Bill Text: NJ A4505 | 2024-2025 | Regular Session | Introduced
Bill Title: Codifies certain requirements and stipulations for licensed veterinarians to engage in telemedicine and telehealth.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced) 2024-06-06 - Introduced, Referred to Assembly Regulated Professions Committee [A4505 Detail]
Download: New_Jersey-2024-A4505-Introduced.html
Sponsored by:
Assemblyman ROY FREIMAN
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
Assemblyman BENJIE E. WIMBERLY
District 35 (Bergen and Passaic)
Assemblywoman ROSAURA "ROSY" BAGOLIE
District 27 (Essex and Passaic)
SYNOPSIS
Codifies certain requirements and stipulations for licensed veterinarians to engage in telemedicine and telehealth.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the use of telemedicine and telehealth by veterinarians and supplementing Title 45 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Asynchronous store-and-forward" means the acquisition and transmission of images, diagnostics, data, and medical information either to or from an originating site or to or from the licensee at a distant site, which allows for the patient to be evaluated without being physically present.
"Client" means a patient's owner, owner's agent, or other person responsible for the patient.
"Cross-coverage service" means a licensee who engages in a remote medical evaluation of a patient, without in-person contact, at the request of another licensee who has established a proper licensee-client-patient relationship with the patient.
"Distant site" means a site at which a licensee is located while providing health care services by means of telemedicine or telehealth.
"Licensee" means an individual licensed by the board as a veterinarian.
"On-call" means a licensee is available, where necessary, to physically attend to the urgent and follow-up needs of a patient for whom the licensee has temporarily assumed responsibility, as designated by the patient's primary care licensee or other health care provider of record.
"Originating site" means a site at which a patient is located at the time that health care services are provided to the patient by means of telemedicine or telehealth.
"Patient" means the animal or group of animals receiving veterinary services from a licensee.
"Telehealth" means the use of information and communications technologies, including telephones, remote patient monitoring devices, or other electronic means, to support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services in accordance with the provisions of P.L.2017, c.117 (C.45:1-61 et seq.).
"Telemedicine" means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care licensee who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening licensee, and in accordance with the provisions of P.L.2017, c.117 (C.45:1-61 et seq.) "Telemedicine" does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text, or facsimile transmission.
2. a. Prior to providing services through telemedicine or telehealth, a licensee shall determine whether providing those services through telemedicine or telehealth would be consistent with the standard of care applicable for those services when provided in-person.
b. If a licensee determines, either before or during the provision of services, that services cannot be provided through telemedicine or telehealth in a manner that is consistent with in-person standards of care, the licensee shall not provide services through telemedicine or telehealth.
c. A licensee who determines that services cannot be provided through telemedicine or telehealth pursuant to subsection b. of this section shall advise the client to obtain services in-person for the patient.
d. A licensee who provides a diagnosis, treatment, or consultation recommendation, including discussions regarding the risk and benefits of a patient's treatment options, through telemedicine or telehealth shall be held to the same standard of care or practice standards as are applicable to in-person settings.
3. a. Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client-patient relationship by:
(1) identifying the patient and the client with, at a minimum, the client's name, date of birth, phone number, and address. A licensee may also use a client's assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
(2) disclosing and validating the licensee's identity, license, title, and, if applicable, specialty and board certifications.
b. Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:
(1) review the patient's history and any available records;
(2) determine whether the standard of care when using telemedicine or telehealth would be the same as the standard provided if the services were rendered in-person. The licensee shall make this determination prior to each unique patient encounter; and
(3) provide the client the opportunity to sign a consent form that authorizes the licensee to release records of the encounter to the patient's primary care provider or other health care provider identified by the client.
c. Notwithstanding subsections a. and b. of this section, service may be provided through telemedicine or telehealth without a proper licensee-client-patient relationship if:
(1) the provision of services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
(2) the provision of services is during episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
(3) a licensee furnishes medical assistance in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
(4) a substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.
