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| 4 | 4 | | |
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| 5 | 5 | | 2023 -- S 0574 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001676 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S TATE OF RHODE IS LAND |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2023 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HEALTH AND SAFETY -- UNIFORM TELEHEALTH ACT |
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| 16 | 16 | | Introduced By: Senators Lauria, Miller, Ujifusa, Bell, Murray, Euer, Kallman, Britto, |
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| 17 | 17 | | McKenney, and Mack |
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| 18 | 18 | | Date Introduced: March 07, 2023 |
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| 19 | 19 | | Referred To: Senate Health & Human Services |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1 |
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| 24 | 24 | | amended by adding thereto the following chapter: 2 |
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| 25 | 25 | | CHAPTER 77.1 3 |
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| 26 | 26 | | UNIFORM TELEHEALTH ACT 4 |
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| 27 | 27 | | 23-77.1-1. Short title. 5 |
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| 28 | 28 | | This chapter shall be known and may be cited as the "Uniform Telehealth Act". 6 |
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| 29 | 29 | | 23-77.1-2. Definitions. 7 |
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| 30 | 30 | | When used in this chapter: 8 |
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| 31 | 31 | | (1) “Board” means an entity to which a state has granted the authority to license, certify, 9 |
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| 32 | 32 | | or discipline individuals who provide health care. 10 |
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| 33 | 33 | | (2) “Electronic” means relating to technology having electrical, digital, magnetic, wireless, 11 |
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| 34 | 34 | | optical, electromagnetic, or similar capabilities. 12 |
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| 35 | 35 | | (3) “Health care” means care, treatment, or a service or procedure, to maintain, monitor, 13 |
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| 36 | 36 | | diagnose, or otherwise affect an individual’s physical or mental illness, injury, or condition. 14 |
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| 37 | 37 | | (4) “Out-of-state practitioner” means an individual licensed, certified, or otherwise 15 |
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| 38 | 38 | | authorized by law of another state to provide health care in that state. 16 |
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| 39 | 39 | | (5) “Practitioner” means an individual: 17 |
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| 40 | 40 | | (i) Licensed or certified under one or more of the following: 18 |
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| 41 | 41 | | (A) Chapter 30 of title 5 (chiropractors); 19 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC001676 - Page 2 of 7 |
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| 45 | 45 | | (B) Chapter 31.1 of title 5 (dental professionals); 1 |
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| 46 | 46 | | (C) Chapter 64 of title 5 (dieticians and nutritionists); 2 |
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| 47 | 47 | | (D) Chapter 4.1 of title 23 (emergency medical service providers); 3 |
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| 48 | 48 | | (E) Chapter 13.6 of title 23 (lactation consultants); 4 |
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| 49 | 49 | | (F) Chapter 63.2 of title 5 (marriage, family and mental health therapists); 5 |
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| 50 | 50 | | (G) Chapter 20.8 of title 23 (massage therapists); 6 |
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| 51 | 51 | | (H) Chapter 34 of title 5 (midwives); 7 |
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| 52 | 52 | | (I) Chapter 34 of title 5 (nurses); 8 |
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| 53 | 53 | | (J) Chapter 17.9 of title 23 (nursing assistants); 9 |
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| 54 | 54 | | (K) Chapter 40.1 of title 5 (occupational therapists); 10 |
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| 55 | 55 | | (L) Chapters 35.1 and 35.2 of title 5 (optometrists and opticians); 11 |
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| 56 | 56 | | (M) Chapter 19.1 of title 5 (pharmacists); 12 |
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| 57 | 57 | | (N) Chapter 40 of title 5 (physical therapists); 13 |
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| 58 | 58 | | (O) Chapter 54 of title 5 (physician assistants); 14 |
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| 59 | 59 | | (P) Chapter 37 of title 5 (physicians); 15 |
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| 60 | 60 | | (Q) Chapter 29 of title 5 (podiatrists); 16 |
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| 61 | 61 | | (R) Chapter 44 of title 5 (psychologists); 17 |
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| 62 | 62 | | (S) Chapter 39 of title 23 (respiratory care professionals); 18 |
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| 63 | 63 | | (T) Chapter 39.1 of title 5 (social workers); or 19 |
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| 64 | 64 | | (U) Chapter 48 of title 5 (speech language pathologists and audiologists) 20 |
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| 65 | 65 | | (ii) Otherwise authorized by the laws of this state, including through the registration 21 |
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| 66 | 66 | | process established under § 23-77.1-7, to provide health care in this state. 22 |
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| 67 | 67 | | (6) “Professional practice standard” includes: 23 |
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| 68 | 68 | | (i) A standard of care; 24 |
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| 69 | 69 | | (ii) A standard of professional ethics; and 25 |
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| 70 | 70 | | (iii) A practice requirement imposed by a board. 26 |
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| 71 | 71 | | (7) “Registered practitioner” means an out-of-state practitioner registered under § 23-77.1-27 |
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| 72 | 72 | | 7. 28 |
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| 73 | 73 | | (8) “Registering board” means a board of this state that registers out-of-state practitioners 29 |
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| 74 | 74 | | under § 23-77.1-7. 30 |
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| 75 | 75 | | (9) “Scope of practice” means the extent of a practitioner’s authority to provide health care. 31 |
