsistent with this section and that no
State shall deny or revoke the license, registration, or certification
of a covered health care professional who otherwise meets the
qualifications of the State for holding the license, registration, or
certification on the basis that the covered health care professional
has engaged or intends to engage in activity covered by subsection (a).
Furthermore, State officials are barred from penalizing VA employees
for performing their Federal duties, whether through criminal
prosecution, license revocation, or civil litigation. See, e.g.,
Intergovernmental Immunity for the Department of Veterans Affairs and
Its Employees When Providing Certain Abortion Services, 46 Op. O.L.C.,
__ at *10 (Sept. 21, 2022), <a href="https://www.justice.gov/d9/2022-11/2022-09-21-va_immunity_for_abortion_services.pdf">https://www.justice.gov/d9/2022-11/2022-09-21-va_immunity_for_abortion_services.pdf</a>.
One commenter raised a concern about whether VA or a future non-VA
employer could take adverse employment action against the health care
professional due to any proposed or actual State action against them.
This commenter also stated that despite VA's preemption in this rule, a
State regulatory body could still pursue action against a VA employee,
which could prohibit such employee from working until the issue is
resolved. While we do not consider any of this comment within the scope
of the rule because it concerns internal VA processes, we will address
the concern to provide clarity and transparency. We do not make any
changes based on this comment.
VA will not take adverse employment action if a State proposes
action against a VA health care professional solely on the basis of
practicing consistent with their Federal duties. A State will typically
not take immediate action against a health care professional whose
practice is inconsistent with State law without first providing a
professional due process. Thus, VA would have an opportunity to assist
providers in their defense of any action proposed by a State as
described above. In order to be employed at VA in certain health care
professions, VA is statutorily required to ensure the health care
professional has an active license, certification, registration, or
other State requirement. Section 7402. If the health care professional
does not meet these qualification standards, VA must remove the
individual from a patient care position, i.e., VA may move health care
professionals to non-patient care positions, if necessary, while the
professionals go through the process of defending their State license.
VA would only take this action if a State has taken action against the
health care professional's State license and the individual has no
other active, current, unrestricted State license.
One commenter recommended VA include a provision in the final rule
that allows VA to continue the employment of a health care professional
whose licensure has been suspended, conditioned, or revoked when VA
believes that the action is based on the employee's activities within
the scope of their VA employment. Similar to the comments above we do
not consider any of this comment within the scope of the rule because
it concerns internal VA processes. We do not make any changes based on
these comments.
Comments Related to the Definition of Health Care Professional
We received several comments related to the definition of health
care professional in the regulation. Although one commenter
specifically thanked VA for excluding contractors from the definition
of health care professional, some commenters requested that VA include
contractors under its definition of health care professional. One
commenter suggested that contractors be included to ensure access to
care. Another commenter stated that contractors are not expressly
excluded under section 1730C; thus, there are no legal barriers to
including them in the definition of health care professional. Another
commenter suggested that VA could create a narrow exception to the
exclusion of VA contractors from this rule in the instance when they
are exempted under HHS's Practice Guidelines for the Administration of
[[Page 47601]]
Buprenorphine for Treating Opioid Use Disorder (HHS Practice
Guidelines) from requiring supervision or collaboration with a Drug
Enforcement Agency registered physician, even if required by State law.
VA stated in the proposed rule that VA-contracted health care
professionals would be excluded from the definition of health care
professional. VA maintains this exclusion because 38 U.S.C. 1730C
requires that a health care professional be an employee of the
Department appointed under 38 U.S.C. 7306, 7401, 7405, 7406, or 7408 or
under title 5 and contracted health care professionals and community
care professionals are not appointed under these authorities. We do not
make any changes based on these comments.
Another commenter opposed amending the definition of health care
professional to include postgraduate health care employees and health
care professional trainees, as there may be ambiguity about which
practice standards to follow, which could lead to unsafe patient care.
