By: Campbell, Schwertner  S.B. No. 2527
         (In the Senate - Filed March 10, 2023; March 23, 2023, read
  first time and referred to Committee on Health & Human Services;
  April 25, 2023, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 6, Nays 0; April 25, 2023,
  sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 2527 By:  Perry
 
 
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(a), Occupations Code, is amended
  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)  is present at the initial appointment or
  meeting with the minor patient; and
                     (B)  consents to the treatment of the minor
  patient.
         SECTION 3.  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 4.  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 platform that:
                           (i)  allows the practitioner to comply with
  the standard of care described in Section 111.007; and
                           (ii)  complies with the privacy requirements
  of the Health Insurance Portability and Accountability Act of 1996
  (Pub. L. No. 104-191).
         (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 5.  Chapter 111, Occupations Code, is amended by
  adding Section 111.0055 to read as follows:
         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 6.  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 7.  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 8.  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 9.  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 any person
  who violates Subsection (a).  If a claimant prevails in an action
  brought under this subsection, the court shall award:
               (1)  injunctive relief sufficient to prevent the
  defendant from violating Subsection (a);
               (2)  statutory damages in an amount of not less than
  $100,000 for each violation of Subsection (a); and
               (3)  reasonable attorney's fees and court costs.
         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)  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 10.  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 11.  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 12.  This Act takes effect September 1, 2023.
 
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