Reference is to Printer's Date 4/28/16--H.
Amend the bill, as and if amended, by striking all after the enacting language and inserting:
/ SECTION 1. This act may be cited as the "South Carolina Telemedicine Act".
SECTION 2. Article 1, Chapter 47, Title 40 of the 1976 Code is amended by adding:
"Section 40-47-37.
(A) A licensee who establishes a
physician-patient relationship solely via telemedicine as
defined in Section 40-47-20(52) shall adhere to the same
standard of care as a licensee employing more traditional
in-person medical care and be evaluated according to the
standard of care applicable to the licensee's area of specialty.
A licensee shall not establish a physician-patient relationship
by telemedicine pursuant to Section 40-47-113(B) for the purpose
of prescribing medication when an in-person physical examination
is necessary for diagnosis. The failure to conform to the
appropriate standard of care is considered unprofessional
conduct under Section 40-47-110(B)(9).
(B) A licensee who
establishes a physician-patient relationship solely via
telemedicine as defined in Section 40-47-20(52) shall generate
and maintain medical records for each patient using such
telemedicine services in compliance with any applicable state
and federal laws, rules, and regulations, including this
chapter, the Health Insurance Portability and Accountability Act
(HIPAA), and the Health Information Technology for Economic and
Clinical Health Act (HITECH). Such records shall be accessible
to other practitioners and to the patient in a timely fashion
when lawfully requested to do so by the patient or by a lawfully
designated representative of the patient.
(C) In addition to
those requirements set forth in subsections (A) and (B), a
licensee who establishes a physician-patient relationship solely
via telemedicine as defined in Section 40-47-20(52) shall:
(1)
adhere to current standards for practice improvement and
monitoring of outcomes and provide reports containing such
information upon request of the board;
(2)
provide an appropriate evaluation prior to diagnosing
and/or treating the patient, which need not be done in-person if
the licensee employs technology sufficient to accurately
diagnose and treat the patient in conformity with the applicable
standard of care; provided, that evaluations in which a licensee
is at a distance from the patient, but a practitioner is able to
provide various physical findings the licensee needs to complete
an adequate assessment, is permitted; further, provided, that a
simple questionnaire without an appropriate evaluation is
prohibited;
(3)
verify the identity and location of the patient and be
prepared to inform the patient of the licensee's name, location,
and professional credentials;
(4)
establish a diagnosis through the use of accepted medical
practices, which may include patient history, mental status
evaluation, physical examination, and appropriate diagnostic and
laboratory testing in conformity with the applicable standard of
care;
(5)
ensure the availability of appropriate follow-up care and
maintain a complete medical record that is available to the
patient and other treating health care practitioners, to be
distributed to other treating health care practitioners only
with patient consent and in accordance with applicable law and
regulation;
(6)
prescribe within a practice setting fully in compliance
with this section and during an encounter in which threshold
information necessary to make an accurate diagnosis has been
obtained in a medical history interview conducted by the
prescribing licensee; provided, however, that Schedule II and
Schedule III prescriptions are not permitted except for those
Schedule II and Schedule III medications specifically authorized
by the board, which may include, but not be limited to, Schedule
II-nonnarcotic and Schedule III-nonnarcotic medications;
further, provided, that licensees prescribing controlled
substances by means of telemedicine must comply with all
relevant federal and state laws including, but not limited to,
participation in the South Carolina Prescription Monitoring
Program set forth in Article 15, Chapter 53, Title 44 of the
1976 Code; further, provided, that prescribing of lifestyle
medications including, but not limited to, hormone replacement
therapies, birth control, or erectile dysfunction drugs are not
permitted unless approved by the board; further, for drugs
intended to treat the symptoms of erectile dysfunction approved
by the board, a licensee also must comply with the provisions of
subsection (D); further, provided, that prescribing
abortion-inducing drugs is not permitted unless approved by the
board; as used in this article 'abortion-inducing drug' means a
medicine, drug, or any other substance prescribed or dispensed
with the intent of terminating the clinically diagnosable
pregnancy of a woman, with knowledge that the termination will
with reasonable likelihood cause the death of the unborn child.
