(a) - (d)(No change.)
(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 of chronic pain with scheduled drugs
through use of telemedicine medical services is prohibited, unless
otherwise allowed under federal and state law. For purposes of this
section, "chronic pain" means a state in which pain persists beyond
the usual course of an acute disease or healing of an injury. Chronic
pain may be associated with a chronic pathological process that causes
continuous or intermittent pain over months or years.
(A)Notwithstanding paragraph (e)(1),
treatment of chronic pain with scheduled drugs through use of telemedicine
medical services is not prohibited by this rule if the patient is
an established chronic pain patient of the APRN and is seeking telephone
refill of an existing prescription, and the APRN determines that such
telemedicine treatment is needed due to the COVID-19 pandemic.
(B)If a patient is treated for chronic
pain with scheduled drugs through the use of telemedicine medical
services as permitted by (e)(1)(A), the medical records must document
the exception and the reason that a telemedicine visit was conducted
instead of an in-person visit.
(C)An APRN, when determining whether
to utilize telemedicine medical services for the treatment of chronic
pain with controlled substances as permitted by (e)(1)(A) above, shall
give due consideration to factors that include, at a minimum, 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.
(D)The emergency amendment of this
rule effective June 8, 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 of acute pain with scheduled drugs through
use of telemedicine medical services is allowed, unless otherwise
prohibited under federal and state law. For purposes of this section,
"acute pain" means the normal, predicted, physiological response to
a stimulus, such as trauma, disease, and operative procedures. Acute
pain is time limited.
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 8, 2020
TRD-202002316 Dusty Johnston
General Counsel
Texas Board of Nursing
Effective date: June 8, 2020
Expiration date: July 7, 2020
For further information, please call: (512) 305-6821
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