Texas 2023 - 88th Regular

Texas Senate Bill SB2527 Compare Versions

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1	1	By: Campbell, Schwertner S.B. No. 2527
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the regulation of telemedicine medical services,
7	7	teledentistry services, and telehealth services; providing a civil
8	8	penalty.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 111.001, Occupations Code, is amended by
11	11	amending Subdivision (1) and adding Subdivision (1-a) to read as
12	12	follows:
13	13	(1) "Controlled substance" has the meaning assigned by
14	14	Section 481.002, Health and Safety Code.
15	15	(1-a) "Dentist," "health professional," and
16	16	"physician" have the meanings assigned by Section 1455.001,
17	17	Insurance Code.
18	18	SECTION 2. Section 111.002, Occupations Code, is amended by
19	19	amending Subsection (a) and adding Subsection (a-1) to read as
20	20	follows:
21	21	(a) A treating physician, dentist, or health professional
22	22	who provides or facilitates the use of telemedicine medical
23	23	services, teledentistry dental services, or telehealth services
24	24	shall:
25	25	(1) ensure that the informed consent of the patient,
26	26	or another appropriate individual authorized to make health care
27	27	treatment decisions for the patient, is obtained before
28	28	telemedicine medical services, teledentistry dental services, or
29	29	telehealth services are provided; and
30	30	(2) with respect to health care treatment for a
31	31	patient who is a minor, develop and implement protocols requiring
32	32	that an individual authorized to make health care treatment
33	33	decisions for the minor patient:
34	34	(A) subject to Paragraph (B), is given notice of
35	35	and the opportunity to attend the initial appointment or meeting
36	36	with the minor patient;
37	37	(B) if the treatment includes the prescription of
38	38	a controlled substance, is present at the initial appointment or
39	39	meeting with the minor patient; and
40	40	(C) consents to the treatment of the minor
41	41	patient.
42	42	(a-1) Subsection (a)(2) does not apply with respect to the
43	43	provision of treatment or counseling to a patient who is a child in
44	44	accordance with Section 32.003 or 32.004, Family Code, as
45	45	applicable.
46	46	SECTION 3. Chapter 111, Occupations Code, is amended by
47	47	adding Section 111.0025 to read as follows:
48	48	Sec. 111.0025. SCOPE OF PRACTICE NOT EXPANDED. (a) A
49	49	health professional who provides telemedicine medical services or
50	50	telehealth services to a patient as described by Section
51	51	111.005(a)(3) may provide only services within the health
52	52	professional's scope of practice.
53	53	(b) This chapter does not change the scope of practice of
54	54	any profession.
55	55	SECTION 4. The heading to Section 111.005, Occupations
56	56	Code, is amended to read as follows:
57	57	Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
58	58	TELEMEDICINE MEDICAL SERVICES, [OR] TELEDENTISTRY DENTAL SERVICES,
59	59	OR TELEHEALTH SERVICES.
60	60	SECTION 5. Sections 111.005(a) and (b), Occupations Code,
61	61	are amended to read as follows:
62	62	(a) For purposes of Section 562.056, a valid
63	63	practitioner-patient relationship is present between a
64	64	practitioner providing a telemedicine medical service, [or a]
65	65	teledentistry dental service, or telehealth service and a patient
66	66	receiving the service as long as the practitioner complies with the
67	67	standard of care described in Section 111.007 and the practitioner:
68	68	(1) has a preexisting practitioner-patient
69	69	relationship with the patient established in accordance with rules
70	70	adopted under Section 111.006;
71	71	(2) communicates, regardless of the method of
72	72	communication, with the patient pursuant to a call coverage
73	73	agreement established in accordance with:
74	74	(A) Texas Medical Board rules with a physician
75	75	requesting coverage of medical care for the patient; or
76	76	(B) State Board of Dental Examiners rules with a
77	77	dentist requesting coverage of dental care for the patient; or
78	78	(3) provides the telemedicine medical services, [or]
79	79	teledentistry dental services, or telehealth services through the
80	80	use of one of the following methods, as long as the practitioner
81	81	complies with the follow-up requirements in Subsection (b), and the
82	82	method allows the practitioner to have access to, and the
83	83	practitioner uses, the relevant clinical information that would be
84	84	required in accordance with the standard of care described in
85	85	Section 111.007:
86	86	(A) synchronous audiovisual interaction between
87	87	the practitioner and the patient in another location;
88	88	(B) asynchronous store and forward technology,
89	89	including asynchronous store and forward technology in conjunction
90	90	with synchronous audio interaction between the practitioner and the
91	91	patient in another location, as long as the practitioner uses
92	92	clinical information from:
93	93	(i) clinically relevant photographic or
94	94	video images, including diagnostic images; or
95	95	(ii) the patient's relevant clinical
96	96	records, such as the relevant medical or dental history, laboratory
97	97	and pathology results, and prescriptive histories; or
98	98	(C) another form of audiovisual
99	99	telecommunication technology that allows the practitioner to
100	100	comply with the standard of care described in Section 111.007.
