SB647 (2020) Detail

(New Title) relative to telemedicine and substance use disorder.


SB 647-FN - AS AMENDED BY THE SENATE

 

02/13/2020   0609s

2020 SESSION

20-3085

01/05

 

SENATE BILL 647-FN

 

AN ACT relative to telemedicine and substance use disorder.

 

SPONSORS: Sen. Kahn, Dist 10; Sen. Fuller Clark, Dist 21; Sen. Gray, Dist 6; Sen. Bradley, Dist 3; Sen. Sherman, Dist 24; Rep. Edwards, Rock. 4; Rep. Campion, Graf. 12; Rep. Marsh, Carr. 8; Rep. Long, Hills. 10

 

COMMITTEE: Health and Human Services

 

─────────────────────────────────────────────────────────────────

 

AMENDED ANALYSIS

 

This bill clarifies prescribing certain drugs via telemedicine.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

02/13/2020   0609s 20-3085

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:

 

1  Statement of Intent.

I.  The general court hereby recognizes that:

(a)  Recent medical research indicates that substance use treatment 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

(b)  Recent court decisions (Smith v. Aroostook County, No. 19-1340 (1st Cir. 2019)) require the increased availability of substance use treatment in correctional facilities; 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)), which registration regulations are pending.

II.  Therefore, the general court hereby enacts the following legislation.

2  Medicaid Coverage of Telehealth Services.  Amend RSA 167:4-d, II(c)-(e) to read as follows:

(c)  "Doorways" means the statewide points of entry for the delivery of substance use services.

(d)  "Originating site" means the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including, but not limited to, a health care provider's office, a hospital, or a health care facility, or the patient's home or another nonmedical environment such as a school-based health center, a university-based health center, or the patient's workplace.

[(d)] (e) "Remote patient monitoring" means the use of electronic technology to remotely monitor a patient's health status through the collection and interpretation of clinical data while the patient remains at an originating site.  Remote patient monitoring may or may not take place in real time.  Remote patient monitoring shall include assessment, observation, education and virtual visits provided by all covered providers including licensed home health care providers.

[(e)] (f) "Store and forward," as it pertains to telemedicine and as an exception to 42 C.F.R. section 410.78, means the use of asynchronous electronic communications between a patient at an originating site and a health care service provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients.  This includes the forwarding and/or transfer of stored medical data from the originating site to the distant site through the use of any electronic device that records data in its own storage and forwards its data to the distant site via telecommunication for the purpose of diagnostic and therapeutic assistance.

3  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.  A provider shall not be required to establish care via face-to-face in-person service when:

(A)  The provider is a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);

(B)  The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;

(C)  The patient is being treated by, and is physically located in a doorway as defined in RSA 167:4-d, II(c);

(D)  The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or

(E)  The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f); and

4  New Paragraph; Medicaid Coverage of Telehealth Services.  Amend RSA 167:4-d by inserting after paragraph V the following new paragraph:

VI.  With written consent of the patient receiving medication assisted treatment through telehealth services provided under this section, the health care provider shall provide notification of the patient’s medication assisted treatment to the doorway, as defined in RSA 167:4-d, II(c), within the region where the patient resides.

5  Controlled Drug Act; Prohibited Acts.  Amend RSA 318-B:2, XVI to read as follows:

XVI.(a)(1) 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 shall require an initial in-person exam by a practitioner licensed to prescribe the drug].  A provider shall not be required to establish care via face-to-face in-person service when:

(A)  The provider is a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);

(B)  The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;

(C)  The patient is being treated by, and is physically located in a doorway as defined in RSA 167:4-d, II(c);

(D)  The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or

(E)  The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).

(2)  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)(1) 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.  Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and].  A provider shall not be required to establish care via face-to-face in-person service when:

(A)  The provider is a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);

(B)  The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;

(C)  The patient is being treated by, and is physically located in a Doorway as defined in RSA 167:4-d, II(c);

(D)  The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or

(E)  The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).  

(2)  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; 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).

