Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB673 Compare Versions

Version 1 (Old)

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4		-	An Act
5		-	ENROLLED SENATE
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 58th Legislature (2021)
	34	+
	35	+	ENGROSSED SENATE
6	36		BILL NO. 673 By: McCortney of the Senate
7	37
8	38		and
9	39
10	40		Newton of the House
11	41
12	42
13	43
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15	45		An Act relating to telemedicine; amending 36 O.S.
16	46		2011, Section 6802, which relates to definitions;
17	47		amending 43A O.S. 2011, Section 1 -103, as last
18	48		amended by Section 29, Chapter 475, O.S.L. 2019 (43A
19	49		O.S. Supp. 2020, Section 1 -103), which relates to
20	50		definitions; amending Section 1, Chapter 228, O.S.L.
21	51		2017 (59 O.S. Supp. 2020, Section 478), which relates
22	52		to definitions; making certain definitions uniform;
23	53		amending Section 2, Chapter 228, O.S.L. 2017 (59 O.S.
24	54		Supp. 2020, Section 478.1), which relates to
25	55		establishment of physician -patient relationship
26	56		through telemedicine; deleting obsolete language; and
27	57		providing an effective date .
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33		-	SUBJECT: Telemedicine
34		-
35	63		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
36		-
37	64		SECTION 1. AMENDATORY 36 O.S. 2011, Section 6802, is
38	65		amended to read as follows:
39		-
40	66		Section 6802. As used in this act the Oklahoma Telemedicine
41	67		Act, “telemedicine” means the practice of health care delivery,
42	68		diagnosis, consultation, treatment, including but not limited to,
43	69		the treatment and prevention of strokes, transfer of medical data,
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44	97		or exchange of medical education information by means of audio,
45	98		video, or data communications. Telemedicine is not a consultation
46	99		provided by telephone or facsimile machine technology-enabled health
47		-
48		-	ENR. S. B. NO. 673 Page 2
49	100		and care management and delivery systems that extend capacity and
50	101		access, which includes:
51		-
52	102		a. synchronous mechanisms, which may include live
53	103		audiovisual interaction between a patient and a health
54	104		care professional or real -time provider to provider
55	105		consultation through live interactive audiovisual
56	106		means,
57		-
58	107		b. asynchronous mechanisms, which include store and
59	108		forward transfers, online exchange of health
60	109		information between a patient and a health care
61	110		professional and online exchange of health information
62	111		between health care professionals, but shall not
63	112		include the use of automated text messages or
64	113		automated mobile applications that serve as the sole
65	114		interaction between a patient and a health care
66	115		professional,
67		-
68	116		c. remote patient monitoring , and
69		-
70	117		d. other electronic means that support clinical health
71	118		care, professional consultation, patient and
72	119		professional health-related education, public health
73	120		and health administration .
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75	148		SECTION 2. AMENDATORY 43A O.S. 2011, Section 1 -103, as
76	149		last amended by Section 29, Chapter 475, O.S.L. 2019 (43A O.S. Supp.
77	150		2020, Section 1-103), is amended to read as follows:
78		-
79	151		Section 1-103. When used in this title, unless otherwise
80	152		expressly stated, or unless the context or subject matter otherwise
81	153		requires:
82		-
83	154		1. “Department” means the Department of Mental Health and
84	155		Substance Abuse Services;
85		-
86	156		2. “Chair” means the chair of the Board of Mental Health and
87	157		Substance Abuse Services;
88		-
89	158		3. “Mental illness” means a substantial disorder of thought,
90	159		mood, perception, psychological orientation or memory that
91		-
92		-	ENR. S. B. NO. 673 Page 3
93	160		significantly impairs judgment, behavior, capacity to recognize
94	161		reality or ability to meet the ordinary demands of life;
95		-
96	162		4. “Board” means the Board of Mental Health and Substance Abuse
97	163		Services as established by the Mental Health Law;
98		-
99	164		5. “Commissioner” means the individual selected and appointed
100	165		by the Board to serve as Commissioner of Mental Health and Substance
101	166		Abuse Services;
102		-
103	167		6. “Indigent person” means a person who has not sufficient
104	168		assets or resources to support the person and to support members of
105	169		the family of the person lawfully dependent on the person for
106	170		support;
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107	197
108	198		7. “Facility” means any hospital, school, building, house or
109	199		retreat, authorized by law to have the care, treatment or custody of
