(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)For purposes of this rule, chronic pain has
the same definition as used in 22 Texas Administrative Code §170.2(4)
(relating to Definitions). [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)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 chronic pain patient of the APRN;
(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 or physician
or 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
communication.
(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. [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 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 August 2, 2021
TRD-202102998 Jena Abel
Deputy General Counsel
Texas Board of Nursing
Earliest possible date of adoption: September 12, 2021
For further information, please call: (512) 228-1862
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