Alabama 2022 Regular Session

Alabama House Bill HB423 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 HB423
2	2	2 218232-1
3	3	3 By Representatives Lee, Daniels, Blackshear, Marques, Isbell,
4	4	4 Drummond, Warren, Rafferty, Sorrells, Collins, Stadthagen,
5	5	5 Lipscomb, Paschal, Oliver, Lovvorn, Gray, Robertson, Hall,
6	6	6 Kitchens and Brown (C)
7	7	7 RFD: Health
8	8	8 First Read: 01-MAR-22
9	9
10	10	Page 0 1 218232-1:n:03/01/2022:GP/ma LSA2022-836
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16	16	7
17	17	8 SYNOPSIS: This bill would allow licensed physicians,
18	18	9 including osteopathic physicians, to practice
19	19	10 telemedicine in the state.
20	20	11 This bill would proscribe the duties and
21	21	12 responsibilities of a physician practicing
22	22	13 telemedicine.
23	23	14 This bill would provide that licensed
24	24	15 physicians practicing telemedicine may prescribe
25	25	16 certain medications without meeting a patient in
26	26	17 person.
27	27	18 This bill would authorize the Board of
28	28	19 Medical Examiners and the Medical Licensure
29	29	20 Commission to adopt rules related to telehealth and
30	30	21 telemedicine.
31	31	22 This bill would repeal existing law relating
32	32	23 to the practice of medicine and osteopathy across
33	33	24 state lines.
34	34	25
35	35	26 A BILL
36	36	27 TO BE ENTITLED
37	37	Page 1 1 AN ACT
38	38	2
39	39	3 Relating to the practice of medicine; to repeal
40	40	4 Sections 34-24-500 through 34-24-508, Code of Alabama 1975,
41	41	5 relating to the licensing of the practice of medicine and
42	42	6 osteopathy across state lines; to add a new Article 12 to
43	43	7 Chapter 24 of Title 34, Code of Alabama 1975; to provide for
44	44	8 the practice of telemedicine in the state.
45	45	9 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
46	46	10 Section 1. Article 12 is added to Chapter 24 of
47	47	11 Title 34, Code of Alabama 1975, to read as follows:
48	48	12 Article 12.
49	49	13 §34-24-700.
50	50	14 It is the intent of the Legislature to expand access
51	51	15 to safe, effective health care services for the residents of
52	52	16 this state through the use of various electronic devices and
53	53	17 technologies. The Legislature finds and declares the
54	54	18 following:
55	55	19 (1) Telehealth has proven to be a viable tool to
56	56	20 supplement traditional, in-person services and provides
57	57	21 additional ways for individuals to access medical care.
58	58	22 (2) Allowing physicians to utilize telehealth
59	59	23 medical services and other electronic devices to provide care
60	60	24 will positively impact residents of this state.
61	61	25 (3) Telehealth should be promoted as sound public
62	62	26 policy and should be available to every Alabama resident,
63	63	Page 2 1 irrespective of their race, identity, age, income,
64	64	2 socioeconomic class, or geographic location.
65	65	3 §34-24-701.
66	66	4 For the purposes of this article, the following
67	67	5 terms shall have the following meanings:
68	68	6 (1) ASYNCHRONOUS. The electronic exchange of health
69	69	7 care documents, images, and information that does not occur in
70	70	8 real-time, including, but not limited to, the collection and
71	71	9 transmission of medical records, clinical data, or laboratory
72	72	10 results.
73	73	11 (2) BOARD OF MEDICAL EXAMINERS. The Alabama Board of
74	74	12 Medical Examiners established pursuant to Section 34-24-53.
75	75	13 (3) CONTROLLED SUBSTANCE. The same meaning as
76	76	14 defined in Section 20-2-2. This term includes an immediate
77	77	15 precursor, as defined in Section 20-2-2.
78	78	16 (4) DIGITAL HEALTH. The delivery of health care
79	79	17 services, patient education communications, or public health
80	80	18 information via software applications, consumer devices, or
81	81	19 other digital media.
82	82	20 (5) DISTANT SITE. The physical location of a
83	83	21 physician at the time in which telehealth medical services are
84	84	22 provided.
