Alabama 2022 Regular Session

Alabama Senate Bill SB272 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		1 SB272
2		-	2 219316-3
	2	+	2 219316-2
3	3		3 By Senators Roberts, Waggoner, Shelnutt, Livingston and
4	4		4 Singleton
5	5		5 RFD: Fiscal Responsibility and Economic Development
6	6		6 First Read: 01-MAR-22
7	7
8		-	Page 0 SB272
9		-	1 SB272
	8	+	Page 0 1 SB272
10	9		2
11	10		3
12		-	4 ENROLLED, An Act,
13		-	5 Relating to the practice of medicine; to repeal
14		-	6 Sections 34-24-500 through 34-24-508, Code of Alabama 1975,
15		-	7 relating to the licensing of the practice of medicine and
16		-	8 osteopathy across state lines; to add a new Article 12 to
17		-	9 Chapter 24 of Title 34, Code of Alabama 1975; to provide for
18		-	10 the practice of telemedicine in the state.
19		-	11 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
20		-	12 Section 1. Article 12 is added to Chapter 24 of
21		-	13 Title 34, Code of Alabama 1975, to read as follows:
22		-	14 Article 12.
23		-	15 §34-24-700.
24		-	16 It is the intent of the Legislature to expand access
25		-	17 to safe, effective health care services for the residents of
26		-	18 this state through the use of various electronic devices and
27		-	19 technologies. The Legislature finds and declares the
28		-	20 following:
29		-	21 (1) Telehealth has proven to be a viable tool to
30		-	22 supplement traditional, in-person services and provides
31		-	23 additional ways for individuals to access medical care.
32		-	Page 1 SB272
33		-	1 (2) Allowing physicians to utilize telehealth
34		-	2 medical services and other electronic devices to provide care
35		-	3 will positively impact residents of this state.
36		-	4 (3) Telehealth should be promoted as sound public
37		-	5 policy and should be available to every Alabama resident,
38		-	6 irrespective of their race, identity, age, income,
39		-	7 socioeconomic class, or geographic location.
40		-	8 §34-24-701.
41		-	9 For the purposes of this article, the following
42		-	10 terms shall have the following meanings:
43		-	11 (1) ASYNCHRONOUS. The electronic exchange of health
44		-	12 care documents, images, and information that does not occur in
45		-	13 real time, including, but not limited to, the collection and
46		-	14 transmission of medical records, clinical data, or laboratory
47		-	15 results.
48		-	16 (2) BOARD OF MEDICAL EXAMINERS. The Alabama Board of
49		-	17 Medical Examiners established pursuant to Section 34-24-53.
50		-	18 (3) CONTROLLED SUBSTANCE. The same meaning as
51		-	19 defined in Section 20-2-2. This term includes an immediate
52		-	20 precursor, as defined in Section 20-2-2.
53		-	21 (4) DIGITAL HEALTH. The delivery of health care
54		-	22 services, patient education communications, or public health
55		-	23 information via software applications, consumer devices, or
56		-	24 other digital media.
57		-	Page 2 SB272
58		-	1 (5) DISTANT SITE. The physical location of a
	11	+	4 ENGROSSED
	12	+	5
	13	+	6
	14	+	7 A BILL
	15	+	8 TO BE ENTITLED
	16	+	9 AN ACT
	17	+	10
	18	+	11 Relating to the practice of medicine; to repeal
	19	+	12 Sections 34-24-500 through 34-24-508, Code of Alabama 1975,
	20	+	13 relating to the licensing of the practice of medicine and
	21	+	14 osteopathy across state lines; to add a new Article 12 to
	22	+	15 Chapter 24 of Title 34, Code of Alabama 1975; to provide for
	23	+	16 the practice of telemedicine in the state.
	24	+	17 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
	25	+	18 Section 1. Article 12 is added to Chapter 24 of
	26	+	19 Title 34, Code of Alabama 1975, to read as follows:
	27	+	20 Article 12.
	28	+	21 §34-24-700.
	29	+	22 It is the intent of the Legislature to expand access
	30	+	23 to safe, effective health care services for the residents of
	31	+	24 this state through the use of various electronic devices and
	32	+	25 technologies. The Legislature finds and declares the
	33	+	26 following:
	34	+	Page 1 1 (1) Telehealth has proven to be a viable tool to
	35	+	2 supplement traditional, in-person services and provides
	36	+	3 additional ways for individuals to access medical care.
	37	+	4 (2) Allowing physicians to utilize telehealth
	38	+	5 medical services and other electronic devices to provide care
	39	+	6 will positively impact residents of this state.