We do not make any changes based on this comment. The definition of
health care professional in section 1730C includes those who are
postgraduate health care employees and those who are health
professional trainees. See section 1730C(b)(2) and (3). Thus, VA is
required by law to include such individuals in its definition of health
care professional for purposes of telehealth.
One commenter suggested VA include certified registered nurse
anesthetists (CRNA) in the definition of health care professional. We
make no changes based on this comment. The proposed rule amended VA's
definition of health care professional defined in 38 CFR 17.417(a)(2)
to be consistent with the statutory definition found in 38 U.S.C.
1730C(b)(1)(A), which includes those appointed pursuant to section
7401. Section 7401(1) includes registered nurses. As CRNAs are advanced
practice registered nurses appointed under section 7401, they are
included in the definition of health care professional in section
1730C(b)(1)(A) and proposed 38 CFR 17.417(a)(2). This definition does
not list specific health care professions, but rather lists the
criteria that must be met to meet the definition of health care
professional.
Comments Related to Quality of Care, Supervision, and Oversight
One commenter was generally supportive of the rule, but highlighted
areas that VA should consider to ensure that VA provides the highest
quality of care possible. The commenter was supportive of the rule's
supervision requirement, but suggested that VA ensure that the proper
level of supervision (i.e., general, direct, or personal) and oversight
is provided to both trainees as well as non-physician health care
professionals.
We appreciate the suggestions from the commenter; however, we will
not make any changes to the rule based on the comment. We agree with
the commenter that the appropriate level of supervision should be
required for trainees, but do not believe it is appropriate to define
that level of supervision in this regulation. The level of supervision
may depend on a variety of factors, in particular which health care
occupation the trainee is practicing in, and therefore would be better
determined sub-regulatorily. As to the commenter's concern about
oversight, this is also beyond the scope of the rulemaking for similar
reasons. However, as part of its telehealth expansion efforts, VA has
developed and refined its telehealth policy to include telehealth
oversight responsibilities that support access to safe, high quality
services for veterans. VA will continue its efforts to enhance quality
management and oversight practices.
Similarly, another commenter raised concerns about the lack of VA
guidance, to include a lack of clear delineation for responsibility and
oversight, regarding clinical supervision of nurses who have completed
their education requirements but are not yet licensed.
While we appreciate this commenter's concerns regarding the need
for clear guidance addressing supervisory requirements, we consider
them beyond the scope of the proposed rule as they relate to internal
VA processes. This rule codifies VA's statutory authority that VA
trainees, such as student nurses and unlicensed postgraduate health
care employees, may participate in telehealth under appropriate
clinical supervision. It does not attempt to delineate or provide
guidance on supervisory requirements based on different professions or
a trainee's level of experience. VA will provide internal guidance to
address the standards of practice that health care professionals should
follow while practicing via telehealth. No changes are being made to
the rule in response to this comment.
Comments Related to VA's National Standards of Practice and Sope of
Practice
Multiple commenters addressed practice standards for various health
care professional occupations. One commenter raised concerns about how
quality of care would be affected were VA to increase the scope of
practice of non-physician health care professionals when they practice
via telehealth particularly, as the commenter asserts, that the
clinical judgment of a non-physician health care professional cannot be
substituted for that of a physician. Similarly, another commenter
raised concerns regarding VA's development of national standards of
practice. Another commenter recommended VA remove physician supervision
requirements for CRNAs, particularly as such supervision does not
impact patient safety and quality of care and instead may restrict
access to care and increase costs.
These comments are beyond the scope of this rulemaking. VA has a
separate regulatory authority at Sec. 17.419 which authorizes it to
develop national standards of practice for VA health care professionals
via sub-regulatory guidance. Each national standard of practice will be
posted on the Federal Register for a 60-day comment period prior to
finalization and implementation. We encourage the commenters to provide
their feedback regarding any potential change in the scope of practice
of non-physician providers when they are posted for public feedback in
the Federal Register.
Other Comments
One commenter recommended that VA correct the use of a comma after
21 CFR 1300 et seq. in 38 CFR 17.417(b)(3). The commenter stated that
the implementing regulations should be cited as 21 CFR 1300 et seq.
without a comma.
