On October 31, the Texas Medical Board held a stakeholder meeting to discuss telemedicine rules.
Executive Director Mari Robinson gave a brief introduction of the existing telemedicine rules, and reinforced that TMB is not proposing to go back and change existing rule language, but to create new rules that include behavioral health and prescribing practice.
- This is the very first step in the process to gauge interest these additions
- The stakeholder has no voting authority
- The next TMB meeting is in February and they will continue to examine possible language
The current telemedicine rule explicitly says that “an established” telemedicine site may not be in the patient’s home.
- Poses problems in the behavioral health world
- The current language would disallow telemedicine in Nursing homes, group homes, actual residences etc.
- Having information on a patient’s home can be very helpful in diagnosis
- Telemedicine is extremely helpful in a crisis situation
- Law enforcement could utilize telemedicine to get support, but usually are not at an “established” site
- DSHS is currently looking at their substance abuse rules and evaluating how telemedicine can be used in a co-occurring situation
- The group discussed the potential cost savings of allowing telemedicine in homes
- Would reduce dependence on the medical transportation program in Medicaid
- Easier on families who have more than one child – transport usually only allows for the child/patient and a parent
- Mari – How do we create language that carves out comorbities and make sure patients are accurately assessed?
- How do we include the “safety factor” of an established site to homes?
- The group agreed that there need to be exceptions to the current rule regarding emergency situations or police interactions
- Need to include a reasonable attempt of privacy
- Should include a follow up visit
- There are reasons that telemedicine should be allowed in homes in cases of infectious diseases
Prescribing
- Internet pharmacies prescribing of controlled substances let to a federal act that in effect prohibits prescribing via telemedicine
- What does TMB want/can do about this?
- The DEA could pass a law that fixes the situation, but they don’t seem too interested
- Jack Stick with HHSC is working with DEA to try and get an exemption
- DEA has not moved forward with registering pharmacies
- Texas’ clinics previous practice of identifying a child with a behavioral health problem, holding a phone call with a psychiatrist confirming diagnosis, and then the clinic would prescribe the meds was deemed illegal by DEA
- There are various work arounds that the group has heard of, but they want to establish an official way to prescribe with telepsychiatry
- PCPs can prescribe, but many patients present at LMHAs and community clinics where there isn’t a PCP
- One member of the group voiced his concern about prescribing ADHD medication without a physical exam because there could be physical repercussions for a misdiagnosis
- Access shortages can be helped by telemedicine, but sometimes there aren’t even enough PCPs to go to an established site
- FLA has passed some legislation that has helped – should look and see what they did
- TMB will try to craft something and work to get the DEA to go along with the TMB rules