Bill Text: MS SB2517 | 2016 | Regular Session | Introduced

---

Bill Title: Telemedicine services under Medical Practice Act; provide standards and require insurance coverage.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2016-02-23 - Died In Committee [SB2517 Detail]

Download: Mississippi-2016-SB2517-Introduced.html

---

MISSISSIPPI LEGISLATURE

2016 Regular Session

To: Public Health and Welfare

By: Senator(s) Kirby

Senate Bill 2517

AN ACT TO AMEND SECTION 73-25-34, MISSISSIPPI CODE OF 1972, TO DEFINE TELEMEDICINE SERVICES IN THE MEDICAL PRACTICE ACT AND TO PROVIDE STANDARDS FOR PHYSICIANS PROVIDING TREATMENT VIA TELEMEDICINE SERVICES; TO CREATE A NEW CODE SECTION WHICH PROVIDES FOR CIVIL PENALTIES FOR ANY HEALTH INSURER, HEALTH SUBSCRIPTION PLAN, HEALTH MAINTENANCE ORGANIZATION THAT DENIES PAYMENT FOR DIAGNOSIS, TREATMENT, OR CONSULTATION PROVIDED BY TELEMEDICINE IF IT WOULD BE COVERED WERE IT PROVIDED IN PERSON; TO AUTHORIZE THE MISSISSIPPI BOARD OF MEDICAL LICENSURE TO PROMULGATE RULES RELATING TO TELEMEDICINE; TO AMEND SECTION 41-3-15, MISSISSIPPI CODE OF 1972, IN CONFORMITY; AND FOR RELATED PURPOSES.

     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

     SECTION 1.  Section 73-25-34, Mississippi Code of 1972, is amended as follows:

     73-25-34.  (1) * * *  For the purposes of this section, telemedicine, or the practice of medicine across state lines, shall be defined to include any one or both of the following:

  (a)  Rendering of a medical opinion concerning diagnosis or treatment of a patient within this state by a physician located outside this state as a result of transmission of individual patient data by electronic or other means from within this state to such physician or his agent; or

F(2

  (b)  The rendering of treatment to a patient within this state by a physician located outside this state as a result of transmission of individual patient data by electronic or other means from within this state to such physician or his agent.  As used in this section:

          (a)  "Telemedicine" is the practice of medicine, as defined in 73- 25-33, using telemedicine services as defined in paragraph (c).

          (b)  "Physician" means a medical doctor (MD) or doctor of osteopathic medicine (DO) located at a site other than the patient.

          (c)  "Telemedicine services" means the delivery of health care services such as diagnosis, consultation or treatment through the use of interactive audio, video or other electronic media.  Telemedicine services must be "real-time" consultation, and it does not include the use of audio-only telephone, e-mail or facsimile.

     (2) * * *  Except as hereinafter provided, no person shall engage in the practice of medicine across state lines (telemedicine) in this state, hold himself out as qualified to do the same, or use any title, word or abbreviation to indicate to or induce others to believe that he is duly licensed to practice medicine across state lines in this state unless he has first obtained a license to do so from the State Board of Medical Licensure and has met all educational and licensure requirements as determined by the State Board of Medical Licensure.  The practice of medicine under this act is deemed to occur at the location of the patient.

     (3) * * *  The requirement of licensure as set forth in subsection (2) above shall not be required where the evaluation, treatment and/or the medical opinion to be rendered by a physician outside this state (a) is requested by a physician duly licensed to practice medicine in this state, and (b) the physician who has requested such evaluation, treatment and/or medical opinion has already established a doctor/patient relationship with the patient to be evaluated and/or treated.  The physician-patient relationship is established when a physician agrees to undertake diagnosis and treatment of a patient through telemedicine services and the patient consents to being treated.  The physician-patient relationship ends when either the patient terminates the physician-patient relationship; the patient no longer requires the care of the physician; or the physician agreed to treat or diagnose only a specific condition or agreed to diagnose or treat only at a specific time or place and that condition diagnosis or treatment has ended; or the physician terminates the physician-patient relationship by notifying the patient in writing of withdrawal from care after a specific time which is stated in a letter.