We disagree with the commenter, as the comma is used as a
description of the citation 21 CFR 1300 et seq. Usually, if something
or someone is sufficiently identified, such as the CFR citation, the
description that follows is considered nonessential and should be
surrounded by commas. However, we acknowledge that the proposed
regulatory text at 38 CFR 17.417(b)(3) had a technical error as a comma
was added after 21 U.S.C. 801. As part of this final rule, we are
removing the comma after 21 U.S.C. 801 from the final regulation text
in 38 CFR 17.417(b)(3).
A commenter appeared to highlight for VA that VA health care
professionals and contractors are exempt from certain requirements from
the Controlled Substances Act as a result of the HHS Practice
Guidelines when prescribing controlled substances. The commenter seemed
to further highlight that the exemption, while only in practice
guideline, still retained the force and effect of law. The HHS Practice
Guidelines provide an exemption from
[[Page 47602]]
certain statutory certification requirements related to training,
counseling, and other ancillary services (i.e., psychosocial services)
to eligible physicians, physician assistants, nurse practitioners,
clinical nurse specialists, certified registered nurse anesthetists,
and certified nurse midwives, who are State licensed and registered by
the Drug Enforcement Agency to prescribe controlled substances. See 86
FR 22439. We presume that the commenter is suggesting VA update its
regulation to include this exception from VA's adherence to the
Controlled Substances Act. We are not making any changes based on this
comment.
As noted by the commenter, the HHS Practice Guidelines were
promulgated pursuant to 21 U.S.C. 823(h)(2)(B)(i)-(ii).\3\ On December
29, 2022, the Consolidated Appropriations Act, 2023, was signed into
law. Division FF, section 1262 of this Act repealed, among other
subsections, 21 U.S.C. 823(h)(2)(B)(i)-(ii). Thus, because the
statutory provisions granting HHS the authority to promulgate the
practice guidelines have been repealed, they have no force or effect on
VA health care providers. However, VA reiterates here that this rule
preempts any State requirements regarding the practice of telehealth,
including such State or local laws, rules, regulations, and
requirements related to the prescribing of controlled substances.
---------------------------------------------------------------------------
\3\ We noted that section 1262 of Division FF of the
Consolidated Appropriations Act, 2023 references 21 U.S.C. 823(g).
However, this is a clerical error, and the repealed portions of the
statute are within 21 U.S.C. 823(h).
---------------------------------------------------------------------------
Section 1730C(e) of title 38, U.S.C. provides 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. Similarly, 38 CFR 17.417(b)(3), provides that health
care professionals' practice is subject to the Federal limitations
imposed by the Controlled Substances Act, 21 U.S.C. 801 et seq. and
implementing regulations at 21 CFR 1300 et seq., on the authority to
prescribe or administer controlled substances, as well as any other
limitations on the provision of VA care set forth in applicable Federal
law, regulation, and policy.
A commenter was also concerned with VA's prioritization of
telehealth over in-person care, especially in instances when a patient
is receiving acute hospital care in the home, as they alleged that
substituting telehealth for in-person interactions can negatively
impact patients, including their relationship with the health care
professional, and should only be used when other options are unsafe.
The commenter also opined that practicing via telehealth can be
challenging for experienced health care professionals, even more so for
student nurse trainees and unlicensed postgraduate Registered Nurses
(RN). Another commenter supported telehealth but also noted there may
be instances when telehealth should not be utilized and in-person care
may be more appropriate.