110	200		an individual with mental illness, or drug or alcohol dependency,
111	201		gambling addiction, eating disorders, an opioid substitution
112	202		treatment program, including, but not limited to, public or private
113	203		hospitals, community mental health centers, clinics, satellites or
114	204		facilities; provided, that facility shall not mean a child guidance
115	205		center operated by the State D epartment of Health;
116		-
117	206		8. “Consumer” means a person under care or treatment in a
118	207		facility pursuant to the Mental Health Law, or in an outpatient
119	208		status;
120		-
121	209		9. “Care and treatment” means medical care and behavioral
122	210		health services, as well as food, clothing an d maintenance,
123	211		furnished to a person;
124		-
125	212		10. Whenever in this law or in any other law, or in any rule or
126	213		order made or promulgated pursuant to this law or to any other law,
127	214		or in the printed forms prepared for the admission of consumers or
128	215		for statistical reports, the words “insane”, “insanity”, “lunacy”,
129	216		“mentally sick”, “mental disease” or “mental disorder” are used,
130	217		such terms shall have equal significance to the words “mental
131	218		illness”;
132		-
133	219		11. “Licensed mental health professional ” means:
134		-
135		-
136		-	ENR. S. B. NO. 673 Page 4
137	220		a. a psychiatrist who is a diplomate of the American
138	221		Board of Psychiatry and Neurology,
139	222
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140	249		b. a psychiatrist who is a diplomate of the American
141	250		Osteopathic Board of Neurology and Psychiatry,
142		-
143	251		c. a physician licensed pursuant to the Oklahoma
144	252		Allopathic Medical and Surgical Licensu re and
145	253		Supervision Act or the Oklahoma Osteopathic Medicine
146	254		Act,
147		-
148	255		d. a clinical psychologist who is duly licensed to
149	256		practice by the State Board of Examiners of
150	257		Psychologists,
151		-
152	258		e. a professional counselor licensed pursuant to the
153	259		Licensed Professional Counse lors Act,
154		-
155	260		f. a person licensed as a clinical social worker pursuant
156	261		to the provisions of the Social Worker ’s Licensing
157	262		Act,
158		-
159	263		g. a licensed marital and family therapist as defined in
160	264		the Marital and Family Therapist Licensure Act,
161		-
162	265		h. a licensed behavioral pr actitioner as defined in the
163	266		Licensed Behavioral Practitioner Act ,
164		-
165	267		i. an advanced practice nurse as defined in the Oklahoma
166	268		Nursing Practice Act,
167		-
168	269		j. a physician’s assistant who is licensed in good
169	270		standing in this state, or
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170	297
171	298		k. a licensed drug and alcohol c ounselor/mental health
172	299		(LADC/MH) as defined in the Licensed Alcohol and Drug
173	300		Counselors Act;
174		-
175	301		12. “Mentally incompetent person ” means any person who has been
176	302		adjudicated mentally or legally incompetent by an appropriate
177	303		district court;
178		-
179		-
180		-	ENR. S. B. NO. 673 Page 5
181	304		13. a. “Person requiring treatment” means a person who
182	305		because of his or her mental illness or drug or
183	306		alcohol dependency:
184		-
185	307		(1) poses a substantial risk of immediate physical
186	308		harm to self as manifested by evidence or serious
187	309		threats of or attempts at suicide or other
188	310		significant self-inflicted bodily harm,
189		-
190	311		(2) poses a substantial risk of immediate physical
191	312		harm to another person or persons as manifested
192	313		by evidence of violent behavior directed toward
193	314		another person or persons,
194		-
195	315		(3) has placed another person or persons in a
196	316		reasonable fear of violent behavior directed
197	317		towards such person or persons or serious
198	318		physical harm to them as manifested by serious
199	319		and immediate threats,
200		-
201	320		(4) is in a condition of severe deterioration such
202	321		that, without immediate intervention, there
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203	349		exists a substantial risk that severe impairment
204	350		or injury will result to the person, or
205		-
206	351		(5) poses a substantial risk of immediate serious
207	352		physical injury to self or death as manifested by
208	353		evidence that the person is unable to provide for
209	354		and is not providing for h is or her basic
210	355		physical needs.
211		-
212	356		b. The mental health or substance abuse history of the
213	357		person may be used as part of the evidence to
214	358		determine whether the person is a person requiring
215	359		treatment or an assisted outpatient. The mental
216	360		health or substance abu se history of the person shall
217	361		not be the sole basis for this determination.