	40	+	7 (3) Telehealth should be promoted as sound public
	41	+	8 policy and should be available to every Alabama resident,
	42	+	9 irrespective of their race, identity, age, income,
	43	+	10 socioeconomic class, or geographic location.
	44	+	11 §34-24-701.
	45	+	12 For the purposes of this article, the following
	46	+	13 terms shall have the following meanings:
	47	+	14 (1) ASYNCHRONOUS. The electronic exchange of health
	48	+	15 care documents, images, and information that does not occur in
	49	+	16 real time, including, but not limited to, the collection and
	50	+	17 transmission of medical records, clinical data, or laboratory
	51	+	18 results.
	52	+	19 (2) BOARD OF MEDICAL EXAMINERS. The Alabama Board of
	53	+	20 Medical Examiners established pursuant to Section 34-24-53.
	54	+	21 (3) CONTROLLED SUBSTANCE. The same meaning as
	55	+	22 defined in Section 20-2-2. This term includes an immediate
	56	+	23 precursor, as defined in Section 20-2-2.
	57	+	24 (4) DIGITAL HEALTH. The delivery of health care
	58	+	25 services, patient education communications, or public health
	59	+	26 information via software applications, consumer devices, or
	60	+	27 other digital media.
	61	+	Page 2 1 (5) DISTANT SITE. The physical location of a
59	62		2 physician at the time in which telehealth medical services are
60	63		3 provided.
61	64		4 (6) HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY
62	65		5 ACT (HIPAA). The Health Insurance Portability and
63	66		6 Accountability Act of 1996, Public Law 104-191, §264, 110
64	67		7 Stat. 1936.
65	68		8 (7) LEGEND DRUG. Any drug, medicine, chemical, or
66	69		9 poison bearing on the label the words, "Caution, federal law
67	70		10 prohibits dispensing without prescription" or other similar
68	71		11 wording indicating that the drug, medicine, chemical, or
69	72		12 poison may be sold or dispensed only upon the prescription of
70	73		13 a licensed medical practitioner.
71	74		14 (8) MEDICAL LICENSURE COMMISSION. The Alabama
72	75		15 Medical Licensure Commission established pursuant to Section
73	76		16 34-24-310.
74	77		17 (9) MEDICAL SUPPLIES. Non-drug medical items,
75	78		18 including durable medical equipment, which may be sold or
76	79		19 dispensed only upon the prescription of a licensed medical
77	80		20 practitioner.
78	81		21 (10) ORIGINATING SITE. The physical location of a
79	82		22 patient at the time in which telehealth medical services are
80	83		23 provided.
81	84		24 (11) PHYSICIAN. Either a doctor of medicine who is
82	85		25 licensed to practice medicine or a doctor of osteopathy who is
83		-	Page 3 SB272
84		-	1 licensed to practice osteopathy in a state, commonwealth,
85		-	2 district, or territory of the United States.
86		-	3 (12) PRESCRIBER. Any person who possesses an active
87		-	4 Alabama controlled substance certificate or a Qualified
88		-	5 Alabama Controlled Substances Registration Certificate issued
89		-	6 by the Board of Medical Examiners.
90		-	7 (13) SYNCHRONOUS. The real-time exchange of medical
91		-	8 information or provision of care between a patient and a
92		-	9 physician via audio/visual technologies, audio only
93		-	10 technologies, or other means.
94		-	11 (14) TELEHEALTH. The use of electronic and
95		-	12 telecommunications technologies, including devices used for
96		-	13 digital health, asynchronous and synchronous communications,
97		-	14 or other methods, to support a range of medical care and
98		-	15 public health services.
99		-	16 (15) TELEHEALTH MEDICAL SERVICES. Digital health,
100		-	17 telehealth, telemedicine, and the applicable technologies and
101		-	18 devices used in the delivery of telehealth. The term does not
102		-	19 include incidental communications between a patient and a
103		-	20 physician.
104		-	21 (16) TELEMEDICINE. A form of telehealth referring to
105		-	22 the provision of medical services by a physician at a distant
106		-	23 site to a patient at an originating site via asynchronous or
107		-	24 synchronous communications, or other devices that may
108		-	25 adequately facilitate and support the appropriate delivery of
109		-	Page 4 SB272
110		-	1 care. The term includes digital health, but does not include
111		-	2 incidental communications between a patient and a physician.
112		-	3 §34-24-702.
113		-	4 (a) Physicians who engage in the provision of
114		-	5 telehealth medical services to any individual in this state
115		-	6 must possess a full and active license to practice medicine or
116		-	7 osteopathy issued by the Medical Licensure Commission.
