| (a) Telemedicine medical services provided at an established
medical site may be used for all patient visits, including initial
evaluations to establish a defined physician-patient relationship
between a distant site provider and a patient.
(b) For new conditions, a patient site presenter must
be reasonably available onsite at the established medical site to
assist with the provision of care. It is at the discretion of the
distant site physician if a patient site presenter is necessary for
follow-up evaluation or treatment of a previously diagnosed condition.
(1) A distant site provider may delegate tasks and
activities to a patient site presenter during a patient encounter.
(2) A distant site provider delegating tasks to a patient
site presenter shall ensure that the patient site presenter to whom
delegation is made is properly supervised.
(c) If the only services provided are related to mental
health services, a patient site presenter is not required, except
in cases of behavioral emergencies, as defined by 25 TAC §415.253
(relating to Definitions).
(d) For the purposes of this chapter the following
shall be considered to be an established medical site:
(1) The patient's home, including a group or institutional
setting where the patient is a resident, if the medical services being
provided in this setting are limited to mental health services;
(2) For medical services, other than mental health
services, to be provided at the patient's home, including a group
or institutional setting where the patient is a resident, the following
requirements must be met:
(A) a patient site presenter is present;
(B) there is a defined physician-patient relationship
as set out in §174.8 of this title (relating to Evaluation and
Treatment of the Patient);
(C) the patient site presenter has sufficient communication
and remote medical diagnostic technology to allow the physician to
carry out an adequate physical examination appropriate for the patient's
presenting condition while seeing and hearing the patient in real
time. All such examinations will be held to the same standard of acceptable
medical practices as those in traditional clinical settings; and
(D) An online questionnaire or questions and answers
exchanged through email, electronic text, or chat or telephonic evaluation
of or consultation with a patient do not meet the requirements for
subparagraph (C) of this paragraph.
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