7  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 substance use disorder (SUD) treatment as permitted in locations enumerated in paragraph IV.  Methadone hydrochloride, as defined in RSA 318-B:10, VII(d)(2) shall not be included in the exemption.

IV.(a)(1) 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 shall require an initial in-person exam by a practitioner licensed to prescribe the drug].  A provider shall not be required to establish care via face-to-face in-person service when:

(A)  The provider is a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);

(B)  The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;

(C)  The patient is being treated by, and is physically located in a Doorway as defined in RSA 167:4-d, II(c);

(D)  The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or

(E)  The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).  

(2)  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)(1) 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.  Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and].  A provider shall not be required to establish care via face-to-face in-person service when:

(A)  The provider is a Department of Veterans Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);

(B)  The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;

(C)  The patient is being treated by, and is physically located in a Doorway as defined in RSA 167:4-d, II(c);

(D)  The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or

(E)  The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).  

(2)  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.

8  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).

9  Contingency.  If HB 1623-FN of the 2020 regular legislative session becomes law, sections 1-8 of this act shall not take effect.  If HB 1623-FN does not become law, then sections 1-8 of this act shall take effect upon its passage.

10  Effective Date.

I.  Sections 1-8 of this act shall take effect as provided in section 9 of this act.

II.  The remainder of this act shall take effect upon its passage.

 

LBAO

20-3085

Amended 3/4/20

 

SB 647-FN- FISCAL NOTE

AS AMENDED BY THE SENATE (AMENDMENT #2020-0609s)

 

AN ACT relative to telemedicine and substance use disorder.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal matching funds.

 

 

 

 

 

METHODOLOGY:

This bill amends RSA 167:4-d by (1) adding a definition of "doorways" within the context of Medicaid coverage of telehealth services, and (2) requiring that notification of medication assisted treatment (MAT) via telehealth services be provided by a health care provider to the appropriate regional doorway, when a patient has consented to such.  In addition, the bill amends RSA 329:1-d to (1) allow for the prescription of controlled drugs classified in schedule II-IV for the purposes of MAT for substance use treatment, and (2) remove references to prescribers treating patients at state-designated community mental health centers or state opioid treatment programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).  The Department of Health and Human Services expects that the proposed changes may increase utilization for telemedicine services, resulting in a potential increase in state Medicaid costs.  However, the Department also expects the changes to result in an indeterminable long-term cost savings as a result of individuals receiving MAT for substance use treatment.  The net result is an indeterminable impact on state expenditures.   

 

AGENCIES CONTACTED:

Department of Health and Human Services

 

Links

SB647 at GenCourtMobile
SB647 Discussion

Action Dates

Date Body Type
Jan. 28, 2020 Senate Hearing
Feb. 13, 2020 Senate Floor Vote
March 17, 2020 House Hearing
March 19, 2020 House Exec Session

Bill Text Revisions

SB647 Revision: 8127 Date: March 9, 2020, 1:39 p.m.
SB647 Revision: 7960 Date: Jan. 14, 2020, 12:45 p.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and Referred to Health and Human Services; SJ 2
Jan. 28, 2020 Hearing: 01/28/2020, Room 101, LOB, 02:40 pm; SC 4
Feb. 13, 2020 Committee Report: Ought to Pass with Amendment # 2020-0609s, 02/13/2020; SC 6A
Feb. 13, 2020 Committee Amendment # 2020-0609s, AA, VV; 02/13/2020; SJ 4
Feb. 13, 2020 Ought to Pass with Amendment 2020-0609s, MA, VV; OT3rdg; 02/13/2020; SJ 4
Feb. 20, 2020 Introduced 02/20/2020 and referred to Health, Human Services and Elderly Affairs
March 17, 2020 ==CANCELLED== Public Hearing: 03/17/2020 02:30 pm LOB 205
March 18, 2020 ==CANCELLED== Subcommittee Work Session: 03/18/2020 11:00 am LOB 104
March 19, 2020 ==CANCELLED== Executive Session: 03/19/2020 10:00 am LOB 205