|(a) The validity of a prescription issued as a result
of a telemedicine medical service is determined by the same standards
that would apply to the issuance of the prescription in an in-person
(b) This rule does not limit the professional judgment,
discretion or decision-making authority of a licensed practitioner.
A licensed practitioner is expected to meet the standard of care and
demonstrate professional practice standards and judgment, consistent
with all applicable statutes and rules when issuing, dispensing, delivering,
or administering a prescription medication as a result of a telemedicine
(c) A valid prescription must be:
(1) issued for a legitimate medical purpose by a practitioner
as part of patient-practitioner relationship as set out in §111.005,
Texas Occupations Code; and
(2) meet all other applicable laws before prescribing,
dispensing, delivering or administering a dangerous drug or controlled
(d) Any prescription drug orders issued as the result
of a telemedicine medical service, are subject to all regulations,
limitations, and prohibitions set out in the federal and Texas Controlled
Substances Act, Texas Dangerous Drug Act and any other applicable
federal and state law.
(e) Limitation on Treatment of Chronic Pain. Chronic
pain is a legitimate medical condition that needs to be treated, but
must be balanced with concerns over patient safety and the public
health crisis involving overdose deaths. The Legislature has already
put into place laws regarding the treatment of pain and requirements
for registration and inspection of pain management clinics. Therefore,
the Board has determined clear legislative intent exists for the limitation
of chronic pain treatment through a telemedicine medical service.
(1) For purposes of this rule, chronic pain has the
same definition as used in 22 Texas Administrative Code §170.2(4)
(relating to Definitions).
(A) Telemedicine medical services used for the treatment
of chronic pain with scheduled drugs by any means other than via audio
and video two-way communication is prohibited, unless a patient:
(i) is an established patient of the APRN being treated
for chronic pain;
(ii) is receiving a prescription that is identical
to a prescription issued at the previous visit; and
(iii) has been seen by the prescribing APRN, physician,
or other health professional as defined in Tex. Occ. Code §111.001(1)
in the last 90 days, either:
(I) in-person; or
(II) via telemedicine using audio and video two-way
(B) An APRN, when determining whether to utilize telemedicine
medical services for the treatment of chronic pain with controlled
substances as permitted by paragraph (1)(A) of this subsection, shall
give due consideration to factors that include, at a minimum, the
date of the patient's last in-person visit, patient co-morbidities,
and occupational related COVID risks. These are not the sole, exclusive,
or exhaustive factors an APRN should consider under this rule.
(C) If a patient is treated for chronic pain with scheduled
drugs through the use of telemedicine medical services as permitted
by paragraph (1)(A) of this subsection, the medical records must document
the exception and the reason that a telemedicine visit was conducted
instead of an in-person visit.
(2) For purposes of this rule, acute pain has the same
definition as used in 22 Texas Administrative Code §170.2(2).
Telemedicine medical services may be used for the treatment of acute
pain with scheduled drugs, unless otherwise prohibited under federal
and state law.