By: Campbell, Schwertner S.B. No. 2527
A BILL TO BE ENTITLED
AN ACT
relating to the regulation of telemedicine medical services,
teledentistry services, and telehealth services; providing a civil
penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 111.001, Occupations Code, is amended by
amending Subdivision (1) and adding Subdivision (1-a) to read as
follows:
(1) "Controlled substance" has the meaning assigned by
Section 481.002, Health and Safety Code.
(1-a) "Dentist," "health professional," and
"physician" have the meanings assigned by Section 1455.001,
Insurance Code.
SECTION 2. Section 111.002, Occupations Code, is amended by
amending Subsection (a) and adding Subsection (a-1) to read as
follows:
(a) A treating physician, dentist, or health professional
who provides or facilitates the use of telemedicine medical
services, teledentistry dental services, or telehealth services
shall:
(1) ensure that the informed consent of the patient,
or another appropriate individual authorized to make health care
treatment decisions for the patient, is obtained before
telemedicine medical services, teledentistry dental services, or
telehealth services are provided; and
(2) with respect to health care treatment for a
patient who is a minor, develop and implement protocols requiring
that an individual authorized to make health care treatment
decisions for the minor patient:
(A) subject to Paragraph (B), is given notice of
and the opportunity to attend the initial appointment or meeting
with the minor patient;
(B) if the treatment includes the prescription of
a controlled substance, is present at the initial appointment or
meeting with the minor patient; and
(C) consents to the treatment of the minor
patient.
(a-1) Subsection (a)(2) does not apply with respect to the
provision of treatment or counseling to a patient who is a child in
accordance with Section 32.003 or 32.004, Family Code, as
applicable.
SECTION 3. Chapter 111, Occupations Code, is amended by
adding Section 111.0025 to read as follows:
Sec. 111.0025. SCOPE OF PRACTICE NOT EXPANDED. (a) A
health professional who provides telemedicine medical services or
telehealth services to a patient as described by Section
111.005(a)(3) may provide only services within the health
professional's scope of practice.
(b) This chapter does not change the scope of practice of
any profession.
SECTION 4. The heading to Section 111.005, Occupations
Code, is amended to read as follows:
Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
TELEMEDICINE MEDICAL SERVICES, [OR] TELEDENTISTRY DENTAL SERVICES,
OR TELEHEALTH SERVICES.
SECTION 5. Sections 111.005(a) and (b), Occupations Code,
are amended to read as follows:
(a) For purposes of Section 562.056, a valid
practitioner-patient relationship is present between a
practitioner providing a telemedicine medical service, [or a]
teledentistry dental service, or telehealth service and a patient
receiving the service as long as the practitioner complies with the
standard of care described in Section 111.007 and the practitioner:
(1) has a preexisting practitioner-patient
relationship with the patient established in accordance with rules
adopted under Section 111.006;
(2) communicates, regardless of the method of
communication, with the patient pursuant to a call coverage
agreement established in accordance with:
(A) Texas Medical Board rules with a physician
requesting coverage of medical care for the patient; or
(B) State Board of Dental Examiners rules with a
dentist requesting coverage of dental care for the patient; or
(3) provides the telemedicine medical services, [or]
teledentistry dental services, or telehealth services through the
use of one of the following methods, as long as the practitioner
complies with the follow-up requirements in Subsection (b), and the
method allows the practitioner to have access to, and the
practitioner uses, the relevant clinical information that would be
required in accordance with the standard of care described in
Section 111.007:
(A) synchronous audiovisual interaction between
the practitioner and the patient in another location;
(B) asynchronous store and forward technology,
including asynchronous store and forward technology in conjunction
with synchronous audio interaction between the practitioner and the
patient in another location, as long as the practitioner uses
clinical information from:
(i) clinically relevant photographic or
video images, including diagnostic images; or
(ii) the patient's relevant clinical
records, such as the relevant medical or dental history, laboratory
and pathology results, and prescriptive histories; or
(C) another form of audiovisual
telecommunication technology that allows the practitioner to
comply with the standard of care described in Section 111.007.
(b) A practitioner who provides telemedicine medical
services or telehealth services to a patient as described by [in]
Subsection (a)(3) shall:
(1) provide the patient with guidance on appropriate
follow-up care; and
(2) at the request of the patient [if the patient
consents and the patient has a primary care physician], provide to
the patient's primary care physician not later than [within] 72
hours after the patient's request [practitioner provides the
services to the patient] a medical record or other report
containing an explanation of the treatment provided by the
practitioner to the patient and the practitioner's evaluation,
analysis, or diagnosis, as appropriate, of the patient's condition.