101	101	(b) A practitioner who provides telemedicine medical
102	102	services or telehealth services to a patient as described by [in]
103	103	Subsection (a)(3) shall:
104	104	(1) provide the patient with guidance on appropriate
105	105	follow-up care; and
106	106	(2) at the request of the patient [if the patient
107	107	consents and the patient has a primary care physician], provide to
108	108	the patient's primary care physician not later than [within] 72
109	109	hours after the patient's request [practitioner provides the
110	110	services to the patient] a medical record or other report
111	111	containing an explanation of the treatment provided by the
112	112	practitioner to the patient and the practitioner's evaluation,
113	113	analysis, or diagnosis, as appropriate, of the patient's condition.
114	114	SECTION 6. Chapter 111, Occupations Code, is amended by
115	115	adding Sections 111.0052 and 111.0055 to read as follows:
116	116	Sec. 111.0052. RECORDS OF CERTAIN TELEMEDICINE MEDICAL
117	117	SERVICES AND TELEHEALTH SERVICES. (a) A health professional who
118	118	provides telemedicine medical services or telehealth services to a
119	119	patient as described by Section 111.005(a)(3) shall:
120	120	(1) maintain a record of each telemedicine medical
121	121	service or telehealth service provided to a patient by the health
122	122	professional until the seventh anniversary of the date the service
123	123	is provided; and
124	124	(2) produce a record described by Subdivision (1) on
125	125	request of the state licensing agency with regulatory authority
126	126	over the health professional that is conducting a regulatory
127	127	investigation or disciplinary action.
128	128	(b) A health professional may designate as custodian of
129	129	records described by Subsection (a)(1) a designated agent in this
130	130	state for any business entity through which the professional
131	131	provided telemedicine medical services or telehealth services to
132	132	the patient. A health professional who designates a custodian
133	133	under this subsection may maintain a complete copy of the records of
134	134	each of the patients to whom the professional provides telemedicine
135	135	medical services or telehealth services as described by Section
136	136	111.005(a)(3).
137	137	Sec. 111.0055. EMERGENCY PROCEDURES. (a) A health
138	138	professional who provides telemedicine medical services or
139	139	telehealth services to a patient as described by Section
140	140	111.005(a)(3) shall develop and implement emergency protocols that
141	141	are appropriate to the standard of care that applies to the
142	142	services. The emergency protocols must be in writing and include
143	143	procedures for making a good faith effort to:
144	144	(1) determine the patient's location if the patient is
145	145	unable to provide the location to the health professional; and
146	146	(2) provide the name, location, and contact
147	147	information of the patient to emergency services in oral, written,
148	148	or digital form.
149	149	(b) If an emergency arises while a health professional is
150	150	providing telemedicine medical services or telehealth services to a
151	151	patient as described by Section 111.005(a)(3), the professional
152	152	shall make a good faith effort to:
153	153	(1) directly contact and coordinate with emergency
154	154	services located near the patient's location; and
155	155	(2) if the emergency arises while the health
156	156	professional is connected to the patient by a synchronous
157	157	technology, remain connected to the patient until emergency
158	158	services have reached the patient's location or the emergency is
159	159	resolved.