218		-
219	362		c. Unless a person also meets the criteria established in
220	363		subparagraph a or b of this paragraph, “person
221	364		requiring treatment” or an “assisted outpatient” shall
222	365		not mean:
223		-
224		-	ENR. S. B. NO. 673 Page 6
225		-
226	366		(1) a person whose mental processes have been
227	367		weakened or impaired by reason of advanced years,
228	368		dementia, or Alzheimer ’s disease,
229		-
230	369		(2) a person with intellectual or developmental
231	370		disability as defined in Title 10 of the Oklahoma
232	371		Statutes,
233		-
234	372		(3) a person with seizure d isorder,
235	373
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236	400		(4) a person with a traumatic brain injury, or
237		-
238	401		(5) a person who is homeless.
239		-
240	402		d. A person who meets the criteria established in this
241	403		section but who is medically unstable, or the facility
242	404		holding the person is unable to treat the additional
243	405		medical conditions of that person, should be
244	406		discharged and transported in accordance with Section
245	407		1-110 of this title;
246		-
247	408		14. “Petitioner” means a person who files a petition alleging
248	409		that an individual is a person requiring treatment or an assisted
249	410		outpatient;
250		-
251	411		15. “Executive director” means the person in charge of a
252	412		facility as defined in this section;
253		-
254	413		16. “Private hospital or facility ” means any general hospital
255	414		maintaining a neuro-psychiatric unit or ward, or any private
256	415		hospital or facility for care and treat ment of a person having a
257	416		mental illness, which is not supported by the state or federal
258	417		government. The term “private hospital” or “facility” shall not
259	418		include nursing homes or other facilities maintained primarily for
260	419		the care of elderly and disabled pe rsons;
261		-
262	420		17. “Individualized treatment plan ” means a proposal developed
263	421		during the stay of an individual in a facility, under the provisions
264	422		of this title, which is specifically tailored to the treatment needs
265	423		of the individual. Each plan shall clearly inc lude the following:
266	424
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267	450
268		-	ENR. S. B. NO. 673 Page 7
269	451		a. a statement of treatment goals or objectives, based
270	452		upon and related to a clinical evaluation, which can
271	453		be reasonably achieved within a designated time
272	454		interval,
273		-
274	455		b. treatment methods and procedures to be used to obtain
275	456		these goals, which methods and procedures are related
276	457		to each of these goals and which include specific
277	458		prognosis for achieving each of these goals,
278		-
279	459		c. identification of the types of professional personnel
280	460		who will carry out the treatment procedures , including
281	461		appropriate medical or other professional involvement
282	462		by a physician or other health professional properly
283	463		qualified to fulfill legal requirements mandated under
284	464		state and federal law,
285		-
286	465		d. documentation of involvement by the individual
287	466		receiving treatment and, if a pplicable, the accordance
288	467		of the individual with the treatment plan, and
289		-
290	468		e. a statement attesting that the executive director of
291	469		the facility or clinical director has made a
292	470		reasonable effort to meet the plan ’s individualized
293	471		treatment goals in the least r estrictive environment
294	472		possible closest to the home community of the
295	473		individual;
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296	500
297	501		18. “Telemedicine” means the practice of health care delivery,
298	502		diagnosis, consultation, evaluation, treatment, transfer of medical
299	503		data, or exchange of medical education info rmation by means of
300	504		audio, video, or data communications. Telemedicine uses audio and
301	505		video multimedia telecommunication equipment which permits two -way
302	506		real-time communication between a health care practitioner and a
303	507		patient who are not in the same physi cal location. Telemedicine
304	508		shall not include consultation provided by telephone or facsimile
305	509		machine technology-enabled health and care management and delivery
306	510		systems that extend capacity and access, which includes:
307		-
308	511		a. synchronous mechanisms, which may i nclude live
309	512		audiovisual interaction between a patient and a health
310	513		care professional or real -time provider to provider
311		-
312		-	ENR. S. B. NO. 673 Page 8
313	514		consultation through live interactive audiovisual
314	515		means,
315		-
316	516		b. asynchronous mechanisms, which include store and
317	517		forward transfers, online ex change of health
318	518		information between a patient and a health care
319	519		professional and online exchange of health information
320	520		between health care professionals, but shall not
321	521		include the use of automated text messages or
322	522		automated mobile applications that serve as the sole
323	523		interaction between a patient and a health care
