Last year we featured an article, Proposed Bill Addresses Use of Telemedicine in NJ, that described the proposed 53-page bill to define telemedicine in accordance with New Jersey state law. In August 2017, Governor Christie signed the bill (SB 291) and the law went into effect on July 21, 2017.
This article summarizes and explains how this law impacts providers.
Let’s look at a few of the terms and what they mean from a legal perspective:
- Telemedicine - providing a health care service using a form of electronics communication or information technology to connect a health care provider to a patient. To be specific, the law states telemedicine services must be provided, “using interactive, real-time, two-way communications technologies.” Audio-only telephone conversation, e-mail, instant messaging, phone texting, or facsimile transmissions are not considered to be telemedicine.
- Telehealth – the use of the communications and information technologies to provide a health care service. This includes telephones, remote patient monitoring devices, or other electronic means for providing for those services.
- Health Care Provider – a medical specialist with a valid license or certification granted by the state of New Jersey. This includes licensed physicians, nurses, nurse practitioners, psychologists, psychiatrists, psychoanalysts, clinical social workers, physician assistants, professional counselors, respiratory therapists, speech pathologists, audiologists, optometrists, etc.
- Asynchronous Store-and-Forward – receiving and transmitting images, diagnostics, data, and other medical information between the health care provider and the patient.
Health Care Provider Requirements
The health care provider must:
- Identify the patient. At a minimum, the provider must know the patient’s name, date of birth, phone number, and address.
- Identify themselves and credentials. This includes the provider’s name, title, and license. It could also include specialty and board certifications.
- Review the patient’s medical history and records prior to the initial consult. If there is an existing relationship between the provider and patient, this could be done during the consult.
- Pre-determine if the provider can provide the standard of care prior to the consult.
- Adhere to HIPAA. The provider must maintain a complete record of the patient’s care and comply with all applicable State and Federal statutes and regulations for recordkeeping, confidentiality, and disclosure of the patient’s medical record.
- Ensure patient has access to his or her medical information upon request. This can also be forwarded to the patient’s primary care provider or health care provider on record. If there are none, the provider can make recommendations or referrals.
- Refer the patient to appropriate follow-up if needed. This includes informing the patient of other treatment options or directing the patient to seek in-person care.
The law does allow for the following exceptions:
- Providers can perform informal non-compensatory consultations when there is no contractual relationship or if it is on an irregular or infrequent basis.
- Medical specialists located outside of New Jersey can perform episodic consultations in response to a request from a New Jersey-based provider.
- Providers can provide medical assistance in response to an emergency or disaster without an expectation of compensation.
- Designated substitute providers can act on behalf of absent providers in the same specialty on an on-call or cross-coverage basis.
- Mental health screeners, screening services, and screening psychiatrists do not need to obtain separate authorization or obtain a waiver from existing regulations prior to providing telemedicine screening services.
This law does not require the provider to obtain informed consent, but New Jersey Medicaid does require it for certain specialties.
Once a valid provider-patient relationship has been established, the provider can prescribe medications. The law does not prohibit the prescription of Schedule II controlled-substances. However, it can only be done after an initial in-person examination. In addition, the provider would need to perform in-person exams every three months for the duration of the time the patient is being prescribed the Schedule II drug. The exception to this rule is a provider can prescribe Schedule II controlled stimulant drugs for a patient under 18 years old if the provider uses interactive, real-time, two-way audio and video technologies and has written consent from the minor’s parent or guardian allowing the provider to waive the in-person exam.
Medicaid, the NJ Family Care Program, and commercial health insurance plans will provide coverage and payment for health care services at the same rate and reimbursement level as is provided for traditional care.
New Jersey Oversight
All telemedicine or telehealth organizations operating within New Jersey must annually register with the Department of Health and submit annual reports that include information, such as patient’s race and ethnicity, diagnostic codes, evaluation management codes, and source of consult payment. The New Jersey Telemedicine and Telehealth Review Commission reviews this information and will make recommendations for policy and law changes, as needed.