This includes off-label use of drugs known to have
abortion-inducing properties, which are prescribed specifically
with the intent of causing an abortion, such as misoprostol
(Cytotec), and methotrexate. This definition does not apply to
drugs that may be known to cause an abortion, but which are
prescribed for other medical indications, including, but not
limited to, chemotherapeutic agents or diagnostic drugs. Use of
such drugs to induce abortion is also known as 'medical',
'drug-induced', and/or 'chemical abortion';
(7)
maintain a complete record of the patient's care according
to prevailing medical record standards that reflects an
appropriate evaluation of the patient's presenting symptoms;
provided that relevant components of the telemedicine
interaction be documented as with any other encounter;
(8)
maintain the patient's records' confidentiality and
disclose the records to the patient consistent with state and
federal law; provided, that licensees practicing telemedicine
shall be held to the same standards of professionalism
concerning medical records transfer and communication with the
primary care provider and medical home as licensees practicing
via traditional means; further, provided, that if a patient has
a primary care provider and a telemedicine provider for the same
ailment, then the primary care provider's medical record and the
telemedicine provider's record constitute one complete medical
record;
(9)
be licensed to practice medicine in South Carolina;
provided, however, a licensee need not reside in South Carolina
so long as he or she has a valid, current South Carolina medical
license; further, provided, that a licensee residing in South
Carolina who intends to practice medicine via telemedicine to
treat or diagnose patients outside of South Carolina shall
comply with other state licensing boards; and
(10)
discuss with the patient the value of having a primary
care medical home and, if the patient requests, provide
assistance in identifying available options for a primary care
medical home.
(D)(1) If the board
authorizes the prescription of a drug intended to treat the
symptoms of erectile dysfunction pursuant to subsection (C)(6),
no person other than a physician licensee may issue the patient
a prescription for such a drug. Before issuing a prescription
for a drug intended to treat the symptoms of erectile
dysfunction, a physician shall:
(a)
refer the patient to a sexual therapist licensed by the
State Board of Examiners in Psychology for an assessment of the
possible causes of the patient's symptoms of erectile
dysfunction and obtain a written report in which the therapist
concludes that the patient's symptoms are not attributable
solely to one or more psychological conditions;
(b)
refer the patient to a health care provider for a cardiac
stress test and obtain a result, described in writing,
indicating that the patient's cardiac health is compatible with
sexual activity;
(c)
notify the patient in writing of the potential risks and
complications associated with taking drugs intended to treat
erectile dysfunction and obtain the patient's signature on a
form acknowledging the patient's receipt of the notification;
and
(d)
provide a written statement, under penalty of perjury,
that the drug the physician is prescribing is necessary to treat
the patient's symptoms of erectile dysfunction, which includes
the physician's medical rationale for issuing the prescription.
(2)
A physician must not issue a prescription for a drug
intended to treat symptoms of erectile dysfunction any sooner
than twenty-four hours after the patient provides written
acknowledgement of receipt of the notification required pursuant
to item (1)(c).
(3)
A physician shall place all documents described in item
(1) in the patient's medical record and retain the documents as
part of that record for not less than seven years.
(4)
To ensure the continued health of a patient to whom a
prescription for a drug intended to treat symptoms of erectile
dysfunction has been issued, the physician, as part of the
patient's course of treatment, including treatment by issuing a
prescription for one or more refills of the drug originally
prescribed to treat symptoms of erectile dysfunction, or the
prescription of another drug for that purpose, shall:
(a)
require the patient to undergo a cardiac stress test every
ninety days while the patient is taking the drug to ensure that
the patient's cardiac health continues to be compatible with
sexual activity; and
(b)
require the patient to attend three sessions of outpatient
counseling within a period of not less than six months after the
drug initially is prescribed to ensure the patient's
understanding of the dangerous side effects of drugs intended to
treat the symptoms of erectile dysfunction and which includes
information on nonpharmaceutical treatments for erectile
dysfunction, including sexual counseling and resources for
patients to pursue celibacy as a viable lifestyle choice.
