Revision: Dec. 6, 2019, 12:38 p.m.
HB 1623-FN - AS INTRODUCED
2020 SESSION
20-2023
01/05
HOUSE BILL 1623-FN
AN ACT relative to telemedicine and substance use disorder.
SPONSORS: Rep. Marsh, Carr. 8; Rep. Allard, Merr. 21; Rep. MacDonald, Carr. 6; Rep. Edwards, Rock. 4; Rep. Baldasaro, Rock. 5; Rep. M. Pearson, Rock. 34; Rep. Snow, Hills. 19; Rep. Crawford, Carr. 4; Rep. Schapiro, Ches. 16; Sen. Bradley, Dist 3; Sen. Kahn, Dist 10
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill clarifies prescribing certain drugs via telemedicine.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
20-2023
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
AN ACT relative to telemedicine and substance use disorder.
Be it Enacted by the Senate and House of Representatives in General Court convened:
I. The general court hereby recognizes that:
(a) Recent court decisions (Smith v. Aroostook County, No. 19-1340 (1st Cir. 2019)) require the increased availability of substance use treatment in correctional facilities;
(b) Recent medical research indicates this can be safely done utilizing telemedicine (Rubin R. Using Telemedicine to Treat Opioid Use Disorder in Rural Areas. JAMA. Published online August 28, 2019); and
(c) Recent changes in federal law allow the registration of certain individuals to prescribe opioid drugs to be used in substance use disorder without first conducting an in person examination (21 U.S.C. section 831(h) and 21 U.S.C. section (e)).
II. Therfore, the general court hereby enacts the following legislation.
2 Medicaid Coverage of Telehealth Services. Amend RSA 167:4-d, III(a)(2) to read as follows:
(2) By which telemedicine services for primary care, remote patient monitoring, and substance use disorder services shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service, provided that a physician or health care provider holding a special registration pursuant to 21 U.S.C. section 831(h), or a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration, shall not be required to have established care via face-to-face in-person service; and
3 Controlled Drug Act; Prohibited Acts. Amend RSA 318-B:2, XVI to read as follows:
XVI.(a) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care, or who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, [and], or in a correctional facility administered by either the state of New Hampshire or one of its counties. Unless the prescriber holds a special registration for telemedicine pursuant to 21 U.S.C. section 831(h), or is exempt from having to obtain a special registration, this shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Unless not required due to special registration, subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.
(b) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA-certified state opioid treatment program, or in a correctional facility administered by either the state of New Hampshire or one of its counties. Unless the prescriber holds a special registration for telemedicine pursuant to 21 U.S.C. section 831(h), or is exempt from having to obtain a special registration, such prescription [authority] shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
4 New Paragraph; Nurse Practice Act; Rulemaking Added. Amend RSA 326-B:9 by inserting after paragraph XII the following new paragraph:
XIII. A process for registering practitioners who have been granted a special registration to prescribe controlled substances via telemedicine pursuant to 21 U.S.C. section 831(h).
5 Physicians and Surgeons; Telemedicine. Amend RSA 329:1-d, III and IV to read as follows:
III. It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV, except as permitted in paragraph IV.
IV.(a) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care, or who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, [and], or in a correctional facility administered by either the state of New Hampshire or one of its counties. Unless the prescriber holds a special registration for telemedicine pursuant to 21 U.S.C. section 831(h), or is exempt from having to obtain a special registration, this shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Unless not required due to special registration, subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.
(b) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA-certified state opioid treatment program, or in a correctional facility administered by either the state of New Hampshire or one of its counties. Unless the prescriber holds a special registration for telemedicine pursuant to 21 U.S.C. section 831(h), or is exempt from having to obtain a special registration, such prescription [authority] shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
6 New Paragraph; Physicians and Surgeons; Rulemaking. Amend RSA 329:9 by inserting after paragraph XX the following new paragraph:
XXI. A process for registering practitioners who have been granted a special registration to prescribe controlled substances via telemedicine pursuant to 21 U.S.C. section 831(h).
7 Effective Date. This act shall take effect 60 days after its passage.
20-2023
12/6/19
HB 1623-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to telemedicine and substance use disorder.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Federal Medicaid Funds | |||
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METHODOLOGY:
This bill amends Medicaid coverage of telehealth coverage by removing the prerequisite to establish care via face-to-face contact, provided the physician or other health care provider holds a special registration pursuant to 21 U.SC. section 831(h), or is exempt from such registration. The Department of Health and Human Services anticipates that while telehealth services are already covered under Medicaid, the bill may result in increased utilization and hence increased costs. Nonetheless, the Department expects the extent of any such increase to be minimal.
The Department of Corrections indicated this bill will have no fiscal impact on the Department.
AGENCIES CONTACTED:
Departments of Corrections and Health and Human Services