SB 238-FN - AS AMENDED BY THE HOUSE
03/30/2023 0588s
03/30/2023 1254s
03/30/2023 1257s
18May2023... 1454h
2023 SESSION
23-0970
05/04
SENATE BILL 238-FN
AN ACT relative to prescribing opioids via telehealth medicine.
SPONSORS: Sen. Prentiss, Dist 5; Sen. Birdsell, Dist 19; Sen. Rosenwald, Dist 13; Sen. Altschiller, Dist 24; Sen. D'Allesandro, Dist 20; Sen. Perkins Kwoka, Dist 21; Sen. Whitley, Dist 15; Sen. Watters, Dist 4; Sen. Carson, Dist 14; Sen. Ricciardi, Dist 9; Rep. Merchant, Sull. 6; Rep. Palmer, Sull. 2; Rep. Morse, Graf. 9
COMMITTEE: Health and Human Services
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AMENDED ANALYSIS
This bill modifies the procedure for physicians, physician assistants and APRN's to prescribe certain non-opioid and opioid controlled drugs by means of 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/30/2023 0588s
03/30/2023 1254s
03/30/2023 1257s
18May2023... 1454h
23-0970
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to prescribing opioids via telehealth medicine.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Telemedicine; Out of State Physicians. Amend RSA 329:1-d, III 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. Methadone hydrochloride, as defined in RSA 318-B:10, VII(d)(2) shall not be included in the exemption.] A physician licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing a physician-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to a physician licensed under this chapter, or a physician assistant in accordance with RSA 328-D:3-b, and all prescribing shall be in compliance with all federal and state laws and regulations.
2 Definitions; Nursing; Telehealth. Amend RSA 326-B:2, I-a to read as follows:
I-a. "Advanced practice registered nurse-patient relationship" means a medical connection between a licensed APRN and a patient that includes an in-person or telemedicine [face-to-face 2-way real-time interactive communication] exam, a history, a diagnosis, a treatment plan appropriate for the licensee's medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have an APRN-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by another licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient's first appointment.
3 Definitions; Nursing; Telehealth. Amend RSA 326-B:2, XII(a)-(c) to read as follows:
XII(a). "Telemedicine" means [the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment] the use of audio, video, or other electronic media and technologies by a licensee in one location to a patient in a different location for the purpose of diagnosis, consultation, or treatment, including the use of synchronous or asynchronous interactions as defined in RSA 310-A:1.
(b) An out-of-state APRN providing services by means of telemedicine shall be deemed to be in the practice of medicine and shall be required to be licensed under this chapter.
(c) [It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV except for use in substance use disorder treatment.] An APRN licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing an advanced practice registered nurse-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to an APRN licensed under this chapter, and all prescribing shall be in compliance with all federal and state laws and regulations.
4 Repeal. RSA 329:1-d, IV, relative to the prescribing of non-opioid controlled drugs, is repealed.
5 Repeal. RSA 326-B:2, XII(d), relative to the prescribing of non-opioid controlled drugs, is repealed.
6 Effective Date. This act shall take effect upon its passage.
23-0970
Amended 4/21/23
SB 238-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENTS #2023-0588s, #2023-1254s, and #2023-1257s)
AN ACT relative to the use of telemedicine to treat mental health conditions.
FISCAL IMPACT: [ X ] State [ X ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill adds mental health conditions as a reason for which a medical professional may allowably prescribe a schedule II through IV controlled drug via telemedicine. In addition, the bill makes it a criminal offense to prescribe controlled drugs via telemedicine without first obtaining consent from the patient or the minor patient's parent or guardian. Theoretically, these changes may result in more or fewer criminal prosecutions, resulting in more or fewer misdemeanor penalties. Although there is no way to project the aggregate impact of the proposed changes, the individual costs associated with such penalties can be seen below.
Judicial Branch | FY 2023 | FY 2024 through 12/31/23 | FY 2024 (Starting 1/1/24 with repeal of Felonies First) | |||
Violation and Misdemeanor Level Offense | $119 | $122 | $122 | |||
Appeals | Varies | Varies | Varies | |||
Judicial Council | FY 2023 | FY 2024 | ||||
Public Defender Program | Has contract with State to provide services. | Has contract with State to provide services. | ||||
Contract Attorney – Misdemeanor | $300/Case $70 administrative fee $100 incarceration fee (If applicable) | $300/Case $70 administrative fee $100 incarceration fee (If applicable) | ||||
Assigned Counsel- Misdemeanor. Travel time to court does not count toward the cap. | $90/Hour up to $2,000 | $90/Hour up to $2,000 | ||||
