Hello and welcome to episode seven of Mark Five: Policy Off Leash, and today is a special episode because I’m joined by my colleague, the executive director of the Veterinary Virtual Care Association, or VVCA, Ali McIntyre, a longtime partner and great friend of mine. Today, we get to unveil our map.
Now, why are we excited about our map? Because we have spent the better part of a month with the Animal Policy Group research team determined to create the most definitive, comprehensive and accurate state by state map of all laws and regulations (including COVID guidances from governors) relating to telemedicine or virtual care. Ali is going to join me in just a moment and we will walk through our map. What we’d like it to be is a tool that you can use with your team any day, all day to answer any question about what the status of any activity or proposed activity might be in a given state. So, Ali, if you’ll join me, we’ll start our tour.
“Thanks, Mark, it’s nice to see you. I’m going to share my screen and Mark will walk us through this beautiful interactive map.”
The title of the map is the Veterinary Telemedicine Regulatory Map. Let’s take a look at the left side of the screen as you’ll see it when you view the map. There are eight categories, we’ll start at the top with states that don’t have a VCPR.
You’ll notice it highlights the two states, Michigan and Connecticut and the District of Columbia or DC, that have no VCPR language whatsoever in their Veterinary Practice Act. This means there’s no restriction on telemedicine being tied to the VCPR in those three jurisdictions.
Now below, the next is states with absolutely no telemedicine VCPR. You’ll see a number of states highlighted, including prominently California, Texas, Illinois and Georgia, some of our larger states. These are states highlighted in which the Veterinary Practice Act laws passed by state legislatures absolutely expressly prohibit the creation of a VCPR through telemedicine or electronic means.
Below that is the category that of states that must have “seen or be acquainted with the animal”. You’ll see a small number of states highlighted, including the state where I live, Arizona. We’re talking about pets mainly here to establish a VCPR. You’ll recall from earlier in these videocasts, we discussed how this is an open question that’s never been tested, whether “seeing or being acquainted with” could be accomplished through telemedicine or some digital tool. That may be something that gets challenged in the years ahead.
This brings us to the most common category. You’ll see most of the country lit up on the map under this category. You must have physically examined the animal. This is intended to mean that the pet is physically in your clinic while a veterinarian is examining it. The majority of states tend to hold this standard.
The next category you can explore is whether there’s a time limit on how long the VCPR lasts in that state. Put differently, if you’ve seen a pet or you’ve met the test for a VCPR, it’s good for typically 12 months. You’d then have to see the pet after that 12 months to have a VCPR in place. During those 12 months, remember, if you do have a VCPR in place, you can use telemedicine as needed, there’s no restriction. In the states highlighted in this category, typically for 12 months you’ve got to see the pet again on the terms the states laid out to have a VCPR in place.
Oklahoma is the one state that has recognized the telemedicine VCPR joining forty nine of the states that do so on the human side in the US. Telemedicine for humans began prominently in Oklahoma and Kentucky in very rural parts of those states because people weren’t getting the in-person care they needed. It only makes sense they would approve the same care for pets. The VCPR law applies all throughout Oklahoma.
Also included in the map is a narrow exception for prescriptions of opioids; Virginia and New Jersey having health codes that govern all health care practitioners, not limited to veterinarians or animal practitioners. This means you can have a VCPR by telemedicine to prescribe an opioid in those two states.
Finally, we have those states which changed the rules regarding the use of the VCPR due to the circumstance of COVID-19 and still have those regulations or versions of those regulations in place. Of the 17 states that have allowed the creation of a telemedicine VCPR temporarily during COVID, states like California and Minnesota for example, have other exceptions in place; they extended the 12 month time period for VCPR to 18 months.
Another use for this map is a direct search for keywords and quotes for VCPR regulations in each of the 50 states and the District of Columbia, here you’ll find the exact legal language of the statute and how it applies. At the top of the map, you’ll see what category of VCPR the state is in. Below that, the site gives you details about changes due to COVID-19. The site also includes useful details for rural practitioners with large animals; for example, whether you can visit the premises to become acquainted with the animal to establish the VCPR. Executive orders given by each state can also be found on the site along with a plethora of links to all information given.
California is a state that has a legislature that likes to legislate, meaning they have a lot of laws pertaining to veterinary medicine. And for many people, they look to what California does as an example of what to do and what not to do. On the subject of telemedicine, California has not been a terribly friendly state in general because it’s one of those states that deters vets from starting a VCPR through telemedicine. But it has some temporary provisions you might find interesting. If a California veterinarian is in or within twenty five miles of an emergency such as COVID-19, “a veterinarian can render necessary and proper care and treatment to an animal patient without establishing a veterinary client patient relationship if conditions are such that one cannot be established in a timely manner”. Below that, it allows you to actually fill out a prescription. If a pet owner prefers not to come into the vet’s office, the veterinarian can do whatever they want to treat an animal – this is a very broad provision here. They can treat the pet through a video or an electronic conversation. The only stipulation is whether the pet already has a VCPR with another veterinarian. If that’s the case, it would be preferable to direct them there. This regulation protects California veterinarians from being sued in forming a relationship via telemedicine. I’d love to see every state have that, but but it is only written as it is here in California.
We did this because we want this to be a living, breathing tool for you, not just for sponsors and members of VVCA, but anybody that can access the map. If there’s a question in your practice that comes up, if there’s a question in a conference, or on a Zoom call, you can link your colleagues to the map and go directly to the full statute if need be. We wanted this to be all encompassing. You can also use VVCA.org to get to know our board members and connect with someone who can answer any questions you may have. I hope this has been useful. And if you have questions about the map, reach out to Ali. And good luck in your practices.
If you want more information or even more fun to engage in an extended conversation with your colleagues about these issues, go to the Vetinary Virtual Care Association or VVCA.org website, where our 3,600-member strong organization is engaging on all topics that concern telemedicine and virtual care for veterinary practices, not just limited to the policies I’m discussing, but how do you use it best? How do you implement it? How do you train your staff? What are the proper roles for all the staff members and most importantly, how pet owners have reacted to it. We’ll see you next week. Thanks.