85	85	23 (6) HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY
86	86	24 ACT (HIPAA). The Health Insurance Portability and
87	87	25 Accountability Act of 1996, Public Law 104-191, §264, 110
88	88	26 Stat. 1936.
89	89	Page 3 1 (7) LEGEND DRUG. Any drug, medicine, chemical, or
90	90	2 poison bearing on the label the words, "Caution, federal law
91	91	3 prohibits dispensing without prescription" or other similar
92	92	4 wording indicating that the drug, medicine, chemical, or
93	93	5 poison may be sold or dispensed only upon the prescription of
94	94	6 a licensed medical practitioner.
95	95	7 (8) MEDICAL LICENSURE COMMISSION. The Alabama
96	96	8 Medical Licensure Commission established pursuant to Section
97	97	9 34-24-310.
98	98	10 (9) MEDICAL SUPPLIES. Non-drug medical items,
99	99	11 including durable medical equipment, which may be sold or
100	100	12 dispensed only upon the prescription of a licensed medical
101	101	13 practitioner.
102	102	14 (10) ORIGINATING SITE. The physical location of a
103	103	15 patient at the time in which telehealth medical services are
104	104	16 provided.
105	105	17 (11) PHYSICIAN. Either a doctor of medicine who is
106	106	18 licensed to practice medicine or a doctor of osteopathy who is
107	107	19 licensed to practice osteopathy in a state, commonwealth,
108	108	20 district, or territory of the United States.
109	109	21 (12) SYNCHRONOUS. The real-time exchange of medical
110	110	22 information or provision of care between a patient and a
111	111	23 physician via audio/visual technologies, audio only
112	112	24 technologies, or other means.
113	113	25 (13) TELEHEALTH. The use of electronic and
114	114	26 telecommunications technologies, including devices used for
115	115	27 digital health, asynchronous and synchronous communications,
116	116	Page 4 1 or other methods, to support a range of medical care and
117	117	2 public health services.
118	118	3 (14) TELEHEALTH MEDICAL SERVICES. Digital health,
119	119	4 telehealth, telemedicine, and the applicable technologies and
120	120	5 devices used in the delivery of telehealth.
121	121	6 (15) TELEMEDICINE. A form of telehealth referring to
122	122	7 the provision of medical services by a physician at a distant
123	123	8 site to a patient at an originating site via asynchronous or
124	124	9 synchronous communications, or other devices that may
125	125	10 adequately facilitate and support the appropriate delivery of
126	126	11 care.
127	127	12 §34-24-702.
128	128	13 (a) Physicians who engage in the provision of
129	129	14 telehealth medical services to any individual in this state
130	130	15 must possess a full and active license to practice medicine or
131	131	16 osteopathy issued by the Medical Licensure Commission.
132	132	17 (b) Notwithstanding subsection (a), a physician who
133	133	18 engages in the provision of telehealth medical services to any
134	134	19 individual in this state is not required to possess a license
135	135	20 issued by the Medical Licensure Commission, if either of the
136	136	21 following apply:
137	137	22 (1) The services are provided on an irregular or
138	138	23 infrequent basis. The term "irregular or infrequent" refers to
139	139	24 telehealth medical services occurring less than 10 days in a
140	140	25 calendar year or involving fewer than 10 patients in a
141	141	26 calendar year.
142	142	Page 5 1 (2) The services are provided in consultation, as
143	143	2 further provided by Section 34-24-74, with a physician
144	144	3 licensed to practice medicine or osteopathy in this state.
145	145	4 (c) Any person who violates the provisions of this
146	146	5 article is subject to criminal prosecution for the unlicensed
147	147	6 practice of medicine or osteopathy, as provided by Section
148	148	7 34-24-51, or injunctive or other action authorized in this
149	149	8 state to prohibit or penalize continued practice without a
150	150	9 license, as provided by Section 34-24-52.