SECTION 6. Chapter 111, Occupations Code, is amended by
adding Sections 111.0052 and 111.0055 to read as follows:
Sec. 111.0052. RECORDS OF CERTAIN TELEMEDICINE MEDICAL
SERVICES AND TELEHEALTH SERVICES. (a) A health professional who
provides telemedicine medical services or telehealth services to a
patient as described by Section 111.005(a)(3) shall:
(1) maintain a record of each telemedicine medical
service or telehealth service provided to a patient by the health
professional until the seventh anniversary of the date the service
is provided; and
(2) produce a record described by Subdivision (1) on
request of the state licensing agency with regulatory authority
over the health professional that is conducting a regulatory
investigation or disciplinary action.
(b) A health professional may designate as custodian of
records described by Subsection (a)(1) a designated agent in this
state for any business entity through which the professional
provided telemedicine medical services or telehealth services to
the patient. A health professional who designates a custodian
under this subsection may maintain a complete copy of the records of
each of the patients to whom the professional provides telemedicine
medical services or telehealth services as described by Section
111.005(a)(3).
Sec. 111.0055. EMERGENCY PROCEDURES. (a) A health
professional who provides telemedicine medical services or
telehealth services to a patient as described by Section
111.005(a)(3) shall develop and implement emergency protocols that
are appropriate to the standard of care that applies to the
services. The emergency protocols must be in writing and include
procedures for making a good faith effort to:
(1) determine the patient's location if the patient is
unable to provide the location to the health professional; and
(2) provide the name, location, and contact
information of the patient to emergency services in oral, written,
or digital form.
(b) If an emergency arises while a health professional is
providing telemedicine medical services or telehealth services to a
patient as described by Section 111.005(a)(3), the professional
shall make a good faith effort to:
(1) directly contact and coordinate with emergency
services located near the patient's location; and
(2) if the emergency arises while the health
professional is connected to the patient by a synchronous
technology, remain connected to the patient until emergency
services have reached the patient's location or the emergency is
resolved.
SECTION 7. Section 111.008, Occupations Code, is amended to
read as follows:
Sec. 111.008. APPLICATION OF CHAPTER TO MENTAL HEALTH
SERVICES [EXCLUDED]. This chapter applies [does not apply] to
mental health services.
SECTION 8. The heading to Section 111.009, Occupations
Code, is amended to read as follows:
Sec. 111.009. LIMITATION ON CERTAIN PRESCRIPTIONS AS
TELEDENTISTRY SERVICES.
SECTION 9. Section 111.009(a), Occupations Code, is amended
to read as follows:
(a) In this section:
(1) "National holiday" means a day described by
Section 662.003(a), Government Code.
(2) "Opiate" ["Controlled substance," "opiate,"] and
"prescribe" have the meanings assigned by Section 481.002, Health
and Safety Code.
[(2) "National holiday" means a day described by
Section 662.003(a), Government Code.]
SECTION 10. Chapter 111, Occupations Code, is amended by
adding Sections 111.010, 111.011, 111.012, and 111.013 to read as
follows:
Sec. 111.010. LIMITATION ON CERTAIN PRESCRIPTIONS AS
TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES. (a) A
health professional who provides telemedicine medical services or
telehealth services to a patient may not allow a patient to select a
particular controlled substance unless the patient has been
examined and diagnosed by the professional.
(b) A health professional who offers telemedicine medical
services or telehealth services may not enter into a contract that:
(1) provides a financial or other incentive to the
health professional based on the professional prescribing a
particular controlled substance to a patient as a telemedicine
medical service or telehealth service;
(2) compensates the health professional based on the
number of prescriptions for controlled substances prescribed to
patients as telemedicine medical services or telehealth services;
or
(3) requires that the health professional prescribe a
certain number of controlled substance prescriptions to patients as
telemedicine medical services or telehealth services.
(c) A violation of this section is grounds for disciplinary
action against the health professional by the agency with
regulatory authority over the professional.
