The Texas Medical Board (Board) proposes amendments to §§174.1 - 174.3, the repeal of §174.4 and §174.6 and new §§174.6 - 174.12, concerning Telemedicine.

The amendment to §174.1, concerning Purpose, adds statutory authority for the chapter and exempts out-of-state telemedicine license holders, federally qualified health centers, and health insurance help-lines from the chapter.

The amendment to §174.2, concerning Definitions, defines distant site provider, established medical site, face-to-face visit, patient site location, patient site presenter; amends the definitions for physician-patient e-mail, telemedicine medical services; and deletes the definition for telepresenter.

The amendment to §174.3, concerning Telemedicine Medical Services, deletes references to the Telecommunications Infrastructure Fund Board (TIFB).

The repeal of §174.4, concerning Use of the Internet in Medical Practice, repeals the language from this section and moves it to Chapter 164 as a new §164.6, which is contemporaneously proposed elsewhere in this issue of the Texas Register.

The amendments to §174.5, concerning Notice of Privacy Practices, provides that physicians who communicate electronically with patients and provide telemedicine medical services, must provide notice to patients of privacy practices, limitations of telemedicine, when in-person evaluations are necessary, and how to file complaints with the Board.

The repeal and replacement of §174.6, concerning Delegation to and Supervision of Telepresenters, repeals §174.6 and adds new language for rules as new §174.6, concerning Telemedicine Medical Services Provided at an Established Medical Site.

New §174.7, concerning Telemedicine Medical Services Provided at Sites other than an Established Medical Site, establishes under what conditions a distant site provider may provide telemedicine medical services at sites other than an established medical site, such as a patient's home.

New §174.8, concerning Evaluation and Treatment of the Patient, establishes standards for physicians who use telemedicine medical services for the evaluation and treatment of patients.

New §174.9, concerning Technology and Security Requirements, establishes requirements relating to technology and security regarding the provision of telemedicine medical services and physician-patient communications through e-mail.

New §174.10, concerning Medical Records for Telemedicine Medical Services, establishes the requirements for the maintenance of medical records for telemedicine medical services and what documents are considered part of the medical records.

New §174.11, concerning On-call Services, establishes that physicians in the same specialty who provide reciprocal services may provide on-call telemedicine medical services for each other's patients.

New §174.12, concerning State Licensure, provides that persons who treat and prescribe through advanced communications technology are engaged in the practice of medicine and must have appropriate licensure unless otherwise exempt.

Nancy Leshikar, General Counsel for the Board, has determined that for each year of the first five years the sections as proposed are in effect the public benefit anticipated as a result of enforcing this proposal will be to ensure that the rules are applied appropriately; to establish uniform definitions for those who practice telemedicine in Texas; to eliminate reference to the TIFB that no longer exists; to move §174.4 to another chapter that more closely relates to the topic; to ensure that patients are given appropriate notice to make informed decisions about their care and their rights as consumers; to establish standards for the provision of telemedicine medical services at established medical sites; to establish a minimum standard of care when telemedicine used for the delivery of medical services; to protect confidential electronic communications between physicians and their patients and that electronic medical records are appropriately safeguarded; to ensure that medical records are appropriately maintained for patients who receive telemedicine medical services to allow for the use of telemedicine medical services through on-call services when a patient's distant site provider is not available and to ensure that those who reside outside of Texas and provide medical services to Texas residents are appropriately licensed.

Ms. Leshikar has also determined that for the first five-year period the sections are in effect there will be no effect to state or local government as a result of enforcing the sections as proposed. The effect to individuals required to comply with these rules as proposed is undetermined, and depends on an individual's current use of unlicensed patient site presenters or use of distant site providers that are not physicians, physician assistants, or advanced practice nurses. The effect on small or micro businesses is undetermined based on the same factors.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments and new rules are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

The amendments and new rules are also authorized by §157.001, Texas Occupations Code.

No other statutes, articles or codes are affected by this proposal.