During the 2016 regular Legislative session, the Louisiana Legislature amended and reenacted several statutes relative to the practice of telemedicine. Under the prior legislation, a physician was required to conduct an in-person patient history and physical exam before engaging in a telemedicine encounter. Now, a physician who is either licensed in the state of Louisiana or has a Louisiana telemedicine permit may treat a patient residing in Louisiana via telemedicine if: the physician has access to the patient’s medical records; creates his or her own medical record on the patient; and, if necessary, provides a referral to a physician in Louisiana or arranges for follow-up care in Louisiana as may be indicated. Another change is that the physician is no longer required to utilize video to communicate with the patient, and instead can use interactive audio (i.e. telephone) if, after accessing and reviewing the patient’s medical records, the physician determines that he is able to meet the same standard of care as if the healthcare services were provided in person.
The Legislature also enacted a new statute, La. R.S. 37:1271.1, to provide for conditions and authorizations relative to the practice of telemedicine at Louisiana licensed healthcare facilities that hold a current registration with the U.S. Drug Enforcement Administration. If a physician uses telemedicine to treat a patient at the facility, the physician, using the same standard of care as if the healthcare services were provided in person, can prescribe a controlled substance without conducting an in-person patient history or physical exam. For example, this revision to the law will permit a physician to prescribe controlled substances to a hospitalized patient via telemedicine without prior in-person contact with the patient.
The Legislature instructed the Louisiana healthcare licensing boards to promulgate Rules consistent with the statutory amendments. On October 20, 2016, the Louisiana State Board of Medical Examiners responded by issuing a Notice of Intent to revise its Rules to conform to the amendments. The LSBME’s proposed revisions incorporate the statutory changes identified above. The physician will no longer be required to conduct an in-person visit, but must be able to refer the patient to another physician in Louisiana or arrange for follow-up care in Louisiana if required by the standard of care. Additionally, the LSBME proposes to remove the current requirement that a physician practicing medicine by telemedicine have a physical practice location in the state or have an arrangement with a physician who maintains a physical practice location in Louisiana to accept patients on referral and for follow-up care. However, a physician will be required to identify on the application for a telemedicine permit the primary locations from which telemedicine will be utilized by the physician.
The LSBME’s proposed Rules impose two changes affecting documentation of telemedicine encounters. First, the record maintained by the physician must clearly state that the patient encounter occurred via telemedicine. Second, the medical record must be made available to the LSBME upon request.
With regard to controlled substances, the LSBME proposed Rules incorporate the new statutory exception for prescribing to patients being treated in licensed healthcare facilities, but maintains the prohibitions against prescribing controlled substances via telemedicine for the treatment of non-cancer related chronic or intractable pain or obesity.
The LSBME is accepting written comments on the proposed rule amendments until November 21, 2016. If requested, a public hearing will be held on November 28, 2016 at 1:30 a.m. at the LSBME office to consider data, views, arguments, information or comments from the public. The amendments to the Rules will not become final until the Legislative oversight process is complete and the Final Rules published in the Louisiana Register.