324	524		professional,
325	525
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326	552		c. remote patient monitoring, and
327		-
328	553		d. other electronic means that support clinical health
329	554		care, professional consultation, patient and
330	555		professional health-related education, public he alth
331	556		and health administration ;
332		-
333	557		19. “Recovery and recovery support ” means nonclinical services
334	558		that assist individuals and families to recover from alcohol or drug
335	559		problems. They include social support, linkage to and coordination
336	560		among allied service pr oviders, including but not limited to
337	561		transportation to and from treatment or employment, employment
338	562		services and job training, case management and individual services
339	563		coordination, life skills education, relapse prevention, housing
340	564		assistance, child care, and substance abuse education;
341		-
342	565		20. “Assisted outpatient” means a person who:
343		-
344	566		a. is either currently under the care of a facility
345	567		certified by the Department of Mental Health and
346	568		Substance Abuse Services as a Community Mental Health
347	569		Center, or is being di scharged from the custody of the
348	570		Oklahoma Department of Corrections, or is being
349	571		discharged from a residential placement by the Office
350	572		of Juvenile Affairs,
351		-
352	573		b. is suffering from a mental illness,
353		-
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356	574		c. is unlikely to survive safely in the community without
357	575		supervision, based on a clinical determination,
358	576
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359	603		d. has a history of lack of compliance with treatment for
360	604		mental illness that has:
361		-
362	605		(1) prior to the filing of a petition, at least twice
363	606		within the last thirty -six (36) months been a
364	607		significant factor in necess itating
365	608		hospitalization or treatment in a hospital or
366	609		residential facility , including admission to a
367	610		community-based structured crisis center as
368	611		certified by the Oklahoma Department of Mental
369	612		Health and Substance Abuse Services, or receipt
370	613		of services in a forensic or other mental health
371	614		unit of a correctional facility, or a specialized
372	615		treatment plan for treatment of mental illness in
373	616		a secure juvenile facility or placement in a
374	617		specialized residential program for juveniles, or
375		-
376	618		(2) prior to the filing of t he petition, resulted in
377	619		one or more acts of serious violent behavior
378	620		toward self or others or threats of, or attempts
379	621		at, serious physical harm to self or others
380	622		within the last twenty -four (24) months,
381		-
382	623		e. is, as a result of his or her mental illness, unl ikely
383	624		to voluntarily participate in outpatient treatment
384	625		that would enable him or her to live safely in the
385	626		community,
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386	653
387	654		f. in view of his or her treatment history and current
388	655		behavior, is in need of assisted outpatient treatment
389	656		in order to prevent a relaps e or deterioration which
390	657		would be likely to result in serious harm to the
391	658		person or persons as defined in this section, and
392		-
393	659		g. is likely to benefit from assisted outpatient
394	660		treatment; and
395		-
396	661		21. “Assisted outpatient treatment ” means outpatient services
397	662		which have been ordered by the court pursuant to a treatment plan
398		-
399		-	ENR. S. B. NO. 673 Page 10
400	663		approved by the court to treat an assisted outpatient ’s mental
401	664		illness and to assist the person in living and functioning in the
402	665		community, or to attempt to prevent a relapse or deterioration tha t
403	666		may reasonably be predicted to result in suicide or the need for
404	667		hospitalization.
405		-
406	668		SECTION 3. AMENDATORY Section 1, Chapter 228, O.S.L.
407	669		2017 (59 O.S. Supp. 2020, Section 478), is amended to read as
408	670		follows:
409		-
410	671		Section 478. A. As used in this act:
411		-
412	672		1. “Store and forward technologies ” means the transmission of a
413	673		patient’s medical information from an originating site to the
414	674		physician or practitioner at the distant site; provided, photographs
415	675		visualized by a telecommunications system s hall be specific to the
416	676		patient’s medical condition and adequate for furnishing or
417	677		confirming a diagnosis or treatment plan;
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418	704
419	705		2. “Telemedicine” means the practice of health care delivery,
420	706		diagnosis, consultation, evaluation and treatment, transfer of
421	707		medical data or exchange of medical education information by means
422	708		of a two-way, real-time interactive communication, not to exclude
423	709		store and forward technologies, between a patient and a physician
424	710		with access to and reviewing the patient ’s relevant clinical
425	711		information prior to the telemedicine visit.