117		-	8 (b) Notwithstanding subsection (a), a physician who
118		-	9 engages in the provision of telehealth medical services to any
119		-	10 individual in this state is not required to possess a license
120		-	11 issued by the Medical Licensure Commission, if either of the
121		-	12 following apply:
122		-	13 (1) The services are provided on an irregular or
123		-	14 infrequent basis. The term "irregular or infrequent" refers to
124		-	15 telehealth medical services occurring less than 10 days in a
125		-	16 calendar year or involving fewer than 10 patients in a
126		-	17 calendar year.
127		-	18 (2) The services are provided in consultation, as
128		-	19 further provided by Section 34-24-74, with a physician
129		-	20 licensed to practice medicine or osteopathy in this state.
130		-	21 (c) A violation of this article shall constitute the
131		-	22 unauthorized practice of medicine.
132		-	23 (d) Nothing in this article shall be interpreted to
133		-	24 limit or restrict the Board of Medical Examiners' or Medical
134		-	25 Licensure Commission's authority to regulate, revoke, suspend,
135		-	Page 5 SB272
136		-	1 sanction, or otherwise discipline any physician licensed to
137		-	2 practice in this state who violates the provisions of this
138		-	3 chapter, the provisions relating to the regulation of
139		-	4 manufacture and distribution of controlled substances, as
140		-	5 provided by Sections 20-2-50 through 20-2-58, or the
141		-	6 administrative rules of the Board of Medical Examiners or the
142		-	7 Medical Licensure Commission while engaging in the practice of
143		-	8 medicine within this or any other state.
144		-	9 (e) Nothing in this article shall be construed to
145		-	10 apply to or to restrict the provision of health-related
146		-	11 services via telehealth by a health care provider other than a
147		-	12 physician, provided that those health-related services are
148		-	13 within the scope of practice of the health care professional
149		-	14 licensed in Alabama.
150		-	15 §34-24-703.
151		-	16 (a) A physician providing telehealth medical
152		-	17 services shall owe to the patient the same duty to exercise
153		-	18 reasonable care, diligence, and skill as would be applicable
154		-	19 if the service or procedure were provided in person.
155		-	20 Telehealth medical services shall be governed by the Medical
156		-	21 Liability Act of 1987, codified in Sections 6-5-540 through
157		-	22 6-5-552, and shall be subject to the exclusive jurisdiction
158		-	23 and venue of the circuit courts of the State of Alabama,
159		-	24 regardless of the citizenship of the parties.
160		-	Page 6 SB272
161		-	1 (b) A physician practicing telemedicine shall do all
162		-	2 of the following, if such action would otherwise be required
163		-	3 in the provision of the same service if delivered in-person:
164		-	4 (1) Establish a diagnosis through the use of
165		-	5 acceptable medical practices, which may include, but not be
166		-	6 limited to, taking a patient history, a mental status
167		-	7 examination, a physical examination, disclosure and evaluation
168		-	8 of underlying conditions, and any diagnostic and laboratory
169		-	9 testing.
170		-	10 (2) Disclose any diagnosis and the evidence for the
171		-	11 diagnosis, and discuss the risks and benefits of treatment
172		-	12 options.
173		-	13 (3) Provide a visit summary to the patient and, if
174		-	14 needed, inform the patient of the availability of, or how to
175		-	15 obtain, appropriate follow-up and emergency care.
176		-	16 (c) The provision of telehealth medical services is
177		-	17 deemed to occur at the patient's originating site within this
178		-	18 state. A licensed physician providing telehealth medical
179		-	19 services may do so at any distant site.
180		-	20 (d) Telehealth medical services may only be provided
181		-	21 following the patient's initiation of a physician-patient
182		-	22 relationship, or pursuant to a referral made by a patient's
183		-	23 licensed physician with whom the patient has an established
184		-	24 physician-patient relationship, in the usual course of
185		-	25 treatment of the patient's existing health condition. The
186		-	Page 7 SB272
187		-	1 physician-patient relationship may be formed without a prior
188		-	2 in-person examination.
189		-	3 (e) Prior to providing any telehealth medical
190		-	4 service, the physician, to the extent possible, shall do all
191		-	5 of the following:
192		-	6 (1) Verify the identity of the patient.
193		-	7 (2) Require the patient to identify his or her
194		-	8 physical location, including the city and state.
195		-	9 (3) Disclose to the patient the identity and
196		-	10 credentials of the physician and any other applicable
197		-	11 personnel.
