[Congressional Record Volume 166, Number 164 (Tuesday, September 22, 2020)]
[House]
[Pages H4680-H4682]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                VA MISSION TELEHEALTH CLARIFICATION ACT

  Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3228) to amend title 38, United States Code, to authorize 
health professional trainees to provide treatment via telemedicine, and 
for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3228

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``VA Mission Telehealth 
     Clarification Act''.

     SEC. 2. LICENSURE OF HEALTH CARE PROFESSIONALS PROVIDING 
                   TREATMENT VIA TELEMEDICINE.

       Section 1730C(b) of title 38, United States Code, is 
     amended to read as follows:
       ``(b) Covered Health Care Professionals.--For purposes of 
     this section, a covered health care professional is any of 
     the following individuals:
       ``(1) A health care professional who--
       ``(A) is an employee of the Department appointed under 
     section 7306, 7401, 7405, 7406, or 7408 of this title, or 
     under title 5;
       ``(B) is authorized by the Secretary to provide health care 
     under this chapter;
       ``(C) is required to adhere to all standards for quality 
     relating to the provision of health care in accordance with 
     applicable policies of the Department; and
       ``(D) has--
       ``(i) an active, current, full, and unrestricted license, 
     registration, or certification in a State to practice the 
     health care profession of the health care professional;
       ``(ii) qualifications prescribed by the Secretary under 
     section 7402(b) of this title for an appointment to a 
     position in the Veterans Health Administration; or
       ``(iii) other authorization from the Secretary to provide 
     health care.
       ``(2) A health professions trainee who--
       ``(A) is appointed under section 7405 or 7406 of this 
     title; and
       ``(B) is under the clinical supervision of a health care 
     professional described in paragraph (1).

[[Page H4681]]

       ``(3) A health care professional who--
       ``(A) is appointed to a position described in paragraph (1) 
     or (3) of section 7401 of this title under--
       ``(i) section 7401 of this title;
       ``(ii) section 7405 of this title; or
       ``(iii) title 5;
       ``(B) is in the process of obtaining, within a timeframe 
     prescribed by the Secretary--
       ``(i) a license, registration, or certification described 
     in paragraph (1)(D)(i);
       ``(ii) qualifications described in paragraph (1)(D)(ii); or
       ``(iii) authorization described in subparagraph (B) or 
     (D)(iii) of paragraph (1); and
       ``(C) is under the clinical supervision of a health care 
     professional described in paragraph (1).''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Tennessee (Mr. David P. 
Roe) each will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Mr. Speaker, I ask that all Members may have 5 
legislative days in which to revise and extend their remarks and to 
insert extraneous material on H.R. 3228, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 3228, as amended, the VA 
Mission Telehealth Clarification Act.
  The John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA 
Maintaining Internal Systems and Strengthening Integrated Outside 
Networks Act of 2018, or the VA MISSION Act, as it is more commonly 
known, expanded VA's ability to provide telehealth to veterans across 
State lines.
  The legislation before us builds on those enhancements by allowing 
healthcare professionals in training to provide tele-healthcare to 
veterans with clinical supervision.
  As we have seen over the course of this pandemic, tele-healthcare is 
becoming more and more a staple of Americans' healthcare experience. As 
this virus will be with us for some time to come, the value and 
reliance on telehealth will continue. It is critical that during this 
time, VA has the authorities necessary to keep veterans healthy and 
safe in their homes.
  This is particularly important for our rural and aging veterans whose 
access to in-person care was already a challenge. We need to do 
everything possible to ensure veterans' access to safe distant care 
whenever it is appropriate.
  Mr. Speaker, I thank Congressman Carter for his dogged work to see 
veterans have what they need during this time. I encourage all of my 
colleagues to support H.R. 3228, as amended.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DAVID P. ROE of Tennessee. Mr. Speaker, I yield myself such time 
as I may consume.
  Mr. Speaker, I rise today in support of H.R. 3228, the Department of 
Veterans Affairs Mission Telehealth Clarification Act.
  The VA healthcare system is our country's largest integrated 
healthcare system, with responsibility for delivering care to 
approximately 7 million veteran patients. The VA healthcare system is 
also the country's largest provider of healthcare education, with 
responsibility for supporting the training of approximately 45,000 
medical and dental residents and thousands more healthcare professional 
trainees every year. I happened to be one of them many years ago.
  The VA Mission Telehealth Clarification Act would authorize VA 
residents and trainees to provide care to veteran patients virtually 
using telehealth, regardless of that resident or trainee's State 
licensure, so long as they are working under the clinical supervision 
of a VA healthcare professional.
  While face-to-face visits between patients and providers are 
irreplaceable in many respects, telehealth is an increasingly important 
tool in the delivery of modern healthcare. That was true even before 
the COVID-19 pandemic created a skyrocketing demand for telehealth 
services.
  In the MISSION Act passed last Congress, we authorized VA providers 
to provide telehealth across State lines in an effort to increase 
access to telehealth to veteran patients, particularly those in rural 
or remote areas or for those whose travel to a medical facility is 
otherwise difficult. However, the law inadvertently exempted VA 
residents, trainees, and certain others from that authority. This bill 
would fix that oversight.
  In doing so, it would further expand veteran access to telehealth, 
which has been critical to ensuring continuity of care throughout the 
last several months. It would also ensure that the medical education VA 
provides to the next generation of healthcare professionals includes 
valuable training and needed experience in the delivery of care via 
telephone, video, and other virtual modalities.
  This bill is sponsored by my good friend, Congressman Buddy Carter 
from Georgia. I am grateful to him for recognizing early on the 
benefits that a well-rounded medical education will have on access and 
quality of care for veterans and all Americans and working so hard to 
give aspiring providers and others working within the VA the ability to 
practice telehealth across State lines, within appropriate parameters.
  Mr. Speaker, I urge all of my colleagues to join me in supporting 
this bill, and I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I reserve the balance of my time.
  Mr. DAVID P. ROE of Tennessee. Mr. Speaker, I yield 4 minutes to the 
gentleman from Georgia (Mr. Carter), my good friend.
  I have had the privilege of visiting his beautiful district, and I 
really appreciate his work on this extremely important issue.
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, I rise today in support of the VA Mission Telehealth 
Clarification Act, which I am proud to have introduced.
  H.R. 3228, the VA Mission Telehealth Clarification Act, is a simple 
bill that builds on the VA MISSION Act's historic expansion of the 
veterans health system.
  One of the most significant parts of the VA MISSION Act was the 
authorization for the VA to use telehealth and provide care across 
State lines. The bill began as the result of a visit I had to a VA 
facility before the current pandemic, as they laid out some of the 
issues they were trying to overcome. But now with the COVID-
19 pandemic, we are seeing how extremely beneficial these technologies 
can be for our veterans.

