Revision: May 8, 2023, 11:01 a.m.
Rep. Cushman, Hills. 28
Rep. Layon, Rock. 13
May 1, 2023
2023-1579h
05/07
Floor Amendment to SB 238-FN
Amend the title of the bill by replacing it with the following:
AN ACT relative to prescribing opioids via telehealth medicine.
Amend the bill by replacing all after the enacting clause with the following:
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 Physicians and Surgeons; Telemedicine. Amend RSA 329:1-d, V to read as follows:
V. A physician providing services by means of telemedicine directly to a patient shall:
(a) Use the same standard of care as used in an in-person encounter;
(b) Maintain a medical record; [and]
(c) Subject to the patient's consent, forward the medical record to the patient's primary care or treating provider, if appropriate; and
(d) Obtain oral or written consent from the patient or, if the patient is a minor, from the patient’s parent or guardian unless state or federal law allows a minor to consent to treatment without the consent of a parent or guardian, for the provision of services through telemedicine.
3 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 [face-to-face 2-way real-time interactive communication] telemedicine 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.
4 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.
(d)(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). 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.
(2) 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). 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.
(e) An APRN providing services by means of telemedicine directly to a patient shall:
(1) Use the same standard of care as used in an in-person encounter;
(2) Maintain a medical record; [and]
(3) Subject to the patient's consent, forward the medical record to the patient's primary care or treating provider, if appropriate; and
(4) Obtain oral or written consent from the patient or, if the patient is a minor, from the patient’s parent or guardian unless state or federal law allows a minor to consent to treatment without the consent of a parent or guardian, for the provision of services through telemedicine.
(f) Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.
5 Repeal. The following are repealed:
I. RSA 329:1-d, IV, relative to the prescribing of non-opioid controlled drugs by doctors through telemedicine.
II. RSA 326-B:2, XII(d), relative to the prescribing of non-opioid controlled drugs by nurses through telemedicine.
6 Effective Date. This act shall take effect upon its passage.
2023-1579h
AMENDED ANALYSIS
This bill modifies the procedure for physicians, physician assistants and APRNs to prescribe certain non-opioid and opioid controlled drugs by means of telemedicine. The bill also clarifies the parental consent required to prescribe such drugs to minors.