198		-	12 (4) Obtain the patient's consent for the use of
199		-	13 telehealth as an acceptable mode of delivering health care
200		-	14 services, including, but not limited to, consent for the mode
201		-	15 of communication used and its limitations. Acknowledgment of
202		-	16 consent shall be documented in the patient's medical record.
203		-	17 (f)(1) If a physician or practice group provides
204		-	18 telehealth medical services more than four times in a 12-month
205		-	19 period to the same patient for the same medical condition
206		-	20 without resolution, the physician shall do either of the
207		-	21 following:
208		-	22 a. See the patient in person within a reasonable
209		-	23 amount of time, which shall not exceed 12 months.
210		-	Page 8 SB272
211		-	1 b. Appropriately refer the patient to a physician
212		-	2 who can provide the in-person care within a reasonable amount
213		-	3 of time, which shall not exceed 12 months.
214		-	4 (2)a. For the purposes of this section, each
215		-	5 pregnancy for a woman shall be considered a separate or new
216		-	6 condition.
217		-	7 b. For the purposes of this subsection, the term
218		-	8 "practice group" shall mean, at a minimum, a group of
219		-	9 providers who have access to the same medical records.
220		-	10 c. The Board of Medical Examiners, by rule or
221		-	11 otherwise, may provide for exemptions to the requirement
222		-	12 contained in subdivision (1) that are no more restrictive than
223		-	13 the provisions of this article.
224		-	14 (3) The provision of telehealth medical services
225		-	15 that includes video communication to a patient at an
226		-	16 originating site with the in-person assistance of a person
227		-	17 licensed by the Board of Medical Examiners or by the Board of
228		-	18 Nursing pursuant to Chapter 21 of Title 34 of the Code of
229		-	19 Alabama 1975, shall constitute an in-person visit for the
230		-	20 purposes of this subsection.
231		-	21 (4) This section does not apply to the provision of
232		-	22 telehealth medical services provided by a physician in active
233		-	23 consultation with another physician who is providing in-person
234		-	24 care to a patient.
235		-	Page 9 SB272
236		-	1 (5) This section shall not apply to the provision of
237		-	2 mental health services as defined in Section 22-50-1.
238		-	3 §34-24-704.
239		-	4 (a) A prescriber may prescribe a legend drug,
240		-	5 medical supplies, or a controlled substance to a patient as a
241		-	6 result of a telehealth medical service if the prescriber is
242		-	7 authorized to prescribe the drug, supplies, or substance under
243		-	8 applicable state and federal laws. To be valid, a prescription
244		-	9 must be issued for a legitimate medical purpose by a
245		-	10 prescriber acting in the usual course of his or her
246		-	11 professional practice.
247		-	12 (b)(1) A prescription for a controlled substance may
248		-	13 only be issued as a result of telehealth medical services if
249		-	14 each of the following apply:
250		-	15 a. The telehealth visit includes synchronous audio
251		-	16 or audio-visual communication using HIPAA compliant equipment
252		-	17 with the prescriber responsible for the prescription.
253		-	18 b. The prescriber has had at least one in-person
254		-	19 encounter with the patient within the preceding 12 months.
255		-	20 c. The prescriber has established a legitimate
256		-	21 medical purpose for issuing the prescription within the
257		-	22 preceding 12 months.
258		-	23 (2) This subsection shall not apply in an in-patient
259		-	24 setting.
260		-	Page 10 SB272
261		-	1 (c) A physician shall be exempt from the
262		-	2 requirements of subsection (b) and may issue a prescription
263		-	3 for a controlled substance to a patient if the prescription is
264		-	4 for the treatment of a patient's medical emergency, as further
265		-	5 defined by rule by the Board of Medical Examiners and the
266		-	6 Medical Licensure Commission.
267		-	7 §34-24-705.
268		-	8 (a) A physician who provides a telehealth medical
269		-	9 service shall comply with all federal and state laws and
270		-	10 regulations applicable to the provision of telehealth medical
271		-	11 services, including the Health Insurance Portability and
272		-	12 Accountability Act (HIPAA), and shall use devices and
273		-	13 technologies in compliance with these laws, rules, and
274		-	14 regulations. A physician who provides telehealth medical
275		-	15 services shall also take reasonable precautions to protect the
276		-	16 privacy and security of all verbal, visual, written, and other
277		-	17 communications involved in the delivery of telehealth medical
278		-	18 services.