As an initial matter, VA respects the decisions that veterans make
as to their own health care decisions and does not force nor require
any veteran to utilize telehealth if they would prefer an in-person
appointment. Further, we disagree with the commenter that telehealth
negatively impacts patients and their relationship with health care
professionals, and we disagree that telehealth should only be used when
other options are unsafe. Telehealth enhances VA's capacity to deliver
essential and critical health care services to beneficiaries located in
areas where health care professionals may be unavailable or to
beneficiaries who may be unable to travel to the nearest VA medical
facility for care because of their medical conditions. Telehealth
increases the accessibility of VA health care, bringing VA medical
services to locations convenient for beneficiaries, including clinics
in remote communities and beneficiaries' homes. Our intent is not to
replace visits that require in-person interactions with telehealth. VA
must ensure that patient care is appropriate and safe. As such, a
health care professional would determine if or when it would be
appropriate for a patient who is receiving acute hospital care in the
home to receive health care via telehealth. When clinically appropriate
and preferred by a patient, telehealth is an important option to
enhance health care access and convenience. With regards to the
commenter's concern about the challenges of student nurse trainees and
unlicensed postgraduate RNs practicing via telehealth, we note that
these employees will be appropriately supervised and will benefit from
exposure to telehealth during their training programs, which will
better prepare them for practice upon graduation, as health care is
provided via telehealth throughout the health care industry. No changes
are being made to the rule in response to this comment.
Another commenter strongly encouraged VA to continue to build upon
the Anywhere to Anywhere VA Health Care initiative, further deploying
digital health innovations that will improve outcomes, reduce costs,
and realize an improved caregiver experience and utilizing every
opportunity to achieve a truly connected continuum of care, especially
for those in rural communities.
While we consider this outside the scope of this rulemaking, VA
appreciates this comment, agrees with the importance of integrating
connected care into VA's health care delivery model, and intends to
remain an innovative leader in this area. No changes are being made to
the rule based on this comment.
Technical Edits
VA is making a technical edit to the definition of telehealth in 38
CFR 17.417(a)(4). VA defines the term telehealth to mean the use of
electronic information or telecommunications technologies to support
clinical health care, patient and professional health-related
education, public health, and health administration. VA notes that the
term virtual health is used interchangeably with the term telehealth.
As such, VA is making a non-substantive change to the definition of
``telehealth'' to add that ``the term virtual health has the same
meaning as the term telehealth and can be used interchangeably.'' No
other changes in the meaning of the definition of telehealth are made
by this change.
VA is also making technical edits to capitalize the term
``federal'' in Sec. 17.417(a)(2)(iv)(D)(4)(b)(1) and (2); correctly
format the cross references to the Controlled Substances Act in Sec.
17.417(b)(3)(i) and (iii); and to replace a hyphen with the word
``through'' in the reference contained in Sec. 17.417(a)(2)(iv)(D).
These were errors in the proposed rule, and making these technical
edits will ensure consistency with Federal Register publishing
guidelines.
Based on the rationale set forth in the Supplementary Information
to the proposed rule and in this final rule, VA is adopting the
proposed rule as final with the changes described in this rule.
Executive Order 13132, Federalism
Executive Order 13132 provides the requirements for preemption of
State law when it is implicated in rulemaking. Where a Federal statute
does not expressly preempt State law, agencies shall construe any
authorization in the statute for the issuance of regulations as
authorizing preemption of State law by rulemaking only when the
exercise of State authority directly conflicts with the exercise of
Federal authority or there is clear evidence to conclude that the
[[Page 47603]]
Congress intended the agency to have the authority to preempt State
law. Through this rulemaking process, we can preempt any State law or
action that conflicts with the exercise of Federal duties in providing
health care via telehealth to VA beneficiaries.
In addition, any regulatory preemption of State law must be
restricted to the minimum level necessary to achieve the objectives of
the statute pursuant to the regulations that are promulgated. In this
rulemaking, State licensure, registration, and certification laws,
rules, regulations, or other State requirements are preempted only to
the extent such State laws are inconsistent with the VA health care
professionals' practicing health care via telehealth while acting
within the scope of their VA employment. VA also has statutory
authority under 38 U.S.C. 1730C to preempt State law. Therefore, we
believe that the rulemaking is restricted to the minimum level
necessary to achieve the objectives of the Federal statute.
The Executive Order also requires an agency that is publishing a
regulation that preempts State law to follow certain procedures. These
procedures include: the agency consult with, to the extent practicable,
the appropriate State and local officials in an effort to avoid
conflicts between State law and Federally protected interests; and the
agency provide all affected State and local officials notice and an
opportunity for appropriate participation in the proceedings.