Assigned Counsel - Supreme Court Appeal | $125/Hour up to $10,000 | $125/Hour up to $10,000 | ||||
It should be noted that a person needs to be found indigent and have the potential of being incarcerated to be eligible for indigent defense services. Historically, approximately 85% of the indigent defense caseload has been handled by the public defender program, with the remaining cases going to contract attorneys (14%) or assigned counsel (1%). Beginning in March of 2021, the public defender program has had to close intake of new cases due to excessive caseloads. Due to these closures, the contract and assigned counsel program have had to absorb significantly more cases. The system is experiencing significant delays in appointing counsel and the costs of representation have increased due to travel time and multiple appointments. | ||||||
NH Association of Counties | FY 2023 | FY 2024 | ||||
County Prosecution Costs | Indeterminable | Indeterminable | ||||
Estimated Average Daily Cost of Incarcerating an Individual | $105 to $125 | $105 to $125 | ||||
AGENCIES CONTACTED:
Judicial Branch, Judicial Council, New Hampshire Association of Counties, and Department of Health and Human Services
| Date | Amendment |
|---|---|
| Feb. 17, 2023 | 2023-0588s |
| March 30, 2023 | 2023-1254s |
| March 30, 2023 | 2023-1257s |
| May 4, 2023 | 2023-1454h |
| May 8, 2023 | 2023-1579h |
| Date | Body | Type |
|---|---|---|
| Feb. 15, 2023 | Senate | Hearing |
| Feb. 23, 2023 | Senate | Floor Vote |
| Feb. 22, 2023 | Senate | Floor Vote |
| Feb. 22, 2023 | Senate | Floor Vote |
| Feb. 22, 2023 | Senate | Floor Vote |
| March 9, 2023 | Senate | Floor Vote |
| Feb. 22, 2023 | Senate | Floor Vote |
| March 9, 2023 | Senate | Floor Vote |
| March 9, 2023 | Senate | Floor Vote |
| March 16, 2023 | Senate | Floor Vote |
| March 16, 2023 | Senate | Floor Vote |
| March 30, 2023 | Senate | Floor Vote |
| April 19, 2023 | House | Hearing |
| April 26, 2023 | House | Exec Session |
| April 26, 2023 | House | Floor Vote |
June 1, 2023: Sen. Birdsell Moved Nonconcur with the House Amendment, MA, VV; 06/01/2023; SJ 16
May 18, 2023: Ought to Pass with Amendment 2023-1454h: MA VV 05/18/2023 HJ 14 P. 5
May 18, 2023: Amendment # 2023-1454h: AA VV 05/18/2023 HJ 14 P. 5
May 8, 2023: Committee Report: Ought to Pass with Amendment # 2023-1454h (NT) 04/26/2023 (Vote 19-0; CC)
April 19, 2023: Executive Session: 04/26/2023 09:30 am LOB 205-207
April 12, 2023: Public Hearing: 04/19/2023 10:30 am LOB 201-203
April 7, 2023: Introduced (in recess of) 04/06/2023 and referred to Health, Human Services and Elderly Affairs
March 30, 2023: Ought to Pass with Amendments 2023-0588s, 2023-1254s, & 2023-1257s: Remainder of the Bill, RC 13Y-10N, MA; OT3rdg; 03/30/2023; SJ 12
March 30, 2023: Ought to Pass with Amendments 2023-0588s, 2023-1254s, & 2023-1257s: Sections 2, 4, 6, and 7, RC 23Y-0N, MA; 03/30/2023; SJ 12
March 30, 2023: The Chair ruled the Question Divisible; 03/30/2023; SJ 12
March 30, 2023: Sen. Soucy Moved to divide the Question on the motion of Ought to Pass as Amended: Sections 2, 4, 6, and 7 and then the remainder of the bill; 03/30/2023; SJ 12
March 30, 2023: Sen. Prentiss Floor Amendment # 2023-1257s, AA, VV; 03/30/2023; SJ 12
March 30, 2023: Sen. Carson Floor Amendment # 2023-1254s, Remainder of the Floor Amendment, RC 13Y-10N, AA; 03/30/2023; SJ 12
March 30, 2023: Sen. Carson Floor Amendment # 2023-1254s, Sections 2, 4, and 6, RC 23Y-0N, AA; 03/30/2023; SJ 12
March 30, 2023: The Chair ruled the Question Divisible; 03/30/2023; SJ 12
March 30, 2023: Sen. Soucy Moved to divide the Question on Floor Amendment #2023-1254s, Sections 2, 4, and 6 and then the remainder of the Floor Amendment; 03/30/2023; SJ 12
March 30, 2023: Sen. Carson Floor Amendment # 2023-1254s; 03/30/2023; SJ 12
March 30, 2023: Committee Amendment # 2023-0588s, AA, VV; 03/30/2023; SJ 12
March 16, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 03/30/2023; SC 15
March 16, 2023: Special Order to 03/30/2023, Without Objection, MA; 03/16/2023 SJ 10
March 9, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 03/16/2023; SC 13
March 9, 2023: Special Order to 03/16/2023, Without Objection, MA; 03/09/2023 SJ 9
Feb. 23, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 03/09/2023; SC 12
Feb. 22, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 03/09/2023; SC 12
Feb. 17, 2023: Special Order to 03/09/2023, Without Objection, MA; 02/22/2023 SC 12
Feb. 22, 2023: Special Order to 03/09/2023, Without Objection, MA; 02/22/2023 SJ 8
Feb. 22, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 02/22/2023; Vote 5-0; CC; SC 11
Feb. 22, 2023: Sen. Birdsell Moved to Remove SB 238 from the Consent Calendar; 02/22/2023; SJ 8
Feb. 17, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 02/22/2023; Vote 5-0; CC; SC 11
Feb. 22, 2023: Committee Report: Ought to Pass with Amendment # 2023-0588s, 02/22/2023; Vote 5-0; CC; SC 11
Feb. 22, 2023: Sen. Birdsell Moved to Remove SB 238 from the Consent Calendar; 02/22/2023; SJ 8
Feb. 8, 2023: Hearing: 02/15/2023, Room 101, LOB, 10:00 am; SC 10
Jan. 24, 2023: Introduced 01/19/2023 and Referred to Health and Human Services; SJ 5