279		-	19 (b) A physician who provides a telehealth medical
280		-	20 service shall maintain complete and accurate medical records
281		-	21 in accordance with rules of the Board of Medical Examiners and
282		-	22 the Medical Licensure Commission, must have access to the
283		-	23 patient's medical records, and must be able to produce the
284		-	24 records upon demand by the patient, the Board of Medical
285		-	25 Examiners, or the Medical Licensure Commission.
286		-	Page 11 SB272
287		-	1 (c) Rules adopted by the Board of Medical Examiners
288		-	2 and the Medical Licensure Commission shall set standards for
289		-	3 the creation, retention, and distribution of medical records
290		-	4 pursuant to the delivery of telehealth medical services.
291		-	5 §34-24-706.
292		-	6 (a) The Board of Medical Examiners and the Medical
293		-	7 Licensure Commission may adopt rules regulating the provision
294		-	8 of telehealth medical services by physicians in this state,
295		-	9 even if the rules displace competition.
296		-	10 (b) Rules adopted by the Board of Medical Examiners
297		-	11 and the Medical Licensure Commission shall promote quality
298		-	12 care, prevent fraud, waste, and abuse, and ensure that
299		-	13 physicians provide adequate supervision of health
300		-	14 professionals who aid in providing telehealth medical
301		-	15 services.
302		-	16 (c) Other than as set forth in this article, the
303		-	17 authority of the Board of Medical Examiners and the Medical
304		-	18 Licensure Commission to regulate physicians providing
305		-	19 telehealth medical services shall be the same as the authority
306		-	20 of the Board of Medical Examiners and the Medical Licensure
307		-	21 Commission to regulate physicians providing services in
308		-	22 person.
309		-	23 §34-24-707.
310		-	24 (a) This article, and the rules adopted by the Board
311		-	25 of Medical Examiners and the Medical Licensure Commission,
312		-	Page 12 SB272
313		-	1 shall apply only to the provision of telehealth medical
314		-	2 services by physicians to individuals located in this state.
315		-	3 (b) The Board of Medical Examiners, the Medical
316		-	4 Licensure Commission, and its officers, agents,
317		-	5 representatives, employees, and directors thereof, shall be
318		-	6 considered to be acting pursuant to clearly expressed state
319		-	7 policy as established in this act and under the active
320		-	8 supervision of the state. The boards, agencies, and
321		-	9 individuals in this section shall not be subject to state or
322		-	10 federal antitrust laws while acting in the manner provided in
323		-	11 this section.
324		-	12 Section 2. Article 10, comprised of Sections
325		-	13 34-24-500 through 34-24-508, of Chapter 24 of Title 34, Code
326		-	14 of Alabama 1975, relating to the licensing of the practice of
327		-	15 medicine and osteopathy across state lines, is repealed.
328		-	16 Section 3. This act shall become effective 90 days
329		-	17 following its passage and approval by the Governor, or its
330		-	18 otherwise becoming law.
331		-	Page 13 SB272
332		-	1
	86	+	26 licensed to practice osteopathy in a state, commonwealth,
	87	+	27 district, or territory of the United States.
	88	+	Page 3 1 (12) PRESCRIBER. Any person who possesses an active
	89	+	2 Alabama controlled substance certificate or a Qualified
	90	+	3 Alabama Controlled Substances Registration Certificate issued
	91	+	4 by the Board of Medical Examiners.
	92	+	5 (13) SYNCHRONOUS. The real-time exchange of medical
	93	+	6 information or provision of care between a patient and a
	94	+	7 physician via audio/visual technologies, audio only
	95	+	8 technologies, or other means.
	96	+	9 (14) TELEHEALTH. The use of electronic and
	97	+	10 telecommunications technologies, including devices used for
	98	+	11 digital health, asynchronous and synchronous communications,
	99	+	12 or other methods, to support a range of medical care and
	100	+	13 public health services.
	101	+	14 (15) TELEHEALTH MEDICAL SERVICES. Digital health,
	102	+	15 telehealth, telemedicine, and the applicable technologies and
	103	+	16 devices used in the delivery of telehealth. The term does not
	104	+	17 include incidental communications between a patient and a
	105	+	18 physician.
	106	+	19 (16) TELEMEDICINE. A form of telehealth referring to
	107	+	20 the provision of medical services by a physician at a distant
	108	+	21 site to a patient at an originating site via asynchronous or
	109	+	22 synchronous communications, or other devices that may
	110	+	23 adequately facilitate and support the appropriate delivery of
	111	+	24 care. The term includes digital health, but does not include
	112	+	25 incidental communications between a patient and a physician.
	113	+	26 §34-24-702.