Because this final rule preempts certain State laws, VA consulted
with State officials prior to the publication of the proposed rule in
compliance with sections 4(d) and (e), as well as section 6(c) of
Executive Order 13132. VA also provided a 60-day comment period on the
proposed rule, which allowed for the State officials to provide
additional comments on the rule. On August 21, 2019, VA sent a letter
to the following: National Association of Boards of Pharmacy,
Association of State and Provincial Psychology Boards, National
Governors Association, American Academy of Physicians Assistants,
National Council of State Boards of Nursing, National Association of
State Directors of Veterans Affairs, Association of Social Work Boards,
and the Federation of State Medical Boards to state VA's intent to
amend the current regulations that allow VA health care professionals
to practice telehealth. VA received 11 comments from the State
officials, which were addressed in the proposed rule.
Executive Orders 12866, 13563, and 14192
VA examined the impact of this rulemaking as required by Executive
Orders 12866 (Sept. 30, 1993) and 13563 (Jan. 18, 2011), which direct
agencies to assess all costs and benefits of available regulatory
alternatives and, if regulation is necessary, to select regulatory
approaches that maximize net benefits. The Office of Information and
Regulatory Affairs has determined that this rulemaking is a not
significant regulatory action under Executive Order 12866, as
supplemented by Executive Order 13563. This final rule is an Executive
Order 14192 deregulatory action because it generates incremental cost
savings, while also simplifying and standardizing telehealth licensing
requirements for VA health professionals. The regulatory impact
analysis associated with this rulemaking can be found as a supporting
document at <a href="http://www.regulations.gov">www.regulations.gov</a>.
Paperwork Reduction Act
This final rule contains no provisions constituting a collection of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The provisions associated with this rulemaking are not processed
by any other entities outside of VA. Therefore, pursuant to 5 U.S.C.
605(b), the initial and final regulatory flexibility analysis
requirements of 5 U.S.C. 603 and 604 do not apply.
Unfunded Mandates
This final rule will not result in the expenditure by State, local,
and Tribal governments, in the aggregate, or by the private sector, of
$100 million or more (adjusted annually for inflation) in any one year.
Congressional Review Act
Pursuant to Subtitle E of the Small Business Regulatory Enforcement
Fairness Act of 1996 (known as the Congressional Review Act) (5 U.S.C.
801 et seq.), the Office of Information and Regulatory Affairs
designated this rule as not satisfying the criteria under 5 U.S.C.
804(2).
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs--health, Grant programs--veterans,
Health care, Health facilities, Health professions, Health records,
Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Reporting and
recordkeeping requirements, Scholarships and fellowships, Travel and
transportation expenses, Veterans.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on September 23, 2025, and authorized the undersigned to sign
and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Taylor N. Mattson,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
For the reasons set forth in the preamble, the Department of
Veterans Affairs amends 38 CFR part 17 as set forth below:
PART 17--MEDICAL
0
1. The authority citation for part 17 is amended by revising the
authority for Sec. 17.417 to read in part as follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
* * * * *
Section 17.417 also issued under 38 U.S.C. 1701 (note), 1709A,
1712A (note), 1722B, 1730C, 7301, 7306, 7330A, 7331, 7401-7403,
7405, 7406, 7408.
* * * * *
0
2. Amend Sec. 17.417 by:
0
a. Revising the section heading and paragraphs (a)(2) and (4) and (b);
and
0
b. In paragraph (c), removing the term ``health care providers'' and
adding in its place the term ``health care professionals'' wherever it
appears.
The revisions read as follows:
Sec. 17.417 Health care professionals practicing via telehealth.