(5)
The provisions of this subsection do not apply to a
prescription for a drug intended to treat the symptoms of
erectile dysfunction for a patient who has been diagnosed with
or treated for prostate cancer.
(6)
For purposes of this subsection, 'erectile dysfunction'
means the persistent inability to achieve or maintain penile
erection sufficient for satisfactory sexual performance.
(E) A licensee,
practitioner, or any other person involved in a telemedicine
encounter must be trained in the use of the telemedicine
equipment and competent in its operation.
(F) Notwithstanding any
of the provisions of this section, the board shall retain all
authority with respect to telemedicine practice as granted in
Section 40-47-10(I) of this chapter."
SECTION 3. Section 40-47-20(52) through (55) of the 1976 Code is amended to read:
"(52)
'Telemedicine' means the practice of medicine using
electronic communications, information technology, or other
means between a licensee in one location and a patient in
another location with or without an intervening
practitioner.
(52)(53)
'Temporary license' means a current, time-limited
document that authorizes practice at the level for which one is
seeking licensure.
(53)(54)
'Unprofessional conduct' means acts or behavior
that fail to meet the minimally acceptable standard expected of
similarly situated professionals including, but not limited to,
conduct that may be harmful to the health, safety, and welfare
of the public, conduct that may reflect negatively on one's
fitness to practice, or conduct that may violate any provision
of the code of ethics adopted by the board or a specialty.
(54)(55)
'Voluntary surrender' means forgoing the
authorization to practice by the subject of an initial or formal
complaint pending further order of the board. It anticipates
other formal action by the board and allows any suspension
subsequently imposed to include this time.
(55)(56)
'Volunteer license' means authorization of a
retired practitioner to provide medical services to others
through an identified charitable organization without
remuneration."
SECTION 4. Section 40-47-110(B)(24)-(25) of the 1976 Code is amended to read:
"(24) improperly
managed medical records, including failure to maintain timely,
legible, accurate, and complete medical records;
or
(25) provided false,
deceptive, or misleading testimony as an expert witness in an
administrative, civil, or criminal proceeding in this State;
or
(26) failed
to comply with the requirements of Section 40-47-37(D) regarding
the prescription of drugs intended to treat symptoms of erectile
dysfunction and courses of treatment for patients receiving
prescriptions for those drugs."
SECTION 5. Section 40-47-113(B) of the 1976 Code is amended to read:
"(B)
Notwithstanding subsection (A), a licensee may prescribe
for a patient whom the licensee has not personally examined
under certain circumstances including, but not limited to,
writing admission orders for a newly hospitalized patient,
prescribing for a patient of another licensee for whom the
prescriber is taking call, prescribing for a patient examined by
a licensed advanced practice registered nurse, a physician
assistant, or other physician extender authorized by law and
supervised by the physician, or continuing
medication on a short-term basis for a new patient prior
to before the patient's first appointment, or
prescribing for a patient for whom the licensee has established
a physician-patient relationship solely via telemedicine so long
as the licensee complies with Section 40-47-37 of this
act."
SECTION 6. If any section, subsection, paragraph, subparagraph, sentence, clause, phrase, or word of this act is for any reason held to be unconstitutional or invalid, such holding shall not affect the constitutionality or validity of the remaining portions of this act, the General Assembly hereby declaring that it would have passed this act, and each and every section, subsection, paragraph, subparagraph, sentence, clause, phrase, and word thereof, irrespective of the fact that any one or more other sections, subsections, paragraphs, subparagraphs, sentences, clauses, phrases, or words hereof may be declared to be unconstitutional, invalid, or otherwise ineffective.
SECTION 7. This act takes effect upon approval by the Governor. /
Renumber sections to conform.
Amend title to conform.