	114	+	Page 4 1 (a) Physicians who engage in the provision of
	115	+	2 telehealth medical services to any individual in this state
	116	+	3 must possess a full and active license to practice medicine or
	117	+	4 osteopathy issued by the Medical Licensure Commission.
	118	+	5 (b) Notwithstanding subsection (a), a physician who
	119	+	6 engages in the provision of telehealth medical services to any
	120	+	7 individual in this state is not required to possess a license
	121	+	8 issued by the Medical Licensure Commission, if either of the
	122	+	9 following apply:
	123	+	10 (1) The services are provided on an irregular or
	124	+	11 infrequent basis. The term "irregular or infrequent" refers to
	125	+	12 telehealth medical services occurring less than 10 days in a
	126	+	13 calendar year or involving fewer than 10 patients in a
	127	+	14 calendar year.
	128	+	15 (2) The services are provided in consultation, as
	129	+	16 further provided by Section 34-24-74, with a physician
	130	+	17 licensed to practice medicine or osteopathy in this state.
	131	+	18 (c) A violation of this article shall constitute the
	132	+	19 unauthorized practice of medicine.
	133	+	20 (d) Nothing in this article shall be interpreted to
	134	+	21 limit or restrict the Board of Medical Examiners' or Medical
	135	+	22 Licensure Commission's authority to regulate, revoke, suspend,
	136	+	23 sanction, or otherwise discipline any physician licensed to
	137	+	24 practice in this state who violates the provisions of this
	138	+	25 chapter, the provisions relating to the regulation of
	139	+	26 manufacture and distribution of controlled substances, as
	140	+	27 provided by Sections 20-2-50 through 20-2-58, or the
	141	+	Page 5 1 administrative rules of the Board of Medical Examiners or the
	142	+	2 Medical Licensure Commission while engaging in the practice of
	143	+	3 medicine within this or any other state.
	144	+	4 (e) Nothing in this article shall be construed to
	145	+	5 apply to or to restrict the provision of health-related
	146	+	6 services via telehealth by a health care provider other than a
	147	+	7 physician, provided that those health-related services are
	148	+	8 within the scope of practice of the health care professional
	149	+	9 licensed in Alabama.
	150	+	10 §34-24-703.
	151	+	11 (a) A physician providing telehealth medical
	152	+	12 services shall owe to the patient the same duty to exercise
	153	+	13 reasonable care, diligence, and skill as would be applicable
	154	+	14 if the service or procedure were provided in person.
	155	+	15 Telehealth medical services shall be governed by the Medical
	156	+	16 Liability Act of 1987, codified in Sections 6-5-540 through
	157	+	17 6-5-552, and shall be subject to the exclusive jurisdiction
	158	+	18 and venue of the circuit courts of the State of Alabama,
	159	+	19 regardless of the citizenship of the parties.
	160	+	20 (b) A physician practicing telemedicine shall do all
	161	+	21 of the following, if such action would otherwise be required
	162	+	22 in the provision of the same service if delivered in-person:
	163	+	23 (1) Establish a diagnosis through the use of
	164	+	24 acceptable medical practices, which may include, but not be
	165	+	25 limited to, taking a patient history, a mental status
	166	+	26 examination, a physical examination, disclosure and evaluation
	167	+	Page 6 1 of underlying conditions, and any diagnostic and laboratory
	168	+	2 testing.
	169	+	3 (2) Disclose any diagnosis and the evidence for the
	170	+	4 diagnosis, and discuss the risks and benefits of treatment
	171	+	5 options.
	172	+	6 (3) Provide a visit summary to the patient and, if
	173	+	7 needed, inform the patient of the availability of, or how to
	174	+	8 obtain, appropriate follow-up and emergency care.
	175	+	9 (c) The provision of telehealth medical services is
	176	+	10 deemed to occur at the patient's originating site within this
	177	+	11 state. A licensed physician providing telehealth medical
	178	+	12 services may do so at any distant site.
	179	+	13 (d) Telehealth medical services may only be provided
	180	+	14 following the patient's initiation of a physician-patient
	181	+	15 relationship, or pursuant to a referral made by a patient's
	182	+	16 licensed physician with whom the patient has an established
	183	+	17 physician-patient relationship, in the usual course of
	184	+	18 treatment of the patient's existing health condition. The
	185	+	19 physician-patient relationship may be formed without a prior
	186	+	20 in-person examination.
	187	+	21 (e) Prior to providing any telehealth medical
	188	+	22 service, the physician, to the extent possible, shall do all
	189	+	23 of the following:
	190	+	24 (1) Verify the identity of the patient.
