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ENGROSSED SENATE
BILL NO. 673 By: McCortney of the Senate
and
Newton of the House
An Act relating to telemedicine; amending 36 O.S.
2011, Section 6802, which relates to definitions;
amending 43A O.S. 2011, Section 1 -103, as last
amended by Section 29, Chapter 475, O.S.L. 2019 (43A
O.S. Supp. 2020, Section 1 -103), which relates to
definitions; amending Section 1, Chapter 228, O. S.L.
2017 (59 O.S. Supp. 2020, Section 47 8), which relates
to definitions; making certain definition s uniform;
amending Section 2, Chapter 228, O.S.L. 2017 (59 O.S.
Supp. 2020, Section 478.1) , which relates to
establishment of physician -patient relationship
through telemedicine ; deleting obsolete language; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2011, Section 6802, is
amended to read as follows:
Section 6802. As used in this act the Oklahoma Telemedicine
Act, “telemedicine” means the practice of health care delivery,
diagnosis, consultation, treatment , including but not limited to,
the treatment and prevention of strokes, transfer of medical da ta,
or exchange of medical education inf ormation by means of audio,
video, or data communications. Telemedicin e is not a consultation
provided by telephone or facsimile machine technology-enabled health
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and care management and delivery systems that extend capacity and
access, which includes:
a. synchronous mechanisms, which may include live
audiovisual interaction between a patient and a health
care professional or real -time provider to provider
consultation through live interactive audiovisual
means,
b. asynchronous mechanisms, which include st ore and
forward transfers, onl ine exchange of health
information between a patient and a health care
professional and online exchange of health information
between health care professionals, but shall not
include the use of automated text messages or
automated mobile applications that serve as the sole
interaction between a p atient and a health care
professional,
c. remote patient monitoring , and
d. other electronic means that support clinical health
care, professional consultation, patient and
professional health-related education, pub lic health
and health administration .
SECTION 2. AMENDATORY 43A O.S. 2011, Section 1 -103, as
last amended by Section 29, Chapter 475, O.S.L. 2019 (43A O.S. Supp.
2020, Section 1-103), is amended to read as follows:
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Section 1-103. When used in this tit le, unless otherwise
expressly stated, or unless the context or subject matter otherwise
requires:
1. “Department” means the Department of Mental Health and
Substance Abuse Serv ices;
2. “Chair” means the chair of the Board of Mental Health and
Substance Abuse Services;
3. “Mental illness” means a substantial disorder of thought,
mood, perception, psychological orientation or memory that
significantly impairs judgment, behavior, capacity to recognize
reality or ability to meet the or dinary demands of life ;
4. “Board” means the Board of Mental Health and Substance Abuse
Services as established by the Mental Health Law;
5. “Commissioner” means the individual selected and appointe d
by the Board to serve as Commissioner of Mental Health and Substance
Abuse Services;
6. “Indigent person” means a person who has not sufficient
assets or resources to support the person and to support members of
the family of the person lawfully depende nt on the person for
support;
7. “Facility” means any hospital, school, build ing, house or
retreat, authorized by law to have the care, treatment or custody of
an individual with mental illness, or drug or alcohol dependency,
gambling addiction, eating di sorders, an opioid substitution
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treatment program, including, but not limited to, public or private
hospitals, community mental health centers, clinics, satellites or
facilities; provided, that facility shall not mean a child guidance
center operated by th e State Department of Health;
