VA Final Telehealth Regulation: What It Does—in Plain English

Matthew Feehan
Oct 3
7 min read

The U.S. Department of Veterans Affairs (“VA”) just published its Final Rule amending 38 C.F.R. § 17.417 that will allow VA clinicians to deliver telehealth care nationwide regardless of state borders, allow controlled-substance prescribing via telehealth under federal Controlled Substances Act ("CSA") standards even when state rules conflict, and clarify who’s covered (VA employees, including trainees) and who is not (VA contractors), while reinforcing VA’s emergency Fourth Mission.

The VA has been working toward this result for years—building on early telehealth rulemaking in 2017–2018 and the VA MISSION Act of 2018—then proposing the current update on August 23, 2022, taking a 60-day comment period (closing October 24, 2022) and reviewing 18 comments before issuing this Final Rule. With official publication and an effective date of November 3, 2025, the Executive Branch has spoken: Veterans will continue to have nationwide, VA-governed access to virtual care when clinically appropriate—without fifty different states limiting healthcare providers.

The article below breaks down what changed and how it affects veterans, caregivers, and military-connected families across the country.

VA Telehealth Generally Preempts State Rules—Nationwide

One of the most significant features of the Final Rule is its explicit reaffirmation of federal preemption. Congress spoke directly to this issue in 38 U.S.C. § 1730C, enacted under the VA MISSION Act of 2018, which authorizes VA clinicians to provide telehealth services “at any location in any State, regardless of where the health care professional or the patient is located”. Section 1730C further states that this authority supersedes any conflicting State law, and that no State may deny or revoke a VA provider’s license solely because the provider practices telehealth as part of their federal duties.

Some commenters worried that such preemption might run afoul of the Tenth Amendment by “commandeering” states into licensing providers who do not meet local requirements. VA rejected that argument. As the agency explained, Congress’s authority to furnish care to veterans derives from Article I, Section 8 of the Constitution, which empowers Congress to provide for the common defense, regulate the armed forces, and enact laws necessary and proper to carry out those duties. Veterans’ benefits—including health care—flow from those federal powers. In short, Congress had the power to authorize nationwide telehealth for VA providers, and it chose to do so.

To make this concrete: imagine a VA physician licensed in California, working at a VA medical center in Texas, who treats a veteran located in North Carolina via a video call. Under state rules, North Carolina might ordinarily claim authority to regulate that encounter. But under 38 U.S.C. § 1730C, North Carolina’s licensure restrictions have no force or effect when they conflict with the physician’s federal duties. The only requirements that bind the provider in this context are (1) holding a valid license in a State and (2) complying with federal standards such as the Controlled Substances Act when prescribing.

The takeaway is straightforward: this Final Rule removes the uncertainty that VA providers could face disciplinary action from a state board simply for delivering VA care via telehealth across state lines. It locks in a uniform, nationwide framework so veterans can access telehealth from anywhere, confident that their care is governed by VA standards—not a patchwork of fifty state rules.

Pros

Veterans in rural areas or underserved states get access to more providers.
Care is standardized nationally, avoiding fifty different state restrictions.
During emergencies or deployments, VA can rapidly surge telehealth across state lines.

Cons

Local state legislatures lose their voice in how medicine is practiced within their borders.
A handful of federal policy drafters in D.C. can restrict or expand access to treatments nationwide—whether states agree or not.
The VA’s own record shows it can be aggressive in shaping prescribing: in this very rule it highlights about a 90% reduction in patients receiving opioids and benzodiazepines together—a policy that some argue went too far, limiting treatment options for those who might benefit, and 'blacklisting' certain medicines based on mere anecdotes or political campaigns.

Do you support the VA’s nationwide federal preemption of state law for telehealth—even if it means states have no say?

0%YES
0%NO
0%Would like more information

Controlled-substance Prescribing: Federal Standards Govern (CSA), not Conflicting State Add-ons

Under the regulation, VA doctors now follow a single nationwide standard when prescribing controlled substances through telehealth. They still have to comply with the federal Controlled Substances Act (CSA) but if a state adds its own telehealth restrictions that conflict with federal law, those state rules simply don’t apply when a provider is acting in their VA role.

This is meant to end the confusion of trying to balance fifty different state prescribing policies. For example, if a VA clinician licensed in Colorado treats a veteran living in Florida by video and the treatment plan includes a controlled medication, the VA clinician follows federal prescribing rules, not Florida’s.

The VA also addressed a serious concern: what happens if a state licensing board objects?

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.

The agency made clear that states cannot punish or revoke a VA provider’s license for actions taken within their official federal duties. And if a state does try, the Department of Justice will defend that VA provider. The only exception is when the provider truly acts outside accepted medical standards or beyond the limits of their VA role.

The VA insists this approach isn’t about loosening safety standards—it’s about consistency and access. The same federal rules that apply in Seattle now apply in Savannah. That means faster continuity of care for veterans managing pain, substance-use disorders, or acute conditions, without waiting for a patchwork of state-specific approvals.

