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Texas Rules Governing Telemedicine

Texas’ rules governing telemedicine are found in the Texas Administrative Code and Texas Occupational Code.  Below is an overview of some requirements currently in Texas governing the practice of telemedicine.

1. Establishing Practitioner-Patient Relationship

The same standard of care that applies to an in-person setting applies to health care services or procedures provided by telemedicine.  Tex. Admin. Code § 174.6 outlines the minimum standards for providing telemedicine, which includes the establishment of a practitioner-patient relationship.  Chapter 111 of the Texas Occupational Code defines a “practitioner-patient relationship” in the telemedicine context as a provider who:

“(3)  provides the telemedicine medical services . . . through the use of one of the following methods, as long as the practitioner complies with the follow-up requirements in Subsection (b), and the method allows the practitioner to have access to, and the practitioner uses, the relevant clinical information that would be required in accordance with the standard of care described in Section 111.007:

(A)  synchronous audiovisual interaction between the practitioner and the patient in another location;

(B)  asynchronous store and forward technology, including asynchronous store and forward technology in conjunction with synchronous audio interaction between the practitioner and the patient in another location, as long as the practitioner uses clinical information from:

(i)  clinically relevant photographic or video images, including diagnostic images; or

(ii)  the patient’s relevant clinical records, such as the relevant medical or dental history, laboratory and pathology results, and prescriptive histories; or

(C)  another form of audiovisual telecommunication technology that allows the practitioner to comply with the standard of care described in Section 111.007.”

Tex. Occ. Code Section 111.005.

2. Fraud and Abuse Protocols

Tex. Admin. Code § 174.3 also requires: “All physicians utilizing telemedicine medical services in their practices shall adopt protocols to prevent fraud and abuse through the use of telemedicine medical services. In order to establish that a physician has made a good faith effort these protocols must be consistent with standards established by the Health and Human Services Commission pursuant to § 531.02161 of the Government Code.”


3. Follow-Up Care & Primary Care Physician

Tex. Occ. Code Section 111.005 requires the practitioner to “(1)  provide the patient with guidance on appropriate follow-up care; and (2)  if the patient consents and the patient has a primary care physician, provide to the patient’s primary care physician within 72 hours after the practitioner provides the services to the patient a medical record or other report containing an explanation of the treatment provided by the practitioner to the patient and the practitioner’s evaluation, analysis, or diagnosis, as appropriate, of the patient’s condition.”


4. Notices of Privacy Practices & Complaint Procedure

Tex. Admin. Code § 174.4 also requires physicians to provide notice of the practice’s privacy practices and “how patients may file a complaint with the Board on the physician’s website or with informed consent materials provided to patients prior to the telemedicine medical service.”


5. Specific Rules for Providing Mental Health Services via Telemedicine

Texas has specific telemedicine rules for the provision of mental health services “[g]iven that many areas of the state lack access to mental health services and providers, the use of technology can help alleviate this shortage.”   Tex. Admin. Code § 174.9.  In response to that understanding, Texas enacted the Section 174.9 of the Administrative Code “to provide greater access to care, while [e]nsuring patient safety”  See Section 174.9 in full for further information.

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