Texas Register

TITLE 22 EXAMINING BOARDS
PART 9TEXAS MEDICAL BOARD
CHAPTER 174TELEMEDICINE AND MENTAL HEALTH SERVICES
SUBCHAPTER ATELEMEDICINE
RULE §174.6Minimum Standards for the Provision of Telemedicine Medical Services [Provided at an Established Medical Site]
ISSUE 09/15/2017
ACTION Proposed
Preamble Texas Admin Code Rule

(a)A health professional providing a health care service or procedure as a telemedicine medical service:

  (1) is subject to the same standard of care that would apply to the provision of the same health care service or procedures in an in person setting;

  (2)must establish a practitioner-patient relationship; and

  (3)must maintain complete and accurate medical records as set out in §165.1 of this title (relating to Medical Records).

(b)Adequate measures must be implemented to ensure that patient communications, recordings and records are protected consistent with Federal and State privacy laws.

[(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.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 1, 2017

TRD-201703487

Mari Robinson, J.D.

Executive Director

Texas Medical Board

Earliest possible date of adoption: October 15, 2017

For further information, please call: (512) 305-7016



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