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| 76 | 76 | | (10) “State” means a state of the United States, the District of Columbia, Puerto Rico, the 32 |
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| 77 | 77 | | United States Virgin Islands, or any other territory or possession subject to the jurisdiction of the 33 |
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| 78 | 78 | | United States. The term includes a federally recognized Indian tribe. 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC001676 - Page 3 of 7 |
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| 82 | 82 | | (11) “Telecommunication technology” means technology that supports communication 1 |
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| 83 | 83 | | through electronic means. The term is not limited to regulated technology or technology associated 2 |
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| 84 | 84 | | with a regulated industry. 3 |
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| 85 | 85 | | (12) “Telehealth” means use of synchronous or asynchronous telecommunication 4 |
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| 86 | 86 | | technology by a practitioner to provide health care to a patient at a different physical location than 5 |
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| 87 | 87 | | the practitioner. 6 |
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| 88 | 88 | | (13) “Telehealth services” means health care provided through telehealth. 7 |
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| 89 | 89 | | 23-77.1-3. Scope. 8 |
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| 90 | 90 | | (a) This chapter applies to the provision of telehealth services to a patient located in this 9 |
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| 91 | 91 | | state. 10 |
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| 92 | 92 | | (b) This chapter does not apply to the provision of telehealth services to a patient located 11 |
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| 93 | 93 | | outside this state. 12 |
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| 94 | 94 | | 23-77.1-4. Telehealth authorization. 13 |
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| 95 | 95 | | (a) A practitioner may provide telehealth services to a patient located in this state if the 14 |
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| 96 | 96 | | services are consistent with the practitioner's scope of practice in this state, applicable professional 15 |
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| 97 | 97 | | practice standards in this state, and requirements and limitations of federal or state law. 16 |
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| 98 | 98 | | (b) This chapter does not authorize the provision of health care otherwise regulated by 17 |
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| 99 | 99 | | federal or state law, unless the provision of the health care complies with the requirements, 18 |
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| 100 | 100 | | limitations, and prohibitions of the federal or state law. 19 |
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| 101 | 101 | | (c) A practitioner-patient relationship may be established through telehealth. 20 |
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| 102 | 102 | | 23-77.1-5. Professional practice standard. 21 |
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| 103 | 103 | | (a) A practitioner who provides telehealth services to a patient located in this state shall 22 |
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| 104 | 104 | | provide the services in compliance with the professional practice standards applicable to a 23 |
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| 105 | 105 | | practitioner who provides comparable in-person health care in this state. Professional practice 24 |
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| 106 | 106 | | standards and law applicable to the provision of health care in this state, including standards and 25 |
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| 107 | 107 | | law relating to prescribing medication or treatment, identity verification, documentation, informed 26 |
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| 108 | 108 | | consent, confidentiality, privacy, and security, apply to the provision of telehealth services in this 27 |
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| 109 | 109 | | state. 28 |
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| 110 | 110 | | (b) A board or agency in this state shall not adopt or enforce a rule that establishes a 29 |
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| 111 | 111 | | different professional practice standard for telehealth services or limits the telecommunication 30 |
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| 112 | 112 | | technology that may be used for telehealth services. 31 |
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| 113 | 113 | | 23-77.1-6. Out-of-state practitioner. 32 |
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| 114 | 114 | | (a) An out-of-state practitioner may provide telehealth services to a patient located in this 33 |
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| 115 | 115 | | state if the out-of-state practitioner: 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC001676 - Page 4 of 7 |
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| 119 | 119 | | (1) Holds a license or certification required to provide health care in this state or is 1 |
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| 120 | 120 | | otherwise authorized to provide health care in this state, including through a multistate compact of 2 |
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| 121 | 121 | | which this state is a member; 3 |
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| 122 | 122 | | (2) Registers under § 23-77.1-7 with the registering board responsible for licensing or 4 |
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| 123 | 123 | | certifying practitioners who provide the type of health care the out-of-state practitioner provides; 5 |
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| 124 | 124 | | or 6 |
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| 125 | 125 | | (3) Provides the telehealth services: 7 |
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| 126 | 126 | | (i) In consultation with a practitioner who has a practitioner-patient relationship with the 8 |
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| 127 | 127 | | patient; 9 |
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| 128 | 128 | | (ii) In the form of a specialty assessment, diagnosis, or recommendation for treatment; or 10 |
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| 129 | 129 | | (iii) Pursuant to a previously established practitioner-patient relationship if the telehealth 11 |
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| 130 | 130 | | services are provided not later than one year after the practitioner with whom the patient has a 12 |