     (4)  (a)  A physician must be licensed in the State of Mississippi.  The requirement of licensure as set forth above shall not be required where the evaluation, treatment and/or the medical opinion to be rendered by a physician outside this state (i) is requested by a physician duly licensed to practice medicine in this state, and (ii) the physician who has requested such evaluation, treatment and/or medical opinion has already established a doctor/patient relationship with the patient to be evaluated and/or treated.

          (b)  Any physician not complying with the regulations of this section is subject to a fine no less than Five Thousand Dollars ($5,000.00) and no greater than One Hundred Thousand Dollars ($100,000.00) per violation.  Any business entity or person associated with, employing or contracting with a physician in violation of this section is also subject to a fine of no less than Five Thousand Dollars ($5,000.00) per violation occurrence and no greater than One Hundred Thousand Dollars ($100,000.00) per violation occurrence.  Fines in this section shall be paid to the Mississippi Trauma Care Systems Fund as set forth in Section 41-59-1 et. seq.

     (5)  A patient shall have given informed consent for all telemedicine services. Informed consent shall be obtained in accordance with any applicable law.

     (6)  Prior to providing telemedicine services, the physician shall obtain and document a patient's relevant clinical history and current symptoms to diagnose, treat, consult and identify underlying conditions, treatment and contraindications, if any.  Medical records must be maintained and accessible in accordance with applicable law.  The content of medical records shall be maintained at or above the same standard as traditional face-to-face medical services.

     (7)  Sufficient privacy and security measures must be in place and documented to assure confidentiality and integrity of the health information of a patient.  Any physician offering telemedicine services as part of his or her practice shall meet or exceed any applicable state and federal laws, rules and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), P.L. 104-191 (1996) as amended, and the Health Information Technology For Economic and Clinical Health Act (HITECH), P.L. 111-115 (2009) as amended.  Such records shall be accessible to other providers and to the patient in accordance with applicable laws, rules and regulations.

     (8)  Prescribing medications via telemedicine is at the professional discretion of the physician.  The indication, appropriateness and safety considerations for each prescription ordered via telemedicine must be evaluated by the physician in accordance with applicable regulations and standards of practice and consequently carry the same professional accountability as if prescribed in person.

     (9)  Within fourteen (14) days of written request by the Mississippi Board of Medical Licensure, a physician providing telemedicine services must show proof of professional liability insurance.  Proof of professional liability insurance is satisfied when a physician produces a current declaration of coverage from an insurance company existing in any state that provides professional liability insurance in its usual course of business.

     (10)  A physician who fails to comply or violates this act is subject to discipline by the Mississippi Board of Medical Licensure.

     (11)  The Mississippi Board of Medical Licensure is authorized to promulgate rules relating to the provisions in this section; provided, however, that any such regulations shall be consistent with and no more restrictive than the provisions contained herein.

     SECTION 2.  No health insurer, health care subscription plan, or health maintenance organizations shall deny payment for diagnosis, treatment or consultation provided by telemedicine if it would be covered were it provided in-person.  Any health insurer, health care subscription plan, or health maintenance organization that denies charges contemplated under this title shall be subject to penalty to include the cost of denied service and a punitive fine no less than Ten Thousand Dollars ($10,000.00) per violation occurrence and no greater than One Hundred Thousand Dollars ($100,000.00) per violation occurrence.  Fines in this section shall be paid to the Mississippi Trauma Care Systems Fund as set forth in Section 41-59-1 et. seq.

     SECTION 3.  Section 41-3-15, Mississippi Code of 1972, is amended as follows:

     41-3-15.  (1)  (a)  There shall be a State Department of Health.

          (b)  The State Board of Health shall have the following powers and duties:

              (i)  To formulate the policy of the State Department of Health regarding public health matters within the jurisdiction of the department;

              (ii)  To adopt, modify, repeal and promulgate, after due notice and hearing, and enforce rules and regulations implementing or effectuating the powers and duties of the department under any and all statutes within the department's jurisdiction, and as the board may deem necessary;

              (iii)  To apply for, receive, accept and expend any federal or state funds or contributions, gifts, trusts, devises, bequests, grants, endowments or funds from any other source or transfers of property of any kind;

