VA Waives State Scope Laws for Nonphysician Practitioners
By Joey Berlin

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The U.S. Department of Veterans Affairs (VA) is waiving state scope-of-practice laws in an interim rule that takes effect Thursday, effectively allowing VA nonphysician practitioners to practice across state lines at VA facilities without physician oversight.

The Texas Medical Association and many others in organized medicine had urged against such an action earlier this year.

The interim final rule “confirms VA’s current practice of allowing VA health care professionals to deliver health care services in a State other than the health care professional’s State of licensure, registration, certification, or other State requirement, thereby enhancing beneficiaries’ access to critical VA health care services,” the agency wrote in the Federal Register.

“The COVID–19 pandemic has highlighted VA’s acute need to exercise its statutory authority of allowing VA health care professionals to practice across State lines,” the agency added. “In response to the pandemic, VA needed to and continues to need to move health care professionals quickly across the country to care for veterans and other beneficiaries and not have State licensure, registration, certification, or other State requirements hinder such actions. Put simply, it is crucial for VA to be able to determine the location and practice of its VA health care professionals to carry out its mission without any unduly burdensome restrictions imposed by State licensure, registration, certification, or other requirements.”

TMA, the American Medical Association (AMA), and dozens of other state and national medical societies opposed a similar move back in June, after the VA allowed nonphysician practitioners in 32 specialties to practice across state lines, and allowed certified registered nurse anesthetists (CRNAs) to practice without physician oversight during the COVID-19 national health emergency.

That letter called the VA’s removal of physician oversight requirements for CRNAs “overly broad, inconsistent with the situation as it is unfolding outside of the VA, and unnecessary to address the immediate needs” the pandemic raised.

“Throughout the coronavirus pandemic physicians, nurses, and the entire health care community have been working side-by-side caring for patients and saving lives. The AMA supports these temporary emergency efforts that allow physicians to practice across state lines to quickly expand the physician workforce in areas of need,” AMA, TMA, and the other organizations wrote in June. “Our success as a nation in flattening the curve of this pandemic is due in no small part to this shared focus and shared responsibility.

“Now more than ever, we need health care professionals working together as part of physician-led health care teams – not in silos. Therefore, it is deeply troubling, that the VA is directing all VA medical facilities to amend their bylaws to allow CRNAs to practice without physician oversight.”

Although the new interim rule is final, the VA is accepting comments on it through Jan. 11, 2021. That will give organized medicine another chance to oppose federal regulations that disregard state laws on license, registration, certification, or other requirements that impact the practice of medicine.

Last Updated On

November 11, 2020

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Joey Berlin

Associate Editor

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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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