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The Department of Veterans Affairs (VA) is amending its regulations to implement a statutory authority establishing a telehealth grant program. Under this authority, VA will enter into new agreements, and expand existing ones, to enhance telehealth capabilities and provide telehealth services through the establishment of telehealth access points in rural, highly rural, or medically underserved areas. This rule also amends the copayment regulation by expanding the copayment exemption for certain telehealth encounters to include all telehealth encounters. These changes will increase veteran access to health care particularly in rural and medically underserved areas. 

Statement of Need:

Veterans in rural and underserved areas face persistent barriers to care, including limited broadband, long travel distances, and health care provider shortages. This final rule will establish a grant program pursuant to Section 701 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 to fund telehealth access points.

Summary of the Legal Basis:

38 U.S.C. 501, 1710, 1720, 1722B; Pub. L. 116-171. This final rule will add regulations governing the grant program in new 38 CFR part 84.

Alternatives:

VA considered expanding mobile clinics or increasing travel reimbursements, but these options were less scalable and more costly.

Anticipated Costs and Benefits:

Estimated cost is $43.4 million over five years, including $4.6 million in administrative costs and $38.8 million in transfers. Benefits include improved access, reduced travel costs, and enhanced Veteran satisfaction. VA anticipates $779,000 in travel savings and a loss of $7.9 million in copayment revenue, which would be offset by broader system efficiencies.

Risks:

The main risk is underutilization of telehealth access points, which will be mitigated by targeting high-need areas and integrating oversight through VA’s Office of Connected Care. Increases on demand are expected to be minimal and manageable.