Sec. 111.011. ADDITIONAL REGULATION OF CERTAIN
PRESCRIPTIONS AS TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
SERVICES; ENFORCEMENT. (a) A person may not:
(1) advertise, offer, or award a financial or other
incentive to a health professional who offers telemedicine medical
services or telehealth services based on the professional
prescribing a particular controlled substance to a patient as a
telemedicine medical service or telehealth service;
(2) compensate a health professional who offers
telemedicine medical services or telehealth services based on the
number of prescriptions for controlled substances prescribed by the
professional to patients as telemedicine medical services or
telehealth services; or
(3) advertise that a health professional who offers
telemedicine medical services or telehealth services will:
(A) prescribe to a patient a particular
controlled substance as a telemedicine medical service or
telehealth service; or
(B) allow a patient to select a particular
controlled substance without the patient being examined and
diagnosed by the professional.
(b) A person who violates Subsection (a) is liable to this
state for a civil penalty in an amount of not less than $100,000 for
each violation. The attorney general may bring an action to collect
a civil penalty imposed under this subsection and, in the name of
this state, to enjoin a violation of Subsection (a). The attorney
general is entitled to recover reasonable expenses incurred in
bringing an action under this subsection, including reasonable
attorney's fees and court costs.
(c) Any person may bring a civil action against a person who
violates Subsection (a). If a claimant prevails in an action under
this subsection, the court shall award injunctive relief sufficient
to prevent the defendant from violating Subsection (a).
Sec. 111.012. PRESCRIPTION OF CONTROLLED SUBSTANCES. (a)
A health professional may not prescribe or provide a refill
prescription to a patient for a Schedule II controlled substance or
a narcotic drug, as defined by Section 481.002, Health and Safety
Code, listed as a Schedule III, IV, or V controlled substance as a
telemedicine medical service or telehealth service unless the
health professional has conducted an in-person examination of the
patient at least once in the 12-month period preceding the
prescription or refill prescription. This subsection does not
apply to the prescription of or refill of a prescription for
buprenorphine.
(b) A health professional may prescribe to a patient a
controlled substance listed in Schedule III, IV, or V, other than a
narcotic drug, as defined by Section 481.002, Health and Safety
Code, as a telemedicine medical service or telehealth service
without conducting an in-person examination of the patient. A
prescription under this subsection must be limited to an initial
30-day supply. It is considered unprofessional conduct by a health
professional who prescribes a controlled substance under this
subsection to enter into a business arrangement with an entity that
facilitates the prescribing of controlled substances to patients on
a month-by-month basis by using a different health professional
each month.
(c) A health professional may provide to a patient as a
telemedicine medical service or telehealth service a refill
prescription for a prescription that was initially prescribed under
Subsection (b) only if the health professional has conducted an
in-person examination of the patient at least once in the 12-month
period preceding the date of the refill prescription.
(d) Before a health professional prescribes a controlled
substance as described by Subsection (a) or (b), the health
professional must consult the appropriate prescription drug
monitoring program to ensure that:
(1) the patient has not been prescribed the controlled
substance within the 30-day period preceding the date the health
professional consults the monitoring program; and
(2) the prescription is appropriate for the patient.
Sec. 111.013. REPORT OF CONTROLLED SUBSTANCE PRESCRIBING
ACTIVITY. (a) On request of an agency with regulatory authority
over a health professional who prescribes a controlled substance as
a telemedicine medical service or telehealth service, or an entity
or group affiliated with the health professional, the health
professional or the entity or group shall submit to the agency a
report of the health professional's prescribing activity for review
by the agency to ensure that a proper practitioner-patient
relationship was established for each prescription and that the
health professional has complied with the standard of care. It is
considered unprofessional conduct for a health professional to fail
to timely submit a report requested by an agency under this
subsection. A health professional's violation of this subsection
is grounds for disciplinary action by an agency with regulatory
authority over the health professional.
(b) The attorney general may at any time, including during
the course of any investigation of a serious injury or death
reasonably attributed to a prescription drug, review a report
submitted to an agency in response to a request under Subsection (a)
to ensure compliance with all applicable laws and regulations.
(c) Each agency with regulatory authority over a health
professional authorized to prescribe a controlled substance shall
adopt rules to prescribe the contents of and establish procedures
for the submission of a report described by Subsection (a).
SECTION 11. Section 562.056(c), Occupations Code, is
amended to read as follows:
(c) For purposes of this section and Section 562.112, a
valid practitioner-patient relationship is present between a
practitioner providing telemedicine medical services, [or]
teledentistry dental services, or telehealth services and the
patient receiving the services if the practitioner has complied
with the requirements for establishing such a relationship in
accordance with Section 111.005.
SECTION 12. Section 111.010(b), Occupations Code, as added
by this Act, applies only to a contract entered into on or after the
effective date of this Act.
SECTION 13. This Act takes effect September 1, 2023.