CHAPTER 246
SB 84 – FINAL VERSION
6May2015… 1332h
06/24/2015 2107CofC
2015 SESSION
SENATE BILL 84
AN ACT relative to the definition of “telemedicine.”
SPONSORS: Sen. Stiles, Dist 24; Sen. Sanborn, Dist 9; Rep. Kotowski, Merr 24; Rep. Martel, Hills 44
COMMITTEE: Health and Human Services
AMENDED ANALYSIS
This bill clarifies when it is appropriate to use telemedicine in practitioner-patient medical circumstances. Under this bill, except for practitioners treating patients in community mental health programs, a practitioner shall not prescribe certain controlled drugs by means of telemedicine.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
6May2015… 1332h
06/24/2015 2107CofC
15-0900
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fifteen
AN ACT relative to the definition of “telemedicine.”
Be it Enacted by the Senate and House of Representatives in General Court convened:
246:1 Pharmacists and Pharmacies; Definitions. Amend RSA 318:1, XV-a to read as follows:
XV-a. “Practitioner-patient relationship” means a medical connection between a licensed practitioner and a patient that includes an in-person or face-to-face 2-way real-time interactive communication exam, a history, a diagnosis, a treatment plan appropriate for the practitioner’s scope of practice, and documentation of all prescription drugs including name and dosage. A practitioner may prescribe for a patient whom the practitioner does not have a practitioner-patient relationship under the following circumstances: for a patient of another practitioner for whom the prescriber is taking call; for a patient examined by another New Hampshire licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment. The definition of a practitioner-patient relationship shall not apply to a practitioner licensed in another state who is consulting to a New Hampshire licensed practitioner with whom the patient has a relationship.
246:2 New Section; Medicaid Coverage for Telehealth Services. Amend RSA 318 by inserting after section 47-i the following new section:
318:47-j Medicaid Coverage for Telehealth Services. Under this chapter, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.
246:3 New Paragraph; Controlled Drug Act, Acts Prohibited. Amend RSA 318-B:2 by inserting after paragraph XII-e the following new paragraph:
XII-f. It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV.
246:4 New Paragraph; Controlled Drug Act; Acts Prohibited; Exceptions. Amend RSA 318-B:2 by inserting after paragraph XV the following new paragraph:
XVI.(a) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, and shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.
(b) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA-certified state opioid treatment program. Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
246:5 Physicians and Surgeons; Physician-Patient Relationship. Amend RSA 329:1-c to read as follows:
329:1-c Physician-Patient Relationship. “Physician-patient relationship” means a medical connection between a licensed physician and a patient that includes an in-person or face-to-face 2-way real-time interactive communication exam, a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have a physician-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by a physician assistant, nurse practitioner, or other licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment or when providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics. Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI. The definition of a physician-patient relationship shall not apply to a physician licensed in another state who is consulting to a New Hampshire licensed physician with whom the patient has a relationship.
246:6 New Section; Physicians and Surgeons; Definition of “Telemedicine”; Exceptions. Amend RSA 329 by inserting after section 1-c the following new section:
329:1-d Telemedicine.
I. “Telemedicine” means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. “Telemedicine” shall not include the use of audio-only telephone or facsimile.
II. An out-of-state physician providing services by means of telemedicine shall be deemed to be in the practice of medicine and shall be required to be licensed under this chapter. This paragraph shall not apply to out-of-state physicians who provide consultation services pursuant to RSA 329:21, II.
III. It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV.
IV.(a) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, and shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.
(b) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA-certified state opioid treatment program. Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
V. A physician providing services by means of telemedicine directly to a patient shall:
(a) Use the same standard of care as used in an in-person encounter;
(b) Maintain a medical record; and
(c) Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.
VI. Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.
246:7 New Paragraph; Nurse Practice Act; Definition Added. Amend RSA 326-B:2 by inserting after paragraph I the following new paragraph:
I-a. “Advanced practice registered nurse-patient relationship” means a medical connection between a licensed APRN and a patient that includes an in-person or face-to-face 2-way real-time interactive communication exam, a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have an APRN-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by another licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment.
246:8 New Paragraph; Nurse Practice Act; Definition Added. Amend RSA 326-B:2 by inserting after paragraph XI the following new paragraph:
XII.(a) “Telemedicine” means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. “Telemedicine” shall not include the use of audio-only telephone or facsimile.
(b) An out-of-state APRN providing services by means of telemedicine shall be deemed to be in the practice of medicine and shall be required to be licensed under this chapter.
(c) It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV.
(d)(1) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, and shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition and drug, but not less than annually.
(2) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA - certified state opioid treatment program. Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
(e) An APRN providing services by means of telemedicine directly to a patient shall:
(1) Use the same standard of care as used in an in-person encounter;
(2) Maintain a medical record; and
(3) Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.
(f) Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.
246:9 Contingency. If SB 112 of the 2015 regular session becomes law, section 2, paragraph VI of section 6, and subparagraph XII(f) of section 8 of this act shall take effect at 12:01 a.m. on the effective date of SB 112. If SB 112 does not take effect section 2, paragraph VI of section 6, and subparagraph XII(f) of section 8 of this act shall not take effect.
246:10 Effective Date.
I. Section 2, paragraph VI of section 6, and subparagraph XII(f) of section 8 of this act shall take effect as provided in section 9 of this act.
II. The remainder of this act shall take effect 60 days after its passage.
Approved: July 13, 2015
Effective Date: I. Section 2, paragraph VI of section 6, and subparagraph XII(f) of section 8 shall take effect as provided in section 9.
II. Remainder shall take effect September 11, 2015