151	151	10 (d) Nothing in this article shall be interpreted to
152	152	11 limit or restrict the Board of Medical Examiners' or Medical
153	153	12 Licensure Commission's authority to regulate, revoke, suspend,
154	154	13 sanction, or otherwise discipline any physician licensed to
155	155	14 practice in this state who violates the provisions of this
156	156	15 chapter, the provisions relating to the regulation of
157	157	16 manufacture and distribution of controlled substances, as
158	158	17 provided by Sections 20-2-50 through 20-2-58, or the
159	159	18 administrative rules of the Board of Medical Examiners or the
160	160	19 Medical Licensure Commission while engaging in the practice of
161	161	20 medicine within this or any other state.
162	162	21 §34-24-703.
163	163	22 (a) A physician providing telehealth medical
164	164	23 services shall owe to the patient the same duty to exercise
165	165	24 reasonable care, diligence, and skill as would be applicable
166	166	25 if the service or procedure were provided in person.
167	167	Page 6 1 (b) A physician practicing telemedicine shall do all
168	168	2 of the following, if such action would otherwise be required
169	169	3 in the provision of the same service if delivered in-person:
170	170	4 (1) Establish a diagnosis through the use of
171	171	5 acceptable medical practices, which may include, but not be
172	172	6 limited to, taking a patient history, a mental status
173	173	7 examination, a physical examination, disclosure and evaluation
174	174	8 of underlying conditions, and any diagnostic and laboratory
175	175	9 testing.
176	176	10 (2) Disclose any diagnosis and the evidence for the
177	177	11 diagnosis, and discuss the risks and benefits of treatment
178	178	12 options.
179	179	13 (3) Provide a visit summary to the patient and, if
180	180	14 needed, inform the patient of the availability of, or how to
181	181	15 obtain, appropriate follow-up and emergency care.
182	182	16 (c) The provision of telehealth medical services is
183	183	17 deemed to occur at the patient's originating site within this
184	184	18 state. A licensed physician providing telehealth medical
185	185	19 services may do so at any distant site.
186	186	20 (d) To reduce fraud, waste, and abuse in the
187	187	21 delivery of medical care to patients, telehealth medical
188	188	22 services may only be provided following the patient's
189	189	23 initiation of a physician-patient relationship, or pursuant to
190	190	24 a referral made by a patient's licensed physician with whom
191	191	25 the patient has an established physician-patient relationship,
192	192	26 in the usual course of treatment of the patient's existing
193	193	Page 7 1 health condition. The physician-patient relationship may be
194	194	2 formed without a prior in-person examination.
195	195	3 (e) Prior to providing any telehealth medical
196	196	4 service, the physician, to the extent possible, shall do all
197	197	5 of the following:
198	198	6 (1) Verify the identity of the patient.
199	199	7 (2) Require the patient to identify his or her
200	200	8 physical location, including the city and state.
201	201	9 (3) Disclose to the patient the identity and
202	202	10 credentials of the physician and any other applicable
203	203	11 personnel.
204	204	12 (4) Obtain the patient's consent for the use of
205	205	13 telehealth as an acceptable mode of delivering health care
206	206	14 services, including, but not limited to, consent for the mode
207	207	15 of communication used and its limitations. Acknowledgment of
208	208	16 consent shall be documented in the patient's medical record.
209	209	17 (f) Unless otherwise provided by rule of the Board
210	210	18 of Medical Examiners, a physician who provides telehealth
211	211	19 medical services to a patient four or more times per year
212	212	20 shall have at least one in-person visit with the patient every
213	213	21 12 months.
214	214	22 §34-24-704.
215	215	23 (a) A physician may prescribe a legend drug, medical
216	216	24 supplies, or a controlled substance to a patient as a result
217	217	25 of a telehealth medical service if the physician is authorized
218	218	26 to prescribe the drug, supplies, or substance under applicable
219	219	27 state and federal laws. To be valid, a prescription must be
220	220	Page 8 1 issued for a legitimate medical purpose by a physician acting
221	221	2 in the usual course of his or her professional practice.
222	222	3 (b) A prescription for a controlled substance may
223	223	4 only be issued as a result of a telehealth medical service if
224	224	5 the physician or another physician in the same practice or
225	225	6 group, within the preceding 12 months, has had at least one
226	226	7 in-person encounter with the patient and established a
227	227	8 legitimate medical purpose for issuing the prescription.