426		-
427	712		“Telemedicine” and “store and forward technologies ” shall not
428	713		include consultations provided by telephone audio -only
429	714		communication, electronic mail, text message, instant messaging
430	715		conversation, website questionn aire, nonsecure video conference or
431	716		facsimile machine Section 478.1 of this title , “telemedicine” means
432	717		technology-enabled health and care management and delivery systems
433	718		that extend capacity and access, which includes:
434		-
435	719		a. synchronous mechanisms, which may include live
436	720		audiovisual interaction between a patient and a health
437	721		care professional or real -time provider to provider
438	722		consultation through live interactive audiovisual
439	723		means,
440		-
441		-
442		-	ENR. S. B. NO. 673 Page 11
443	724		b. asynchronous mechanisms, which include store and
444	725		forward transfers, online exchange of health
445	726		information between a patient and a health care
446	727		professional and online exchange of health information
447	728		between health care professionals, but shall not
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448	756		include the use of automated text messages or
449	757		automated mobile applications that serv e as the sole
450	758		interaction between a patient and a health care
451	759		professional,
452		-
453	760		c. remote patient monitoring, and
454		-
455	761		d. other electronic means that support clinical health
456	762		care, professional consultation, patient and
457	763		professional health-related education, public health
458	764		and health administration .
459		-
460	765		SECTION 4. AMENDATORY Section 2, Chapter 228, O.S.L.
461	766		2017 (59 O.S. Supp. 2020, Section 478.1), is amended to read as
462	767		follows:
463		-
464	768		Section 478.1. A. Unless otherwise prohibited by law, a valid
465	769		physician-patient relationship may be established by an allopathic
466	770		or osteopathic physician with a patient located in this state
467	771		through telemedicine, provided that the physician:
468		-
469	772		1. Holds a license to practice medicine in this state;
470		-
471	773		2. Confirms with the pati ent the patient’s identity and
472	774		physical location; and
473		-
474	775		3. Provides the patient with the treating physician ’s identity
475	776		and professional credentials.
476		-
477	777		B. Telemedicine and store and forward technology encounters
478	778		shall comply with the Health Insurance Portabil ity and
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479	806		Accountability Act of 1996 and ensure that all patient
480	807		communications and records are secure and confidential.
481		-
482	808		C. Telemedicine encounters and encounters involving store and
483	809		forward technologies in this state shall not be used to establish a
484	810		valid physician-patient relationship for the purpose of prescribing
485		-
486		-	ENR. S. B. NO. 673 Page 12
487	811		opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or
488	812		carisprodol, but may be used to prescribe opioid antagonists or
489	813		partial agonists pursuant to Sections 1 -2506.1 and 1-2506.2 of Title
490	814		63 of the Oklahoma Statutes.
491		-
492	815		D. A physician-patient relationship shall not be created solely
493	816		based on the receipt of patient health information by a physician.
494	817		The duties and obligations created by a physician -patient
495	818		relationship shall not apply until the physician affirmatively:
496		-
497	819		1. Undertakes to diagnose and treat the patient; or
498		-
499	820		2. Participates in the diagnosis and treatment of the patient.
500		-
501	821		SECTION 5. This act shall become effective November 1, 2021.
502	822
503		-
504		-	ENR. S. B. NO. 673 Page 13
505		-	Passed the Senate the 1st day of March, 2021.
506		-
507		-
508		-
509		-	Presiding Officer of the Senate
510		-
511		-
512		-	Passed the House of Represen tatives the 20th day of April, 2021.
513		-
514		-
515		-
516		-	Presiding Officer of the House
517		-	of Representatives
518		-
519		-	OFFICE OF THE GOVERNOR
520		-	Received by the Office of the Governor this ____________________
521		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
522		-	By: _______________________________ __
523		-	Approved by the Governor of the State of Oklahoma this _____ ____
524		-	day of _________________ __, 20_______, at _______ o'clock __ _____ M.
525		-
526		-	_________________________________
527		-	Governor of the State of Oklahoma
528		-
529		-
530		-	OFFICE OF THE SECRETARY OF STATE
531		-	Received by the Office of the Secretary of State this _______ ___
532		-	day of __________________, 20 _______, at _______ o'clock _______ M.
533		-	By: _______________________________ __
	823	+	COMMITTEE REPORT BY: COM MITTEE ON PUBLIC HEALTH, dated 03/31/2021 -
	824	+	DO PASS.