	191	+	25 (2) Require the patient to identify his or her
	192	+	26 physical location, including the city and state.
	193	+	Page 7 1 (3) Disclose to the patient the identity and
	194	+	2 credentials of the physician and any other applicable
	195	+	3 personnel.
	196	+	4 (4) Obtain the patient's consent for the use of
	197	+	5 telehealth as an acceptable mode of delivering health care
	198	+	6 services, including, but not limited to, consent for the mode
	199	+	7 of communication used and its limitations. Acknowledgment of
	200	+	8 consent shall be documented in the patient's medical record.
	201	+	9 (f)(1) If a physician or practice group provides
	202	+	10 telehealth medical services more than four times in a 12-month
	203	+	11 period to the same patient for the same medical condition
	204	+	12 without resolution, the physician shall do either of the
	205	+	13 following:
	206	+	14 a. See the patient in person within a reasonable
	207	+	15 amount of time, which shall not exceed 12 months.
	208	+	16 b. Appropriately refer the patient to a physician
	209	+	17 who can provide the in-person care within a reasonable amount
	210	+	18 of time, which shall not exceed 12 months.
	211	+	19 (2)a. For the purposes of this section, each
	212	+	20 pregnancy for a woman shall be considered a separate or new
	213	+	21 condition.
	214	+	22 b. For the purposes of this subsection, the term
	215	+	23 "practice group" shall mean, at a minimum, a group of
	216	+	24 providers who have access to the same medical records.
	217	+	25 c. The Board of Medical Examiners, by rule or
	218	+	26 otherwise, may provide for exemptions to the requirement
	219	+	Page 8 1 contained in subdivision (1) that are no more restrictive than
	220	+	2 the provisions of this article.
	221	+	3 (3) The provision of telehealth medical services
	222	+	4 that includes video communication to a patient at an
	223	+	5 originating site with the in-person assistance of a person
	224	+	6 licensed by the Board of Medical Examiners or by the Board of
	225	+	7 Nursing pursuant to Chapter 21 of Title 34 of the Code of
	226	+	8 Alabama 1975, shall constitute an in-person visit for the
	227	+	9 purposes of this subsection.
	228	+	10 (4) This section does not apply to the provision of
	229	+	11 telehealth medical services provided by a physician in active
	230	+	12 consultation with another physician who is providing in-person
	231	+	13 care to a patient.
	232	+	14 (5) This section shall not apply to the provision of
	233	+	15 mental health services as defined in Section 22-50-1.
	234	+	16 §34-24-704.
	235	+	17 (a) A prescriber may prescribe a legend drug,
	236	+	18 medical supplies, or a controlled substance to a patient as a
	237	+	19 result of a telehealth medical service if the prescriber is
	238	+	20 authorized to prescribe the drug, supplies, or substance under
	239	+	21 applicable state and federal laws. To be valid, a prescription
	240	+	22 must be issued for a legitimate medical purpose by a
	241	+	23 prescriber acting in the usual course of his or her
	242	+	24 professional practice.
	243	+	25 (b)(1) A prescription for a controlled substance may
	244	+	26 only be issued as a result of telehealth medical services if
	245	+	27 each of the following apply:
	246	+	Page 9 1 a. The telehealth visit includes synchronous audio
	247	+	2 or audio-visual communication using HIPAA compliant equipment
	248	+	3 with the prescriber responsible for the prescription.
	249	+	4 b. The prescriber has had at least one in-person
	250	+	5 encounter with the patient within the preceding 12 months.
	251	+	6 c. The prescriber has established a legitimate
	252	+	7 medical purpose for issuing the prescription within the
	253	+	8 preceding 12 months.
	254	+	9 (2) This subsection shall not apply in an in-patient
	255	+	10 setting.
	256	+	11 (c) A physician shall be exempt from the
	257	+	12 requirements of subsection (b) and may issue a prescription
	258	+	13 for a controlled substance to a patient if the prescription is
	259	+	14 for the treatment of a patient's medical emergency, as further
	260	+	15 defined by rule by the Board of Medical Examiners and the
	261	+	16 Medical Licensure Commission.
	262	+	17 §34-24-705.
	263	+	18 (a) A physician who provides a telehealth medical
	264	+	19 service shall comply with all federal and state laws and
	265	+	20 regulations applicable to the provision of telehealth medical
	266	+	21 services, including the Health Insurance Portability and
	267	+	22 Accountability Act (HIPAA), and shall use devices and
	268	+	23 technologies in compliance with these laws, rules, and
	269	+	24 regulations. A physician who provides telehealth medical
	270	+	25 services shall also take reasonable precautions to protect the
	271	+	26 privacy and security of all verbal, visual, written, and other
	272	+	Page 10 1 communications involved in the delivery of telehealth medical
	273	+	2 services.
