The Texas Medical Board (Board) proposes amendments to §174.2 and proposes new §§174.7, 174.9 and 174.11, concerning Telemedicine.

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.

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 §174.9, 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 §174.11, 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.

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 the proposals will be:

Section 174.2 - to establish uniform definitions for those who practice telemedicine in Texas.

Section 174.7 - to establish standards for the use of telemedicine medical services at non-medical sites. The proposed rules will accommodate the developing trends in health care delivery not authorized under existing rules as well as changes in the Health and Human Services Commission's (HHSC) rules for Medicaid telemedicine reimbursement. Also the proposed changes expand the current rules to authorize a majority of the types of telemedicine that are currently being practiced in Texas in both rural and urban areas.

Section 174.9 - to establish standards for the provision of telemedicine medical services at established medical sites.

Section 174.11 - to allow for the use of telemedicine medical services through on-call services when a patient's distant site provider is not available.

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

Comments on the proposals may be submitted to Jennifer Kaufman, 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 amendment 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 amendment and new rules are also authorized by §157.001, Texas Occupations Code.

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