              (iv)  To enter into, and to authorize the executive officer to execute contracts, grants and cooperative agreements with any federal or state agency or subdivision thereof, or any public or private institution located inside or outside the State of Mississippi, or any person, corporation or association in connection with carrying out the provisions of this chapter, if it finds those actions to be in the public interest and the contracts or agreements do not have a financial cost that exceeds the amounts appropriated for those purposes by the Legislature;

              (v)  To appoint, upon recommendation of the Executive Officer of the State Department of Health, a Director of Internal Audit who shall be either a Certified Public Accountant or Certified Internal Auditor, and whose employment shall be continued at the discretion of the board, and who shall report directly to the board, or its designee; and

              (vi)  To discharge such other duties, responsibilities and powers as are necessary to implement the provisions of this chapter.

          (c)  The Executive Officer of the State Department of Health shall have the following powers and duties:

              (i)  To administer the policies of the State Board of Health within the authority granted by the board;

              (ii)  To supervise and direct all administrative and technical activities of the department, except that the department's internal auditor shall be subject to the sole supervision and direction of the board;

              (iii)  To organize the administrative units of the department in accordance with the plan adopted by the board and, with board approval, alter the organizational plan and reassign responsibilities as he or she may deem necessary to carry out the policies of the board;

              (iv)  To coordinate the activities of the various offices of the department;

              (v)  To employ, subject to regulations of the State Personnel Board, qualified professional personnel in the subject matter or fields of each office, and such other technical and clerical staff as may be required for the operation of the department.  The executive officer shall be the appointing authority for the department, and shall have the power to delegate the authority to appoint or dismiss employees to appropriate subordinates, subject to the rules and regulations of the State Personnel Board;

              (vi)  To recommend to the board such studies and investigations as he or she may deem appropriate, and to carry out the approved recommendations in conjunction with the various offices;

              (vii)  To prepare and deliver to the Legislature and the Governor on or before January 1 of each year, and at such other times as may be required by the Legislature or Governor, a full report of the work of the department and the offices thereof, including a detailed statement of expenditures of the department and any recommendations the board may have;

              (viii)  To prepare and deliver to the Chairmen of the Public Health and Welfare/Human Services Committees of the Senate and House on or before January 1 of each year, a plan for monitoring infant mortality in Mississippi and a full report of the work of the department on reducing Mississippi's infant mortality and morbidity rates and improving the status of maternal and infant health; and

              (ix)  To enter into contracts, grants and cooperative agreements with any federal or state agency or subdivision thereof, or any public or private institution located inside or outside the State of Mississippi, or any person, corporation or association in connection with carrying out the provisions of this chapter, if he or she finds those actions to be in the public interest and the contracts or agreements do not have a financial cost that exceeds the amounts appropriated for those purposes by the Legislature.  Each contract or agreement entered into by the executive officer shall be submitted to the board before its next meeting.

     (2)  The State Board of Health shall have the authority to establish an Office of Rural Health within the department.  The duties and responsibilities of this office shall include the following:

          (a)  To collect and evaluate data on rural health conditions and needs;

          (b)  To engage in policy analysis, policy development and economic impact studies with regard to rural health issues;

          (c)  To develop and implement plans and provide technical assistance to enable community health systems to respond to various changes in their circumstances;

          (d)  To plan and assist in professional recruitment and retention of medical professionals and assistants; and

          (e)  To establish information clearinghouses to improve access to and sharing of rural health care information.

     (3)  The State Board of Health shall have general supervision of the health interests of the people of the state and to exercise the rights, powers and duties of those acts which it is authorized by law to enforce.

     (4)  The State Board of Health shall have authority:

          (a)  To make investigations and inquiries with respect to the causes of disease and death, and to investigate the effect of environment, including conditions of employment and other conditions that may affect health, and to make such other investigations as it may deem necessary for the preservation and improvement of health.

          (b)  To make such sanitary investigations as it may, from time to time, deem necessary for the protection and improvement of health and to investigate nuisance questions that affect the security of life and health within the state.

          (c)  To direct and control sanitary and quarantine measures for dealing with all diseases within the state possible to suppress same and prevent their spread.

          (d)  To obtain, collect and preserve such information relative to mortality, morbidity, disease and health as may be useful in the discharge of its duties or may contribute to the prevention of disease or the promotion of health in this state.

