One of the most important healthcare bills to come out of the 85th regular Texas legislative session is Senate Bill 1107. This bill, which has been signed by Governor Abbott, resets the playing field for telemedicine and brings Texas law more in line with other states.
Previously, the scope of telemedicine in Texas had been restricted by statutes and Texas Medical Board rules which required a practitioner who wanted to treat a patient via telemedicine to first establish a valid practitioner-patient relationship through a face-to-face encounter. There were provisions allowing a practitioner to avoid an initial face-to-face meeting through the use of a presenter who was onsite with the patient, however, in practice this exemption was unwieldy at best and an insurmountable barrier for many telemedicine providers. These restrictions were contentious and the source of repeated litigation, most notably the series of successful state and federal lawsuits filed by Teladoc against the Texas Medical Board.
Senate Bill 1107 bars the Texas Medical Board and other state agencies from requiring a face-to-face encounter in order to establish a valid practitioner-patient relationship. Instead, it provides a valid practitioner-patient relationship exists if:
· The practitioner has a preexisting practitioner-patient relationship;
· The practitioner is communicating with the patient pursuant to a call coverage agreement; or
· The practitioner provides telemedicine services through one of the acceptable methods set out elsewhere in the bill.
To be acceptable, a practitioner treating a patient through telemedicine must have access to “relevant clinical information,” such as relevant medical records or test results, and must send the patient’s primary care provider a report on the encounter within seventy-two hours. The law also makes clear the same standard of care applies to a telemedicine encounter as it would to a traditional face-to-face visit. Conversely, state agencies cannot adopt rules creating a higher standard of care for telemedicine.
One of main limitations of the prior law were the restrictions on a practitioner’s ability to prescribe medications through telemedicine. The new law directs the Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board, and Texas State Board of Pharmacy to jointly adopt rules on what constitutes a valid prescription in the context of telemedicine. Importantly, it also ties these agencies hands by stating such rules must still permit the establishment of a valid practitioner-patient relationship as provided by the rest of the bill. It is still to be seen how this is implemented by the Medical Board and other agencies and whether the forthcoming rules will create unnecessary burdens to prescribing through telemedicine.
With twenty-eight million residents, many of which are in rural communities far from specialist or even regular primary care, Texas has always been a promising environment for telemedicine. Senate Bill 1007 should go a long way to opening Texas to telemedicine and its touted benefits of greater access to care and lower costs. Still, practitioners should remain aware the full landscape for telemedicine in Texas will not become apparent until the Texas Medical Board and other state agencies adopt rules outlining specific requirements, particularly on prescribing. Additionally, federal law, such as the Ryan-Haight Act, can apply as can another state’s law if the telemedicine encounter is occurring across state lines. Speaking with experienced legal counsel from early date is always prudent.