8. “Consumer” means a person under care or trea tment in a
facility pursuant to the Mental Health Law, or in an outpatient
status;
9. “Care and treatment” means medical care and behavioral
health services, as well as food, cl othing and maintenance,
furnished to a person;
10. Whenever in this law or in any other law, or in any rule or
order made or promulgated pursuant to this law or to any other law,
or in the printed forms prepared for the admission of consumers or
for statistical reports, the words “insane”, “insanity”, “lunacy”,
“mentally sick”, “mental disease” or “mental disorder” are used,
such terms shall have equal significance to the words “mental
illness”;
11. “Licensed mental health professional ” means:
a. a psychiatrist who is a diplomate of the American
Board of Psychiatry and Neurology,
b. a psychiatrist who is a diplomate of the American
Osteopathic Board of Neurology and Psychiatry,
c. a physician licensed pursuant to the Oklahoma
Allopathic Medical and Surgica l Licensure and
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Supervision Act or the Oklahoma Osteopat hic Medicine
Act,
d. a clinical psychologist who is duly licensed to
practice by the State Board of Examiners of
Psychologists,
e. a professional counselor licensed pursuant to the
Licensed Professional Counselors Act,
f. a person licensed as a clinical so cial worker pursuant
to the provisions of the Social Worker’s Licensing
Act,
g. a licensed marital and family therapist as defined in
the Marital and Family Therapist Licensure Act,
h. a licensed behavioral practitioner as defined in the
Licensed Behavioral Practitioner Act,
i. an advanced practice nurse as defined in the Oklahoma
Nursing Practice Act,
j. a physician’s assistant who is licensed in good
standing in this state, or
k. a licensed drug and alcohol counselor/mental health
(LADC/MH) as defined in the Licensed Alcohol a nd Drug
Counselors Act;
12. “Mentally incompetent person ” means any person who has been
adjudicated mentally or legally incompetent by an appropriate
district court;
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13. a. “Person requiring treatment” means a person who
because of his or her mental illne ss or drug or
alcohol dependency:
(1) poses a substantial risk of immediate physical
harm to self as manifested by evidence or serious
threats of or attempts at suicide or other
significant self-inflicted bodily harm,
(2) poses a substantial risk of immedi ate physical
harm to another person or persons as manifested
by evidence of violent behavior directed toward
another person or persons,
(3) has placed another person or persons i n a
reasonable fear of violent behavior directed
towards such person or person s or serious
physical harm to them as manifested by serious
and immediate threats,
(4) is in a condition of severe deterioration such
that, without immediate intervention, there
exists a substantial risk that severe impairment
or injury will result to the person, or
(5) poses a substantial risk of immediate serious
physical injury to self or death as manifested by
evidence that the person is unable to provide for
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and is not providing for his or her basic
physical needs.
b. The mental health or substance abu se history of the
person may be used as part of the evidence to
determine whether the person is a person requiring
treatment or an assisted outpatient. The mental
health or substance abuse history of the person shall
not be the sole basis for this determi nation.
c. Unless a person also meets the criteria established in
subparagraph a or b of this paragraph, “person
requiring treatment” or an “assisted outpatient” shall
not mean:
(1) a person whose mental processes have been
weakened or impaired by reason o f advanced years,
dementia, or Alzheimer’s disease,
(2) a person with intellectual or developmental
disability as defined in Title 10 of the Oklahoma
Statutes,
(3) a person with seizure disorder,
(4) a person with a traumatic brain in jury, or
(5) a person who is homeless.