Pros

Creates one national playbook for prescribing—no more confusion across 50 state lines.
Speeds up treatment for veterans in remote or underserved areas.
Protects VA clinicians from conflicting or politically driven state rules.
Allows continuity of care in emergencies and disaster responses under VA’s “Fourth Mission.”

Cons

Concentrates power over prescribing policy in Washington, D.C., far from state oversight.
Reduces state authority to set safety standards or adapt to local conditions.
Makes it easier for the VA to enforce restrictive national policies with little room for local flexibility.
May discourage some clinicians who prefer practicing under their state’s regulatory framework.

Do you support a single federal standard for VA prescribing through telehealth?

YES
NO
Would like more information

Who’s Covered and Who Isn’t

Not everyone practicing under the VA umbrella is covered by this new rule, and that distinction matters.

The Final Rule makes clear that VA-employed clinicians—doctors, nurses, psychologists, pharmacists, and even postgraduate trainees—are fully covered when providing telehealth as part of their federal duties. These are the professionals directly appointed and supervised by the VA, operating under its credentialing systems, policies, and oversight. When they treat veterans, whether in person or over a video call, they’re doing so as federal employees protected by federal law.

But contracted and community-care providers—the doctors and specialists outside VA payroll who still treat veterans through programs like the Community Care Network—are not covered. For them, state licensure and telehealth laws still apply. The VA drew that line intentionally, saying the rule is tied to federal employment, not to who the VA pays for services.

The agency also made an important clarification: “virtual health” and “telehealth” mean the same thing for regulatory purposes. That may sound like bureaucratic hair-splitting, but it matters. It sets one standard for supervision, quality control, and credentialing, especially when the VA has to mobilize quickly during natural disasters or national emergencies under its Fourth Mission.

In short, this rule empowers the people inside VA’s walls—and leaves those outside them still bound by the patchwork of state systems.

The Federal Rulemaking Process and Your Voice

When an agency like the VA publishes a Proposed Rule, it isn’t asking for permission—it’s asking for feedback. That 60-day comment window isn’t a vote; it’s a legal requirement under the Administrative Procedure Act, designed to make sure the agency hears from stakeholders before finalizing a rule.

In this case, one commenter publicly criticized the VA for not allowing enough time to involve state licensing boards and lobbying groups. But that complaint misses the mark. This rule didn’t appear overnight—it’s been in development for nearly a decade. The first version of VA’s telehealth preemption rule dates back to 2017, and the broader debate over federal versus state authority in veterans’ health care has been playing out in both Congress and the Executive Branch ever since. By the time this rule was proposed in August 2022, every major veterans’ organization, medical association, and state board had already had multiple opportunities to weigh in.

The VA’s final rule simply brings that long debate to its conclusion—codifying what Congress already authorized in the VA MISSION Act of 2018 and what the VA has been doing in practice since the pandemic: providing care to veterans wherever they are, without artificial borders.

For veterans and advocates, the real takeaway is this: commenting matters. It’s one of the few moments where individual voices—whether you’re a veteran, spouse, provider, or policy wonk—can directly shape how federal law is applied. A well-reasoned comment becomes part of the permanent record; agencies have to read and typically respond to it in the Federal Register.

That’s how the system keeps itself accountable, and how we, the veterans' community, advocate for ourselves.

About Combat Veterans of America

Combat Veterans of America (CVA) is a new, independent Veterans Service Organization (501(c)(19) application pending) built to move the conversation forward. We’re not here for the ceremonial salutes, endless banquets, covers, or the “good-old-boy” routines that too often define the veteran world. CVA is built by post-9/11 and modern-era veterans who are tired of being spoken for. We focus on policy, reform, and real-world impact—from health care and education to debt relief and federal accountability.

Our goal is simple: change the broken veteran narrative. Veterans aren’t fragile. We’re capable, disciplined, and engaged citizens who’ve earned a voice in how the government operates—especially when it concerns the systems that serve us.

Follow Combat Veterans of America’s blog for upcoming analyses of proposed and pending regulations, new legislation, and policies that affect veterans, servicemembers, and their families nationwide.

About the Author

Matthew Feehan, J.D. is an Army National Guard veteran and former infantry officer with more than a decade of combined military, legal, and federal contracting experience. A former DOJ Honors Law Clerk and U.S. Army Corps of Engineers Law Clerk / Operations Officer, he has worked across the federal system as a contractor, federal employee, and servicemember—from regulatory policy to complex contracting—helping agencies navigate the same statutes and rulemaking processes that shape veterans’ benefits today.

Feehan now serves as a Senior Policy Advisor with the Veterans Education Project, a Board Member of Combat Veterans of America (CVA) (Sergeant-at-Arms), and an independent consultant focused on ethics, compliance, and veterans’ policy. His work examines how law and regulation actually play out in the real world—where they meet veterans, families, and the institutions meant to serve them.

Views expressed are solely the author’s and do not necessarily reflect the positions of Combat Veterans of America, the National Command Council, or any other organization.