(a) * * *
(2) Health care professional. The term health care professional is
an individual who:
(i) Is appointed to an occupation in the Veterans Health
Administration that is listed in or authorized under 38 U.S.C. 7306,
7401, 7405, 7406, or 7408, or title 5 of the U.S. Code;
(ii) Is required to adhere to all standards for quality relating to
the provision of health care in accordance with applicable VA policies;
(iii) Is not a VA-contracted health care professional; and
(iv) Is qualified to provide health care as follows:
[[Page 47604]]
(A) Has an active, current, full, and unrestricted license,
registration, certification, or satisfies another State requirement in
a State to practice the health care profession of the health care
professional;
(B) Has other qualifications as prescribed by the Secretary for one
of the health care professions listed under 38 U.S.C. 7402(b);
(C) Is an employee otherwise authorized by the Secretary to provide
health care services; or
(D) Is under the clinical supervision of a health care professional
that meets the requirements of paragraph (a)(2)(iii)(A) through (C) of
this section and is either:
(1) A health professions trainee appointed under 38 U.S.C. 7405 or
38 U.S.C. 7406 participating in clinical or research training under
supervision to satisfy program or degree requirements; or
(2) A health care employee, appointed under title 5, 38 U.S.C.
7401(1), (3), or 38 U.S.C. 7405 for any category of personnel described
in 38 U.S.C. 7401(1), (3) who must obtain full and unrestricted
licensure, registration, or certification or meet the qualification
standards as defined by the Secretary within the specified time frame.
* * * * *
(4) Telehealth. The term telehealth means the use of electronic
information or telecommunications technologies to support clinical
health care, patient and professional health-related education, public
health, and health administration. The term virtual health has the same
meaning as the term telehealth and can be used interchangeably.
(b) Health care professional's practice via telehealth. (1) When a
State law, license, registration, certification, or other State
requirement is inconsistent with this section, the health care
professional is required to abide by their Federal duties and
requirements. No State shall deny or revoke the license, registration,
or certification of a covered health care professional who otherwise
meets the qualifications of the State for holding the license,
registration, or certification on the basis that the covered health
care professional has engaged or intends to engage in activity covered
under this section.
(2) VA health care professionals may practice their health care
profession within the scope of their Federal duties in any State
irrespective of the State or location within a State where the health
care professional or the beneficiary is physically located, if the
health care professional is using telehealth to provide health care to
a beneficiary.
(3) Prescribing controlled substances via telehealth.
(i) Health care professionals' practice is subject to the
limitations imposed by the Controlled Substances Act, 21 U.S.C. 801 et
seq., and implementing regulations at 21 CFR chapter II, on the
authority to prescribe or administer controlled substances, as well as
any other limitations on the provision of VA care set forth in
applicable Federal statute, regulation, and policy.
(ii) State law, license, registration, certification, or other
State requirements conflicting with a VA health care professional's
prescribing of controlled substances via telehealth are not applicable
laws for VA health care professionals practicing their health care
profession within the scope of their Federal duties in any State.
(iii) State requirements conflicting with a VA health care
professional's prescribing of controlled substances via telehealth are
not applicable through the Controlled Substances Act, 21 U.S.C. 801 et
seq., and implementing regulations at 21 CFR chapter II, for health
care professionals' practice insofar as statute or regulation refer to
``applicable State law''.
(4) Examples of where a health care professional's VA practice of
telehealth may be inconsistent or conflict with a State law or State
license, registration, or certification requirements related to
telehealth include when:
(i) The beneficiary and the health care professional are physically
located in different States during the episode of care;
(ii) The beneficiary is receiving services in a State other than
the health care professional's State of licensure, registration, or
certification;
(iii) The health care professional is delivering services while the
professional is located in a State other than the health care
professional's State of licensure, registration, or certification;
(iv) The health care professional is delivering services while the
professional is either on or outside VA property;
(v) The beneficiary is receiving services while the beneficiary is
located either on or outside VA property;
(vi) The beneficiary has not been previously assessed, in person,
by the health care professional;
(vii) The beneficiary has verbally agreed to participate in
telehealth but has not provided VA with a signed written consent; or
(viii) The beneficiary is receiving a controlled substance
medication in a State other than the health care professional's State
of licensure, registration, or certification.
* * * * *
[FR Doc. 2025-19324 Filed 10-1-25; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on October 2, 2025.
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