d. A person who meets the criteria established in this
section but who is medically unstable, or the facility
holding the person is unable to treat the additiona l
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medical conditions of that person, should be
discharged and transported in a ccordance with Section
1-110 of this title;
14. “Petitioner” means a person who files a petition alleging
that an individual is a person requiring treatment or an assisted
outpatient;
15. “Executive director” means the person in cha rge of a
facility as defined in this section;
16. “Private hospital or facility ” means any general hospital
maintaining a neuro-psychiatric unit or ward, or any private
hospital or facility for care and treatment of a person having a
mental illness, which is not supported by t he state or federal
government. The term “private hospital” or “facility” shall not
include nursing homes or other facilities maintained primarily for
the care of elderly and di sabled persons;
17. “Individualized treatment plan ” means a proposal develope d
during the stay of an individual in a facility, under the provisions
of this title, which is specifically tailored to the treatment needs
of the individual. Each plan shall cl early include the following:
a. a statement of treatment goals or objectives, based
upon and related to a clinical evaluation, which can
be reasonably achieved within a designated time
interval,
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b. treatment methods and procedures to be used to obtain
these goals, which methods and procedures are related
to each of these goals and w hich include specific
prognosis for achieving each of these goals,
c. identification of the types of professional personnel
who will carry out the treatment procedures , including
appropriate medical or other professional involvement
by a physician or other health professional properly
qualified to fulfill legal requirements mandated under
state and federal law,
d. documentation of involvement by the individual
receiving treatment and, if applicable, the accordance
of the individual wit h the treatment plan, and
e. a statement attesting that the executive director of
the facility or clinical director has made a
reasonable effort to meet the plan ’s individualized
treatment goals in th e least restrictive environment
possible closest to the home community of the
individual;
18. “Telemedicine” means the practice of health care delivery,
diagnosis, consultation, evaluation, treatment, transfer of medical
data, or exchange of medical educa tion information by means of
audio, video, or data commu nications. Telemedici ne uses audio and
video multimedia telecommunication equipment which permits two -way
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real-time communication between a health care practitioner and a
patient who are not in the s ame physical location. Telemedicine
shall not include consultation provided b y telephone or facsimile
machine technology-enabled health and care management and delivery
systems that extend capacity and access, which includes:
a. synchronous mechanisms, which may includ e live
audiovisual interaction between a p atient and a health
care professional or real-time provider to provider
consultation through live interactive audiovisual
means,
b. asynchronous mechanisms, which include sto re and
forward transfers, online exchang e of health
information between a patient and a health care
professional and online exchange of health information
between health care professionals, but shall not
include the use of automated text messages or
automated mobile applications that serve as th e sole
interaction between a patient and a health care
professional,
c. remote patient monitoring, and
d. other electronic means that support clinical health
care, professional consultation, patient and
professional health-related education, pu blic health
and health administration ;
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19. “Recovery and recovery support ” means nonclinical services
that assist individuals and families to recover from alcohol or drug
problems. They include social support, l inkage to and coordination
among allied service providers, including but not limited to
transportation to and from treatment or employment , employment
services and job training, case management and individual services
coordination, life skills education, r elapse prevention, housing
assistance, child care, and substance abuse education;
20. “Assisted outpatient” means a person who:
a. is either currently under the care of a facility
certified by the Department of Mental Health and
Substance Abuse Services a s a Community Mental Health
Center, or is being discharged from the custody of the
Oklahoma Department of Corrections, or is being
discharged from a residential placement by the Office
of Juvenile Affairs,
b. is suffering from a mental illness,
c. is unlikely to survive safely in the community with out
supervision, based on a clinical determinatio n,
d. has a history of lack of compliance with treatment for
mental illness that has:
(1) prior to the filing of a petition, at least twice
within the last thirty -six (36) months been a
significant factor in necessitating
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hospitalization or treatment in a hospital or
residential facility , including admission to a
community-based structured crisis center as
certified by the Oklahoma Department of Mental
Health and Substance Abuse Services, or receipt
of services in a forensic or other mental health
unit of a correctional facility, or a specialized
treatment plan for treatment of mental illness in
a secure juvenile facility or placement in a
specialized residential prog ram for juveniles, or
(2) prior to the filing of the petition, resulted in
one or more acts of serious violent behavior
toward self or others or threats of, or attempts
at, serious physical harm to self or others
within the last twenty -four (24) months,
e. is, as a result of his or her mental illne ss, unlikely
to voluntarily participate in outpat ient treatment
that would enable him or her to live safely in the
community,
f. in view of his or her treatment history and current
behavior, is in need of assisted outpatient treatment
in order to prevent a relapse or deterioration which
would be likely to result in serious harm to the
person or persons as defined in this section, and
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g. is likely to benefit from assisted outpatient
treatment; and
21. “Assisted outpatient treatment” means outpatient service s
which have been ordered by the court pursuant t o a treatment plan
approved by the court to tr eat an assisted outpatient’s mental
illness and to assist the person in living and functioning in the
community, or to attempt to prevent a relapse or deteriorat ion that
may reasonably be predicted to result in suicide or the need for
hospitalization.