          (e)  To charge and collect reasonable fees for health services, including immunizations, inspections and related activities, and the board shall charge fees for those services; provided, however, if it is determined that a person receiving services is unable to pay the total fee, the board shall collect any amount that the person is able to pay.

          (f)  (i)  To establish standards for, issue permits and exercise control over, any cafes, restaurants, food or drink stands, sandwich manufacturing establishments, and all other establishments, other than churches, church-related and private schools, and other nonprofit or charitable organizations, where food or drink is regularly prepared, handled and served for pay; and

              (ii)  To require that a permit be obtained from the Department of Health before those persons begin operation.  If any such person fails to obtain the permit required in this subparagraph (ii), the State Board of Health, after due notice and opportunity for a hearing, may impose a monetary penalty not to exceed One Thousand Dollars ($1,000.00) for each violation.  However, the department is not authorized to impose a monetary penalty against any person whose gross annual prepared food sales are less than Five Thousand Dollars ($5,000.00).  Money collected by the board under this subparagraph (ii) shall be deposited to the credit of the State General Fund of the State Treasury.

          (g)  To promulgate rules and regulations and exercise control over the production and sale of milk pursuant to the provisions of Sections 75-31-41 through 75-31-49.

          (h)  On presentation of proper authority, to enter into and inspect any public place or building where the State Health Officer or his representative deems it necessary and proper to enter for the discovery and suppression of disease and for the enforcement of any health or sanitary laws and regulations in the state.

          (i)  To conduct investigations, inquiries and hearings, and to issue subpoenas for the attendance of witnesses and the production of books and records at any hearing when authorized and required by statute to be conducted by the State Health Officer or the State Board of Health.

 * * *  (j)  To promulgate rules and regulations, and to collect data and information, on (i) the delivery of services through the practice of telemedicine; and (ii) the use of electronic records for the delivery of telemedicine services.

          ( * * *kj)  To enforce and regulate domestic and imported fish as authorized under Section 69-7-601 et seq.

     (5)  (a)  The State Board of Health shall have the authority, in its discretion, to establish programs to promote the public health, to be administered by the State Department of Health. Specifically, those programs may include, but shall not be limited to, programs in the following areas:

              (i)  Maternal and child health;

              (ii)  Family planning;

              (iii)  Pediatric services;

              (iv)  Services to crippled and disabled children;

              (v)  Control of communicable and noncommunicable disease;

              (vi)  Chronic disease;

              (vii)  Accidental deaths and injuries;

              (viii)  Child care licensure;

              (ix)  Radiological health;

              (x)  Dental health;

              (xi)  Milk sanitation;

              (xii)  Occupational safety and health;

              (xiii)  Food, vector control and general sanitation;

              (xiv)  Protection of drinking water;

              (xv)  Sanitation in food handling establishments open to the public;

              (xvi)  Registration of births and deaths and other vital events;

              (xvii)  Such public health programs and services as may be assigned to the State Board of Health by the Legislature or by executive order; and

              (xviii)  Regulation of domestic and imported fish for human consumption.

          (b)  The State Board of Health and State Department of Health shall not be authorized to sell, transfer, alienate or otherwise dispose of any of the home health agencies owned and operated by the department on January 1, 1995, and shall not be authorized to sell, transfer, assign, alienate or otherwise dispose of the license of any of those home health agencies, except upon the specific authorization of the Legislature by an amendment to this section.  However, this paragraph (b) shall not prevent the board or the department from closing or terminating the operation of any home health agency owned and operated by the department, or closing or terminating any office, branch office or clinic of any such home health agency, or otherwise discontinuing the providing of home health services through any such home health agency, office, branch office or clinic, if the board first demonstrates that there are other providers of home health services in the area being served by the department's home health agency, office, branch office or clinic that will be able to provide adequate home health services to the residents of the area if the department's home health agency, office, branch office or clinic is closed or otherwise discontinues the providing of home health services.  This demonstration by the board that there are other providers of adequate home health services in the area shall be spread at length upon the minutes of the board at a regular or special meeting of the board at least thirty (30) days before a home health agency, office, branch office or clinic is proposed to be closed or otherwise discontinue the providing of home health services.

