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Current Dermatology Reports
Published in: Current Dermatology Reports 2/2019

01-06-2019 | Care | Teledermatology (D Oh, Section Editor)

Legal and Regulatory Issues with Teledermatology

Authors: Taylor A. Goodspeed, Rachel E. Page, Laura E. Koman, Ann T. Hollenbeck, Alexis S. Gilroy

Published in: Current Dermatology Reports | Issue 2/2019

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Abstract

Purpose of Review

This article provides an overview of the legal and regulatory requirements that providers engaging in teledermatology must consider when structuring telemedicine arrangements and developing a telehealth strategy.

Recent Findings

The numerous state and federal legal and regulatory considerations applicable to teledermatology offerings are rapidly changing: new laws and regulations are proposed and adopted every year.

Summary

At the state level, requirements are often state specific and address a wide variety of topics such as establishing the physician-patient relationship, technology-specific requirements, and practice and prescribing standards when delivering care through telemedicine. At the federal level, laws and regulations address federal health care program reimbursement, digital devices, and data privacy, among other topics.
Literature
1.
See, e.g., Mich. Comp. Laws § 333.16171(e).
2.
•• Interstate Medical Licensure Compact, The IMLC. https://​imlcc.​org/​. Accessed 14 Jan. 2019. Identifies states taking part in model interstate medical licensure compact.
3.
As of 2018, nine States – Alabama, Louisiana, Maine, Minnesota, New Mexico, Oklahoma, Ohio, Oregon, and Texas – issue special telemedicine licenses or certificates. See, e.g., Ala. Code § 34024-502; Ala. Admin. Code R. 540-X-15-.16; La. Rev Stat. § 37:1276.1; Minn. Stat. § 147.032; Ohio Rev. Code § 4731.296; Or. Rev. Stat. § 677. 139; Or. Admin. R. 847-025-0000; 22 Tex. Admin. Code § 172.12.
4.
See, e.g., Ind. Code. § 21-1-9.5-9; see also Alaska Med Bd Policies and Procedures, “Telemedicine,” at 2.
5.
This evaluation does not include diagnoses and treatments using controlled substances and the prescription of certain lifestyle drugs. See, e.g., Fla. Admin. Code r. 64B8-9.0141(1) (“Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders.”); N.D. Cent. Code § 19-02.1-15.1 (requiring an “in-person medical evaluation” prior to prescribing “specified drugs” including muscle relaxants, centrally acting analgesics with opioid activity, drugs containing butalbital and phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction).
6.
See, e.g., Ark. Code § 17–80-404(a)(2) (“Once a professional relationship is established, a healthcare professional may provide healthcare services through telemedicine, including interactive audio.”).
7.
See, e.g., Iowa Admin. Code r. 653-13.11(11) (requiring provider using telemedicine to identify the patient’s medical home or treating physicians).
8.
See, e.g., Iowa Admin Code r. 653-13.11(9).
9.
10.
11.
12.
13.
See, e.g., Kan Stat. Ann. § 65-1626(vvv) (“A “valid prescription order” means a prescription used for a legitimate medical purpose and does not include “[a] prescription issued solely on the basis of an internet-based questionnaire or consultation without an appropriate prescriber-patient relationship.”).
14.
See, e.g., 22 D.C. Municipal Regs. §§ 1300.7, 1399 (A valid patient-practitioner relationship means, at a minimum, that “the practitioner has met face to face with the patient, has obtained a patient history, and conducted a physical examination or evaluation adequate to establish a diagnosis.”).
15.
See, e.g., Ala. Admin. Code r. 680-X-2-.33 (“A pharmacist shall not dispense a prescription drug if the pharmacist has knowledge, or reasonably should have known under the circumstances, that the order for such drug was issued on the basis of an internet-based questionnaire, an internet-based consultation, or a telephonic consultation, all without a valid preexisting patient-practitioner relationship.”)
16.
See, e.g., Ark. Code § 17-92-1003 (requiring an in-person examination to establish a proper practitioner-patient relationship for purposes of issuing a valid prescription unless the relationship is established pursuant to Arkansas’ Telemedicine Act).
17.
See, e.g., Minn. Stat. § 151.37 (indicating that a prescription drug order for controlled substances, muscle relaxants, centrally acting analgesics with opioid activity, drugs containing butalbital, and phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction will be valid only if accompanied by an in-person examination).
18.
•• 42 U.S.C. § 1395m. Sets forth the requirements for Medicare program reimbursement.
19.
•• Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019, 83 Fed. Reg. 59,836 (November 23, 2018). Sets forth the requirements for “virtual check-ins” under the Medicare program.
20.
See, e.g., Okla Admin Code § 435:10–7-13.
21.
• Gilroy AS, Rockwell KA. Tele-ICU legal and regulatory issues. In: Koenig, MA, editor. Telemedicine in the ICU. Springer; 2019. Provides information on federal and state privacy and data security laws relevant to telehealth.
22.
See, e.g., V.T.C.A. Occ. Code § 111.005 (requiring provision of medical records to the patient’s primary care provider within 72 hours if the patient consents).
23.
24.
25.
• South Dakota v. Wayfair, 138 S. Ct. 2080, 2099. 2018. Recent Supreme Court case that suggests that all that is required for a state to assert jurisdiction over an entity for sales tax purposes is that a business avails itself of the “substantial privilege of carrying on business” in the state.
Metadata
Title
Legal and Regulatory Issues with Teledermatology
Authors
Taylor A. Goodspeed
Rachel E. Page
Laura E. Koman
Ann T. Hollenbeck
Alexis S. Gilroy
Publication date
01-06-2019
Publisher
Springer US
Keywords
Care
Telemedicine
Published in
Current Dermatology Reports / Issue 2/2019
Electronic ISSN: 2162-4933
DOI
https://doi.org/10.1007/s13671-019-0254-0

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