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| 131 | 131 | | relationship last provided health care to the patient. 13 |
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| 132 | 132 | | (b) A requirement for licensure or certification of an out-of-state practitioner who 14 |
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| 133 | 133 | | supervises an out-of-state practitioner providing telehealth services may be satisfied through 15 |
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| 134 | 134 | | registration under § 23-77.1-7. 16 |
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| 135 | 135 | | (c) A requirement for licensure or certification of an out-of-state practitioner who controls 17 |
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| 136 | 136 | | or is otherwise associated with an entity that provides health care to a patient located in this state 18 |
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| 137 | 137 | | may be satisfied through registration under § 23-77.1-7 if the entity does not provide in-person 19 |
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| 138 | 138 | | health care to a patient located in this state. 20 |
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| 139 | 139 | | 23-77.1-7. Board registration of out-of-state practitioner. 21 |
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| 140 | 140 | | (a) A board established under any one of the provisions cited in § 23-77.1-2(5)(i) shall 22 |
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| 141 | 141 | | register, for the purpose of providing telehealth services in this state, an out-of-state practitioner 23 |
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| 142 | 142 | | not licensed, certified, or otherwise authorized to provide health care in this state if the practitioner: 24 |
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| 143 | 143 | | (1) Submits a completed application in the form prescribed by the registering board; 25 |
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| 144 | 144 | | (2) Holds an active, unrestricted license or certification in another state that is substantially 26 |
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| 145 | 145 | | equivalent to a license or certification issued by the registering board to provide health care; 27 |
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| 146 | 146 | | (3) Is not subject to a pending disciplinary investigation or action by a board; 28 |
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| 147 | 147 | | (4) Has not been disciplined by a board during the five (5) year period immediately before 29 |
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| 148 | 148 | | submitting the application, other than discipline relating to a fee payment or continuing education 30 |
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| 149 | 149 | | requirement addressed to the satisfaction of the board that took the disciplinary action; 31 |
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| 150 | 150 | | (5) Never has been disciplined on a ground that the registering board determines would be 32 |
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| 151 | 151 | | a basis for denying a license or certification in this state; 33 |
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| 152 | 152 | | (6) Consents to personal jurisdiction in this state for an action arising out of the provision 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC001676 - Page 5 of 7 |
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| 156 | 156 | | of a telehealth service in this state; 1 |
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| 157 | 157 | | (7) Appoints a registered agent for service of process in this state in accordance with the 2 |
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| 158 | 158 | | law of this state and identifies the agent in the form prescribed by the registering board; 3 |
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| 159 | 159 | | (8) Has professional liability insurance that includes coverage for telehealth services 4 |
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| 160 | 160 | | provided to patients located in this state in an amount not less than the amount required for a 5 |
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| 161 | 161 | | practitioner providing the same services in this state; and 6 |
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| 162 | 162 | | (9) Pays the registration fee under subsection (d) of this section. 7 |
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| 163 | 163 | | (b) A registering board shall not register under this chapter an out-of-state practitioner if 8 |
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| 164 | 164 | | the practitioner does not satisfy all requirements of subsection (a) of this section. 9 |
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| 165 | 165 | | (c) A registering board shall create an application for registration under subsection (a) of 10 |
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| 166 | 166 | | this section and a form for identifying the agent under subsection (a)(7) of this section. 11 |
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| 167 | 167 | | (d) A registering board may establish a registration fee that reflects the expected cost of 12 |
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| 168 | 168 | | registration under this section and the cost of undertaking investigation, disciplinary action, and 13 |
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| 169 | 169 | | other activity relating to registered practitioners. 14 |
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| 170 | 170 | | (e) A registering board shall make available to the public information about registered 15 |
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| 171 | 171 | | practitioners in the same manner it makes available to the public information about licensed or 16 |
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| 172 | 172 | | certified practitioners authorized to provide comparable health care in this state. 17 |
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| 173 | 173 | | (f) This section does not affect any other law of this state relating to an application by an 18 |
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| 174 | 174 | | out-of-state practitioner for licensure or certification. 19 |
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| 175 | 175 | | 23-77.1-8. Disciplinary action by the registering board. 20 |
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| 176 | 176 | | (a) A registering board may take disciplinary action against a registered practitioner who: 21 |
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| 177 | 177 | | (1) Violates this chapter; 22 |
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| 178 | 178 | | (2) Holds a license or certification that has been restricted in a state; or 23 |
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| 179 | 179 | | (3) Has been disciplined by a board, other than discipline relating to a fee payment or 24 |