          (c)  The State Department of Health may undertake such technical programs and activities as may be required for the support and operation of those programs, including maintaining physical, chemical, bacteriological and radiological laboratories, and may make such diagnostic tests for diseases and tests for the evaluation of health hazards as may be deemed necessary for the protection of the people of the state.

     (6)  (a)  The State Board of Health shall administer the local governments and rural water systems improvements loan program in accordance with the provisions of Section 41-3-16.

          (b)  The State Board of Health shall have authority:

              (i)  To enter into capitalization grant agreements with the United States Environmental Protection Agency, or any successor agency thereto;

              (ii)  To accept capitalization grant awards made under the federal Safe Drinking Water Act, as amended;

              (iii)  To provide annual reports and audits to the United States Environmental Protection Agency, as may be required by federal capitalization grant agreements; and

              (iv)  To establish and collect fees to defray the reasonable costs of administering the revolving fund or emergency fund if the State Board of Health determines that those costs will exceed the limitations established in the federal Safe Drinking Water Act, as amended.  The administration fees may be included in loan amounts to loan recipients for the purpose of facilitating payment to the board; however, those fees may not exceed five percent (5%) of the loan amount.

     (7)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  The department shall issue a license to Alexander Milne Home for Women, Inc., a 501(c)(3) nonprofit corporation, for the construction, conversion, expansion and operation of not more than forty-five (45) beds for developmentally disabled adults who have been displaced from New Orleans, Louisiana, with the beds to be located in a certified ICF-MR facility in the City of Laurel, Mississippi.  There shall be no prohibition or restrictions on participation in the Medicaid program for the person receiving the license under this subsection (7).  The license described in this subsection shall expire five (5) years from the date of its issue.  The license authorized by this subsection shall be issued upon the initial payment by the licensee of an application fee of Sixty-seven Thousand Dollars ($67,000.00) and a monthly fee of Sixty-seven Thousand Dollars ($67,000.00) after the issuance of the license, to be paid as long as the licensee continues to operate.  The initial and monthly licensing fees shall be deposited by the State Department of Health into the special fund created under Section 41-7-188.

     (8)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  The State Department of Health is authorized to issue a license to an existing home health agency for the transfer of a county from that agency to another existing home health agency, and to charge a fee for reviewing and making a determination on the application for such transfer not to exceed one-half (1/2) of the authorized fee assessed for the original application for the home health agency, with the revenue to be deposited by the State Department of Health into the special fund created under Section 41-7-188.

     (9)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  For the period beginning July 1, 2010, through July 1, 2017, the State Department of Health is authorized and empowered to assess a fee in addition to the fee prescribed in Section 41-7-188 for reviewing applications for certificates of need in an amount not to exceed twenty-five one-hundredths of one percent (.25 of 1%) of the amount of a proposed capital expenditure, but shall be not less than Two Hundred Fifty Dollars ($250.00) regardless of the amount of the proposed capital expenditure, and the maximum additional fee permitted shall not exceed Fifty Thousand Dollars ($50,000.00).  Provided that the total assessments of fees for certificate of need applications under Section 41-7-188 and this section shall not exceed the actual cost of operating the certificate of need program.

     (10)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  The State Department of Health is authorized to extend and renew any certificate of need that has expired, and to charge a fee for reviewing and making a determination on the application for such action not to exceed one-half (1/2) of the authorized fee assessed for the original application for the certificate of need, with the revenue to be deposited by the State Department of Health into the special fund created under Section 41-7-188.

     (11)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  The State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of any institution for the aged or infirm, including any other remedy less than closure to protect the health and safety of the residents of said institution or the health and safety of the general public.

     (12)  Notwithstanding any other provision to the contrary, the State Department of Health shall have the following specific powers:  The State Department of Health is authorized and empowered, to require the temporary detainment of individuals for disease control purposes based upon violation of any order of the State Health Officer, as provided in Section 41-23-5.  For the purpose of enforcing such orders of the State Health Officer, persons employed by the department as investigators shall have general arrest powers.  All law enforcement officers are authorized and directed to assist in the enforcement of such orders of the State Health Officer.

     SECTION 4.  This act shall take effect and be in force from and after July 1, 2016.

---