228	228	9 (c) A physician shall be exempt from the
229	229	10 requirements of subsection (b) and may issue a prescription
230	230	11 for a controlled substance to a patient if the prescription is
231	231	12 for the treatment of a patient's medical emergency, as further
232	232	13 defined by rule by the Board of Medical Examiners and the
233	233	14 Medical Licensure Commission.
234	234	15 (d) The Board of Medical Examiners and the Medical
235	235	16 Licensure Commission may adopt rules granting additional
236	236	17 exemptions or imposing additional requirements and limitations
237	237	18 on the issuance of prescriptions, including those for
238	238	19 controlled substances, through the use of telehealth.
239	239	20 §34-24-705.
240	240	21 (a) A physician who provides a telehealth medical
241	241	22 service shall comply with all federal and state laws and
242	242	23 regulations applicable to the provision of telehealth medical
243	243	24 services, including the Health Insurance Portability and
244	244	25 Accountability Act (HIPAA), and shall use devices and
245	245	26 technologies in compliance with these laws, rules, and
246	246	27 regulations. A physician who provides telehealth medical
247	247	Page 9 1 services shall also take reasonable precautions to protect the
248	248	2 privacy and security of all verbal, visual, written, and other
249	249	3 communications involved in the delivery of telehealth medical
250	250	4 services.
251	251	5 (b) A physician who provides a telehealth medical
252	252	6 service shall maintain complete and accurate medical records
253	253	7 in accordance with rules of the Board of Medical Examiners and
254	254	8 the Medical Licensure Commission, must have access to the
255	255	9 patient's medical records, and must be able to produce the
256	256	10 records upon demand by the patient, the Board of Medical
257	257	11 Examiners, or the Medical Licensure Commission.
258	258	12 (c) Rules adopted by the Board of Medical Examiners
259	259	13 and the Medical Licensure Commission shall set standards for
260	260	14 the creation, retention, and distribution of medical records
261	261	15 pursuant to the delivery of telehealth medical services.
262	262	16 §34-24-706.
263	263	17 (a) The Board of Medical Examiners and the Medical
264	264	18 Licensure Commission may adopt rules regulating the provision
265	265	19 of telehealth medical services by physicians in this state,
266	266	20 even if the rules displace competition.
267	267	21 (b) Rules adopted by the Board of Medical Examiners
268	268	22 and the Medical Licensure Commission shall promote quality
269	269	23 care, prevent fraud, waste, and abuse, and ensure adequate
270	270	24 supervision of health professionals who aid in providing
271	271	25 telehealth medical services.
272	272	26 (c) Rules adopted by the Board of Medical Examiners
273	273	27 and the Medical Licensure Commission may expand upon,
274	274	Page 10 1 supplement, or clarify, but may not conflict with, the
275	275	2 definitions, standards, or other provisions of this article.
276	276	3 §34-24-707.
277	277	4 (a) This article, and the rules adopted by the Board
278	278	5 of Medical Examiners and the Medical Licensure Commission,
279	279	6 shall apply only to the provision of telehealth medical
280	280	7 services by physicians to individuals located in this state.
281	281	8 (b) The Board of Medical Examiners, the Medical
282	282	9 Licensure Commission, and its officers, agents,
283	283	10 representatives, employees and directors thereof, shall be
284	284	11 considered to be acting pursuant to clearly expressed state
285	285	12 policy as established in this act and under the active
286	286	13 supervision of the state. The boards, agencies, and
287	287	14 individuals in this section shall not be subject to state or
288	288	15 federal antitrust laws while acting in the manner provided in
289	289	16 this section.
290	290	17 Section 2. Article 10, comprised of Sections
291	291	18 34-24-500 through 34-24-508, of Chapter 24 of Title 34, Code
292	292	19 of Alabama 1975, relating to the licensing of the practice of
293	293	20 medicine and osteopathy across state lines, are repealed.
294	294	21 Section 3. This act shall become effective 90 days
295	295	22 following its passage and approval by the Governor, or its
296	296	23 otherwise becoming law.
297	297	Page 11