  In fact, the VA Medical Center in Charleston, South Carolina, which 
serves part of my district along Georgia's coast, had an over 200 
percent increase in telehealth medical services during the pandemic 
when we spoke in May.
  Even more incredibly, the VA announced it had a 1,000 percent 
increase in telehealth video appointments using its VA Video Connect 
Program during the first months of the pandemic. This is an extremely 
important ability for the VA to have. However, the law did not 
authorize trainees within the VA to use telehealth technologies, only 
practitioners with a full license.
  As telehealth medicine grows in prevalence, we need for interns, 
residents, and fellows to gain experience using these services, 
especially considering that many of these trainees later go on to work 
as doctors at the VA, bringing with them a wealth of experience.
  Rather than depending on doctors to learn while on the job, which 
could delay the rollout of care, this bill would allow trainees to gain 
experience on telehealth systems while properly supervised by 
credentialed VA staff.
  Mr. Speaker, I am pleased to say that the bill was further improved 
through the committee process after input from my colleagues in the VA. 
The bill will not only allow for trainees to participate in telehealth, 
but it will also expand the ability to practice telemedicine to all 
appropriately qualified healthcare professionals at the VA, fixing the 
issue once and for all.
  While Congress intended for trainees and others to be included from 
the beginning, the VA's reading of the law did not include them, 
although they have expressed their desire to include them in telehealth 
services.

                              {time}  1415

  The VA Mission Telehealth Clarification Act will give VA the 
certainty to provide essential telehealth programs

[[Page H4682]]

to our veterans, improving the quality and timeliness of their care.
  Again, this is a commonsense bill with bipartisan support and has 
received the support from the American Legion, Veterans of Foreign 
Wars, AMVETS, and Paralyzed Veterans of America, among others.
  Mr. TAKANO. Mr. Speaker, I have no further speakers. I am prepared to 
close, and I reserve the balance of my time.
  Mr. DAVID P. ROE of Tennessee. Mr. Speaker, I yield myself the 
balance of my time.
  Mr. Speaker, I want to thank the gentleman from Georgia (Mr. Carter), 
my good friend who serves on the Doctors Caucus with me, for bringing 
this important piece of legislation up.
  Mr. Speaker, this pandemic actually has done one good thing, and that 
is to advance telehealth. Just to give you some scope of this, the VA 
went from tens of thousands of mental health visits--and we know that 
people have been isolated. Certainly, many of our elderly have been 
confined; they can't visit people. They have gone from tens of 
thousands of mental health visits per month to hundreds of thousands of 
visits. So we are able to stay in touch with patients in need.
  I know in my own medical practice in Tennessee, it has been extremely 
helpful for patients to access their physicians through telehealth. I 
think we are going to continue this, and I think the next Congress is 
going to have to address how Medicare and Medicaid funds these 
telehealth visits outside the VA, it is that important for care.
  If you live in a rural area in rural Appalachia like I do, the only 
way we are going to get specialty care for our patients in need--and in 
many cases, in our cities--is via telehealth, because these specialists 
are so hard to find and there are so few of them. And especially in 
cases like neurology and pediatrics, these are very difficult people to 
see.
  So I really am appreciative of this. I appreciate Dr. Carter bringing 
it up, and I certainly thank the chairman for putting this on the 
agenda.
  Mr. Speaker, I encourage all of my colleagues to support this, and I 
yield back the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I want to thank the ranking member for his comments 
about the VA really being a pioneer in this moment, that the expansion 
of tele-mental health, especially, has seen a logarithmic increase, and 
it has implications for Medicare and Medicaid. I am hearing from the 
civilian medical sector about the need to follow the VA's example.
  I am very proud of the work the VA has done to respond to this 
pandemic moment by making sure that our veterans, no matter where they 
live, have access to medical care through telehealth and tele-mental 
health, especially.
  I want to thank, again, the sponsor of this legislation, and I want 
to urge all of my colleagues to join me in passing this important 
legislation, H.R. 3228, as amended.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Takano) that the House suspend the rules 
and pass the bill, H.R. 3228, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________