(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
setting.
(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
medical service.
(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,
of Texas Occupations Code; and
(2)meet all other applicable laws before prescribing,
dispensing, delivering or administering a dangerous drug or controlled
substance.
(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)Treatment for Chronic Pain. For purposes
of this rule, chronic pain has the same definition as used in §170.2(4)
of this title (relating to Definitions).
(A)Treatment of chronic pain with
scheduled drugs through use of telemedicine medical services is prohibited,
unless:
(i)a patient is an established chronic pain patient
of the physician and is seeking telephone refill of an existing prescription,
and the physician determines that such telemedicine treatment is needed
due to the COVID-19 pandemic; or
(ii)the treatment is otherwise allowed under federal
and state law.
(B)If a patient is treated for chronic
pain with scheduled drugs through the use of telemedicine medical
services as permitted by subsection (A)(i) or (ii), the patient's
medical records must document the exception and the reason that a
telemedicine visit was conducted instead of an in-person visit.
(C)A physician, when determining
whether to utilize telemedicine medical services for the treatment
of chronic pain with scheduled drugs as permitted by subsection (A)(i)
or (ii), shall give due consideration to factors that include: 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 a physician should consider under this rule.
(D)The emergency amendment of this
rule effective June 5, 2020 shall be in effect for only 30 days or
the duration of the time period that the Governor's disaster declaration
of March 13, 2020 in response to the COVID-19 pandemic is in effect,
whichever is shorter.
(2)Treatment for Acute Pain. For purposes
of this rule, acute pain has the same definition as used in §170.2(2)
of this title. Treatment of acute pain with scheduled drugs through
use of telemedicine medical services is allowed, unless otherwise
prohibited under federal and state law.
[(A)Treatment of chronic pain with
scheduled drugs through use of telemedicine medical services is prohibited,
unless otherwise allowed under federal and state law.]
[(B)Treatment of acute pain with
scheduled drugs through use of telemedicine medical services is allowed,
unless otherwise prohibited under federal and state law.]
The agency certifies that legal counsel
has reviewed the emergency adoption and found it to be within the
state agency's legal authority to adopt.
Filed with the Office
of the Secretary of
State on June 5, 2020
TRD-202002297 Scott Freshour
General Counsel
Texas Medical Board
Effective date: June 5, 2020
Expiration date: July 4, 2020
For further information, please call: (512) 305-7016
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