	274	+	3 (b) A physician who provides a telehealth medical
	275	+	4 service shall maintain complete and accurate medical records
	276	+	5 in accordance with rules of the Board of Medical Examiners and
	277	+	6 the Medical Licensure Commission, must have access to the
	278	+	7 patient's medical records, and must be able to produce the
	279	+	8 records upon demand by the patient, the Board of Medical
	280	+	9 Examiners, or the Medical Licensure Commission.
	281	+	10 (c) Rules adopted by the Board of Medical Examiners
	282	+	11 and the Medical Licensure Commission shall set standards for
	283	+	12 the creation, retention, and distribution of medical records
	284	+	13 pursuant to the delivery of telehealth medical services.
	285	+	14 §34-24-706.
	286	+	15 (a) The Board of Medical Examiners and the Medical
	287	+	16 Licensure Commission may adopt rules regulating the provision
	288	+	17 of telehealth medical services by physicians in this state,
	289	+	18 even if the rules displace competition.
	290	+	19 (b) Rules adopted by the Board of Medical Examiners
	291	+	20 and the Medical Licensure Commission shall promote quality
	292	+	21 care, prevent fraud, waste, and abuse, and ensure that
	293	+	22 physicians provide adequate supervision of health
	294	+	23 professionals who aid in providing telehealth medical
	295	+	24 services.
	296	+	25 (c) Other than as set forth in this article, the
	297	+	26 authority of the Board of Medical Examiners and the Medical
	298	+	27 Licensure Commission to regulate physicians providing
	299	+	Page 11 1 telehealth medical services shall be the same as the authority
	300	+	2 of the Board of Medical Examiners and the Medical Licensure
	301	+	3 Commission to regulate physicians providing services in
	302	+	4 person.
	303	+	5 §34-24-707.
	304	+	6 (a) This article, and the rules adopted by the Board
	305	+	7 of Medical Examiners and the Medical Licensure Commission,
	306	+	8 shall apply only to the provision of telehealth medical
	307	+	9 services by physicians to individuals located in this state.
	308	+	10 (b) The Board of Medical Examiners, the Medical
	309	+	11 Licensure Commission, and its officers, agents,
	310	+	12 representatives, employees, and directors thereof, shall be
	311	+	13 considered to be acting pursuant to clearly expressed state
	312	+	14 policy as established in this act and under the active
	313	+	15 supervision of the state. The boards, agencies, and
	314	+	16 individuals in this section shall not be subject to state or
	315	+	17 federal antitrust laws while acting in the manner provided in
	316	+	18 this section.
	317	+	19 Section 2. Article 10, comprised of Sections
	318	+	20 34-24-500 through 34-24-508, of Chapter 24 of Title 34, Code
	319	+	21 of Alabama 1975, relating to the licensing of the practice of
	320	+	22 medicine and osteopathy across state lines, is repealed.
	321	+	23 Section 3. This act shall become effective 90 days
	322	+	24 following its passage and approval by the Governor, or its
	323	+	25 otherwise becoming law.
	324	+	Page 12 1
333	325		2
334		-	3
335		-	4
336		-	President and Presiding Officer of the Senate
337		-
338		-	5
339		-	6 Speaker of the House of Representatives
340		-	SB2727
341		-	8 Senate 29-MAR-22
342		-	9 I hereby certify that the within Act originated in and passed
343		-	10 the Senate, as amended.
344		-	11
345		-	12 Patrick Harris,
346		-	13 Secretary.
	326	+	3 Senate
	327	+	Read for the first time and referred to the Senate4
	328	+	5 committee on Fiscal Responsibility and Economic
	329	+	Development.......................................6 0.1-MAR-22
	330	+	7
	331	+	Read for the second time and placed on the8
	332	+	calendar 1 amendment.............................9 0.2-MAR-22
	333	+	10
	334	+	Read for the third time and passed as amended ....11 2.9-MAR-22
	335	+	Yeas 3312
	336	+	13 Nays 0
347	337		14
348	338		15
349		-	16
350		-	17 House of Representatives
351		-	18 Passed: 05-APR-22
352		-	19
353		-	20
354		-	21 By: Senator Roberts
355		-	Page 14
	339	+	16 Patrick Harris,
	340	+	17 Secretary.
	341	+	18
	342	+	Page 13