4. a. A licensee who has satisfied the requirements of section 3 of this act may provide health care services to a patient through the use of telemedicine and may engage in telehealth to support and facilitate the provision of health care services to patients.
b. Prior to providing services through telemedicine or telehealth, a licensee shall determine the patient's originating site and record this information in the patient's record.
c. A licensee providing healthcare services through telemedicine shall use interactive, real-time, two-way communication technologies, which shall include, except as provided in subsection e. of this section, a video component that allows a licensee to see a patient and client and the patient and client to see the licensee during the provision of services.
d. A licensee providing services through telemedicine or telehealth may use asynchronous store-and-forward technology to allow for the electronic transmission of:
(1) images;
(2) diagnostics;
(3) data; and
(4) medical information.
e. If, after accessing and reviewing the patient's records, a licensee determines that the licensee is able to meet the standard of care for services if they were being provided in-person without using the video component described in subsection c. of this section, the licensee may use interactive, real-time, two-way audio in combination with asynchronous store-and-forward technology, without a video component.
f. During the provision of services through telemedicine or telehealth, and after the provision of services, a licensee, or another designated licensee, shall provide the licensee's name, professional credentials, and contact information to the client. The contact information shall enable the client to contact the licensee for at least 72 hours following the provision of services, or for a longer period if warranted by the patient's circumstances and accepted standards of care.
g. Prior to providing services through telemedicine or telehealth, a licensee shall review any patient history or records provided by a client as follows:
(1) for an initial encounter with a patient, history and records shall be reviewed prior to the provision of services through telemedicine or telehealth; and
(2) for any subsequent interactions with a patient, history and records shall be reviewed either prior to the provision of services through telemedicine or telehealth or contemporaneously with the encounter with the patient.
h. After the provision of services through telemedicine or telehealth, a licensee shall provide the client, upon request, with the patient's records created due to the services provided.
i. A licensee shall provide, upon a client's written request, the patient's information to the patient's primary care provider.
j. A licensee engaging in telemedicine or telehealth shall refer a patient for follow-up care when necessary.
5. a. A licensee providing services through telemedicine or telehealth may issue a prescription to a patient if the issuance of the prescription is consistent with the standard of care or practice standards applicable to the in-person setting.
b. A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-client-patient relationship pursuant to section 3 of this act.
c. Notwithstanding subsection a. above, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.
6. A licensee who provides services through telemedicine or telehealth shall maintain a record of the care provided to a patient. The records shall comply with the requirements of section 8 of this act, and all other applicable State and federal statutes, rules, and regulations for recordkeeping, confidentiality, and disclosure of a patient's record.
7. In order to establish that a licensee has made a good faith effort to prevent fraud and abuse when providing services through telemedicine or telehealth, a licensee shall establish written protocols that address:
(1) authentication and authorization of users;
(2) authentication of the patient and client during the initial intake pursuant to paragraph (1) of subsection a. of section 3 of this act;
(3) authentication of the origin of information;
(4) the prevention of unauthorized access to the system or information;
(5) system security, including the integrity of information that is collected, program integrity, and system integrity;
(6) maintenance of documentation about system and information usage;
(7) information storage, maintenance, and transmission; and
(8) synchronization and verification of patient profile data.
8. a. Licensees who provide services through telemedicine or telehealth, or their authorized representatives, shall, prior to providing services, give clients notice regarding telemedicine and telehealth, including the risks and benefits of being treated through telemedicine or telehealth and how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate as a result of a technological or equipment failure. A licensee shall obtain a signed and dated statement indicating that the client received this notice.
b. When telemedicine or telehealth is unable to provide all pertinent clinical information that a licensee exercising ordinary skill and care would deem reasonably necessary to provide care to a patient, the licensee shall inform the client of this prior to the conclusion of the provision of care through telemedicine or telehealth and shall advise the client regarding the need for the patient to obtain an additional in-person medical evaluation reasonably able to meet the patient's needs.
9. This act shall take effect immediately.
STATEMENT
The bill codifies existing regulations to stipulate the requirements for veterinarians to follow when engaging in telemedicine and telehealth.
Specifically, the bill provides that a licensed veterinarian is responsible for determining whether providing patient services through telemedicine or telehealth is consistent with the standard of care for those same services provided in-person. The licensee is to also provide notice regarding the risks and benefits of being treated through telemedicine and telehealth.
The bill requires the licensee to establish licensee-client-patient relationships in advance of providing services through telemedicine or telehealth. In addition, the licensee will review the patient history through any available records and provide the client with the opportunity to sign applicable consent forms. The bill makes exceptions to the requirement for establishing licensee-patient-client relationships if: the purpose is for an informal consultation without the expectation of compensation; to provide consultation with a medical specialist in another jurisdiction; the assistance is provided in response to an emergency, provided there is no charge for the medical assistance; or, a substitute licensee is acting on behalf of an absent licensee on an on-call basis.
Licensees engaged in telemedicine or telehealth are required to use two-way, interactive communication technologies and may use technology to allow for the electronic transmission of images, diagnostics, data, and medical information.
Lastly, when telemedicine or telehealth is unable to provide all pertinent clinical information to provide care to the patient, the licensee is required to advise the client regarding the need for the patient to obtain an additional in-person medical evaluation.