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| 180 | 180 | | continuing education requirement addressed to the satisfaction of the board that imposed the 25 |
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| 181 | 181 | | discipline. 26 |
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| 182 | 182 | | (b) A registering board may take an action under subsection (a) of this section that it is 27 |
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| 183 | 183 | | authorized to take against a licensed or certified practitioner who provides comparable health care 28 |
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| 184 | 184 | | in this state. 29 |
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| 185 | 185 | | (c) Disciplinary action under this section includes suspension or revocation of the 30 |
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| 186 | 186 | | registered practitioner’s registration in accordance with any other law of this state applicable to 31 |
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| 187 | 187 | | disciplinary action against a practitioner who provides comparable health care in this state. 32 |
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| 188 | 188 | | 23-77.1-9. Duties of registered practitioner. 33 |
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| 189 | 189 | | A registered practitioner: 34 |
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| 190 | 190 | | |
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| 191 | 191 | | |
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| 192 | 192 | | LC001676 - Page 6 of 7 |
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| 193 | 193 | | (1) Shall notify the registering board not later than ten (10) days after a board in another 1 |
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| 194 | 194 | | state notifies the practitioner that it has initiated an investigation, placed a restriction on the 2 |
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| 195 | 195 | | practitioner's license or certification, or taken a disciplinary action against the practitioner; 3 |
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| 196 | 196 | | (2) Shall maintain professional liability insurance that includes coverage for telehealth 4 |
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| 197 | 197 | | services provided to patients located in this state in an amount not less than the amount required 5 |
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| 198 | 198 | | for a licensed or certified practitioner providing the same services in this state; and 6 |
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| 199 | 199 | | (3) Shall not open an office physically located in this state or provide in-person health care 7 |
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| 200 | 200 | | to a patient located in this state. 8 |
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| 201 | 201 | | 23-77.1-10. Location of care - Venue. 9 |
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| 202 | 202 | | (a) The provision of a telehealth service under this chapter occurs at the patient’s location 10 |
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| 203 | 203 | | at the time the service is provided. 11 |
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| 204 | 204 | | (b) In a civil action arising out of a practitioner's provision of a telehealth service to a 12 |
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| 205 | 205 | | patient under this chapter, brought by the patient or the patient’s personal representative, 13 |
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| 206 | 206 | | conservator, guardian, or a person entitled to bring a claim under the state’s wrongful death statute, 14 |
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| 207 | 207 | | venue is proper in the patient’s county of residence in this state or in another county authorized by 15 |
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| 208 | 208 | | law. 16 |
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| 209 | 209 | | 23-77.1-11. Rulemaking authority. 17 |
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| 210 | 210 | | A board may adopt rules and regulations pursuant to chapter 35 of title 42 to administer, 18 |
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| 211 | 211 | | enforce, implement, or interpret this chapter. 19 |
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| 212 | 212 | | 23-77.1-12. Uniformity of application and construction. 20 |
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| 213 | 213 | | In applying and construing this chapter, a court shall consider the promotion of uniformity 21 |
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| 214 | 214 | | of the law among jurisdictions that enact it. 22 |
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| 215 | 215 | | 23-77.1-13. Severability. 23 |
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| 216 | 216 | | If a provision of this chapter or its application to a person or circumstance is held invalid, 24 |
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| 217 | 217 | | the invalidity does not affect another provision or application that can be given effect without the 25 |
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| 218 | 218 | | invalid provision. 26 |
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| 219 | 219 | | SECTION 2. This act shall take effect upon passage. 27 |
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| 221 | 221 | | LC001676 |
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| 223 | 223 | | |
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| 224 | 224 | | |
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| 225 | 225 | | LC001676 - Page 7 of 7 |
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| 226 | 226 | | EXPLANATION |
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| 227 | 227 | | BY THE LEGISLATIVE COUNCIL |
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| 228 | 228 | | OF |
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| 229 | 229 | | A N A C T |
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| 230 | 230 | | RELATING TO HEALTH AND SAFETY -- UNIFORM TELEHEALTH A CT |
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| 231 | 231 | | *** |
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| 232 | 232 | | This act would allow an out-of-state health care practitioner, registered with the applicable 1 |
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| 233 | 233 | | board, to provide telehealth services to a patient located in this state if the services are consistent 2 |
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| 234 | 234 | | with the practitioner's scope of practice and state and federal professional standards. 3 |
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| 235 | 235 | | This act would take effect upon passage. 4 |
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| 236 | 236 | | ======== |
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| 237 | 237 | | LC001676 |
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| 239 | 239 | | |
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