160	160	SECTION 7. Section 111.008, Occupations Code, is amended to
161	161	read as follows:
162	162	Sec. 111.008. APPLICATION OF CHAPTER TO MENTAL HEALTH
163	163	SERVICES [EXCLUDED]. This chapter applies [does not apply] to
164	164	mental health services.
165	165	SECTION 8. The heading to Section 111.009, Occupations
166	166	Code, is amended to read as follows:
167	167	Sec. 111.009. LIMITATION ON CERTAIN PRESCRIPTIONS AS
168	168	TELEDENTISTRY SERVICES.
169	169	SECTION 9. Section 111.009(a), Occupations Code, is amended
170	170	to read as follows:
171	171	(a) In this section:
172	172	(1) "National holiday" means a day described by
173	173	Section 662.003(a), Government Code.
174	174	(2) "Opiate" ["Controlled substance," "opiate,"] and
175	175	"prescribe" have the meanings assigned by Section 481.002, Health
176	176	and Safety Code.
177	177	[(2) "National holiday" means a day described by
178	178	Section 662.003(a), Government Code.]
179	179	SECTION 10. Chapter 111, Occupations Code, is amended by
180	180	adding Sections 111.010, 111.011, 111.012, and 111.013 to read as
181	181	follows:
182	182	Sec. 111.010. LIMITATION ON CERTAIN PRESCRIPTIONS AS
183	183	TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES. (a) A
184	184	health professional who provides telemedicine medical services or
185	185	telehealth services to a patient may not allow a patient to select a
186	186	particular controlled substance unless the patient has been
187	187	examined and diagnosed by the professional.
188	188	(b) A health professional who offers telemedicine medical
189	189	services or telehealth services may not enter into a contract that:
190	190	(1) provides a financial or other incentive to the
191	191	health professional based on the professional prescribing a
192	192	particular controlled substance to a patient as a telemedicine
193	193	medical service or telehealth service;
194	194	(2) compensates the health professional based on the
195	195	number of prescriptions for controlled substances prescribed to
196	196	patients as telemedicine medical services or telehealth services;
197	197	or
198	198	(3) requires that the health professional prescribe a
199	199	certain number of controlled substance prescriptions to patients as
200	200	telemedicine medical services or telehealth services.
201	201	(c) A violation of this section is grounds for disciplinary
202	202	action against the health professional by the agency with
203	203	regulatory authority over the professional.
204	204	Sec. 111.011. ADDITIONAL REGULATION OF CERTAIN
205	205	PRESCRIPTIONS AS TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
206	206	SERVICES; ENFORCEMENT. (a) A person may not:
207	207	(1) advertise, offer, or award a financial or other
208	208	incentive to a health professional who offers telemedicine medical
209	209	services or telehealth services based on the professional
210	210	prescribing a particular controlled substance to a patient as a
211	211	telemedicine medical service or telehealth service;
212	212	(2) compensate a health professional who offers
213	213	telemedicine medical services or telehealth services based on the
214	214	number of prescriptions for controlled substances prescribed by the
215	215	professional to patients as telemedicine medical services or
216	216	telehealth services; or
217	217	(3) advertise that a health professional who offers
218	218	telemedicine medical services or telehealth services will:
219	219	(A) prescribe to a patient a particular
220	220	controlled substance as a telemedicine medical service or
221	221	telehealth service; or
222	222	(B) allow a patient to select a particular
223	223	controlled substance without the patient being examined and
224	224	diagnosed by the professional.
225	225	(b) A person who violates Subsection (a) is liable to this
226	226	state for a civil penalty in an amount of not less than $100,000 for
227	227	each violation. The attorney general may bring an action to collect
228	228	a civil penalty imposed under this subsection and, in the name of
229	229	this state, to enjoin a violation of Subsection (a). The attorney
230	230	general is entitled to recover reasonable expenses incurred in
231	231	bringing an action under this subsection, including reasonable
232	232	attorney's fees and court costs.
233	233	(c) Any person may bring a civil action against a person who
234	234	violates Subsection (a). If a claimant prevails in an action under
235	235	this subsection, the court shall award injunctive relief sufficient
236	236	to prevent the defendant from violating Subsection (a).