SECTION 3. AMENDATORY Section 1, Chapter 228, O.S.L.
2017 (59 O.S. Supp. 2020, Section 478), is amended to read as
follows:
Section 478. A. As used in this act:
1. “Store and forward technol ogies” means the transmission of a
patient’s medical information from an originating site to the
physician or practitioner at the distant site; provided, photographs
visualized by a telecommunications s ystem shall be specific to the
patient’s medical condition and adequate for fu rnishing or
confirming a diagnosis or treatment plan;
2. “Telemedicine” means the practice of health care delivery,
diagnosis, consultation, evaluati on and treatment, transfer o f
medical data or exchange of medical education inform ation by means
of a two-way, real-time interactive communication, not to exclude
store and forward technologies, between a patient and a physician
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with access to and reviewin g the patient’s relevant clinical
information prior to the telemedicine visit.
“Telemedicine” and “store and forward technologies” shall not
include consultations provided by telephone audio -only
communication, electronic mail, text message, instant messag ing
conversation, website qu estionnaire, nonsecure video conference or
facsimile machine Section 478.1 of this title , “telemedicine” means
technology-enabled health and care management and delivery systems
that extend capacity and access, which includes:
a. synchronous mechanisms, wh ich may include live
audiovisual interaction between a patient and a health
care professional or real-time provider to provider
consultation through live interactive audiovisual
means,
b. asynchronous mechanisms, which include sto re and
forward transfers, online exchange of health
information between a patien t and a health care
professional and onli ne exchange of health information
between health care professionals, but shall not
include the use of automated text messages or
automated mobile applications th at serve as the sole
interaction between a patient and a health care
professional,
c. remote patient monitoring, and
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d. other electronic means that support clinical health
care, professional consultation, patient and
professional health-related education, public health
and health administration .
SECTION 4. AMENDATORY Sectio n 2, Chapter 228, O.S.L.
2017 (59 O.S. Supp. 2020, Section 478.1), is amended to read as
follows:
Section 478.1. A. Unless otherwise prohibited by law, a valid
physician-patient relationship may be established by an allopathic
or osteopathic physician wi th a patient located in this state
through telemedicine, provided that the physician:
1. Holds a license to practice medicine in t his state;
2. Confirms with the patient the patient ’s identity and
physical location; and
3. Provides the patient with the treating physician’s identity
and professional credentials.
B. Telemedicine and store and forwar d technology encounters
shall comply with the Health Insurance Portability and
Accountability Act of 1996 and ensure t hat all patient
communications and record s are secure and confidential.
C. Telemedicine encounters and encounters involving store and
forward technologies in this state shall not be used to establish a
valid physician-patient relationship for the purpose of prescribing
opiates, synthetic opiates , semisynthetic opiates, benzodiazepine or
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carisprodol, but may be used to prescribe opioid antag onists or
partial agonists pursuan t to Sections 1-2506.1 and 1-2506.2 of Title
63 of the Oklahoma Statutes.
D. A physician-patient relationship shall not be c reated solely
based on the receipt of patient health information by a physician.
The duties and obligations created by a physician -patient
relationship shall not apply until the physician affirmatively:
1. Undertakes to diagnose and treat the patient; or
2. Participates in the diagnosis and treatment of the patient.
SECTION 5. This act shall become effective Novemb er 1, 2021.
Passed the Senate the 1st day of March, 2021.
Presiding Officer of the Senate
Passed the House of Represen tatives the ____ day of __________,
2021.
Presiding Officer of the House
of Representatives