237	237	Sec. 111.012. PRESCRIPTION OF CONTROLLED SUBSTANCES. (a)
238	238	A health professional may not prescribe or provide a refill
239	239	prescription to a patient for a Schedule II controlled substance or
240	240	a narcotic drug, as defined by Section 481.002, Health and Safety
241	241	Code, listed as a Schedule III, IV, or V controlled substance as a
242	242	telemedicine medical service or telehealth service unless the
243	243	health professional has conducted an in-person examination of the
244	244	patient at least once in the 12-month period preceding the
245	245	prescription or refill prescription. This subsection does not
246	246	apply to the prescription of or refill of a prescription for
247	247	buprenorphine.
248	248	(b) A health professional may prescribe to a patient a
249	249	controlled substance listed in Schedule III, IV, or V, other than a
250	250	narcotic drug, as defined by Section 481.002, Health and Safety
251	251	Code, as a telemedicine medical service or telehealth service
252	252	without conducting an in-person examination of the patient. A
253	253	prescription under this subsection must be limited to an initial
254	254	30-day supply. It is considered unprofessional conduct by a health
255	255	professional who prescribes a controlled substance under this
256	256	subsection to enter into a business arrangement with an entity that
257	257	facilitates the prescribing of controlled substances to patients on
258	258	a month-by-month basis by using a different health professional
259	259	each month.
260	260	(c) A health professional may provide to a patient as a
261	261	telemedicine medical service or telehealth service a refill
262	262	prescription for a prescription that was initially prescribed under
263	263	Subsection (b) only if the health professional has conducted an
264	264	in-person examination of the patient at least once in the 12-month
265	265	period preceding the date of the refill prescription.
266	266	(d) Before a health professional prescribes a controlled
267	267	substance as described by Subsection (a) or (b), the health
268	268	professional must consult the appropriate prescription drug
269	269	monitoring program to ensure that:
270	270	(1) the patient has not been prescribed the controlled
271	271	substance within the 30-day period preceding the date the health
272	272	professional consults the monitoring program; and
273	273	(2) the prescription is appropriate for the patient.
274	274	Sec. 111.013. REPORT OF CONTROLLED SUBSTANCE PRESCRIBING
275	275	ACTIVITY. (a) On request of an agency with regulatory authority
276	276	over a health professional who prescribes a controlled substance as
277	277	a telemedicine medical service or telehealth service, or an entity
278	278	or group affiliated with the health professional, the health
279	279	professional or the entity or group shall submit to the agency a
280	280	report of the health professional's prescribing activity for review
281	281	by the agency to ensure that a proper practitioner-patient
282	282	relationship was established for each prescription and that the
283	283	health professional has complied with the standard of care. It is
284	284	considered unprofessional conduct for a health professional to fail
285	285	to timely submit a report requested by an agency under this
286	286	subsection. A health professional's violation of this subsection
287	287	is grounds for disciplinary action by an agency with regulatory
288	288	authority over the health professional.
289	289	(b) The attorney general may at any time, including during
290	290	the course of any investigation of a serious injury or death
291	291	reasonably attributed to a prescription drug, review a report
292	292	submitted to an agency in response to a request under Subsection (a)
293	293	to ensure compliance with all applicable laws and regulations.
294	294	(c) Each agency with regulatory authority over a health
295	295	professional authorized to prescribe a controlled substance shall
296	296	adopt rules to prescribe the contents of and establish procedures
297	297	for the submission of a report described by Subsection (a).
298	298	SECTION 11. Section 562.056(c), Occupations Code, is
299	299	amended to read as follows:
300	300	(c) For purposes of this section and Section 562.112, a
301	301	valid practitioner-patient relationship is present between a
302	302	practitioner providing telemedicine medical services, [or]
303	303	teledentistry dental services, or telehealth services and the
304	304	patient receiving the services if the practitioner has complied
305	305	with the requirements for establishing such a relationship in
306	306	accordance with Section 111.005.
307	307	SECTION 12. Section 111.010(b), Occupations Code, as added
308	308	by this Act, applies only to a contract entered into on or after the
309	309	effective date of this Act.
310	310	SECTION 13. This Act takes effect September 1, 2023.