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Hello Gloria,My name isXXXXX a licensed attorney and registered nurse. I am very happy to try and answer your question today. I would also like to take a moment to wish you every success in your business pursuits.This is a great time to be delving into such waters. In fact, as you may already be aware, quite recently Arizona enacted the Telemedicine Reimbursement Parity Act, which is now the law of that state jurisdiction. I offer that comment as a general statement indicating what a favorable environment Arizona is to interested practitioners, patients and providers. More specifically, there are four statutes governing your specific circumstances. This is actually a real and unusual benefit, having an entire statutory chapter devoted to the specific topic of telemedicine, as only a minority handful of states address the topic so directly and provide statutory guidance. Otherwise, in the majority of state jurisdictions, one is pretty much left to guess. If you click on each of the following links, you will be taken directly to the laws:
Ariz. Rev. Stat. Ann. § 36-3601
Ariz. Rev. Stat. Ann. § 36-3602
Ariz. Rev. Stat. Ann. § 36-3603
Ariz. Rev. Stat. Ann. § 36-3604
That is the first step, simply reading the law. Next, read the official word promulgated by the Arizona Medical Board (it is labeled perhaps a bit off as "Internet Prescribing", but this is the current authoritative word on the topic of telemedicine):
Finally, pose specific directions directly to the source:
Arizona Medical Board
That is it for the state law aspects of telemedicine, but you also astutely raise the issue of federal privacy law. One could devote literally months of years to reading the voluminous statutes, rules and regulations promulgated upon the Health Insurance Portability and Accountability Act of 1996, Pub.L. 104–191, 110 Stat. 1936. However, for some reasonably concise resources, I would love to point you toward the following item:
Telemedicine Office of the Future
This is a very nice PowerPoint presentation from a real world perspective. Plus, it is tailored to Arizona practice, which is very nice.
The crux of the matter is this. The law already sets forth the standards and expectations for the use, storage, dissemination, transmission, etc. of protected health information and has for many years. Nothing has changed in that regard, meaning there are no "special" or "unique" "telemedicine HIPAA laws". In other words, by compliant (just as one would for a traditional "brick and mortar" medical practice) and all will be well with a telemedicine center, too.
If you have a follow-up question or need clarification, please just say the word by using "reply" to reach me. I will be sure to check back for any further word from you when I am again working online in this forum.I truly hope all works out for you and that the information I have provided proves useful. Thanks so much for using this service!Take care,Ben, J.D., R.N.
This information is helpful and I am thrilled with your background. I have read the Arizona Medical Board rules of prescribing online and in relation to telemedicine. This establishes that prescriptions should not be prescribed to patients that have not been set as established patients and thus may render the process of my business model as limited. Now, there are sites such as http://www.americanwell.com that currently offer services in the state of Arizona. They suggest and promote the idea of being able to prescribe medications for minor ailments over video conferencing. This, potentially, is in violation of the prescribing rules. Do these prescription rules apply also to nurse practitioners? If yes, I am assuming that they are functioning under some other law that would allow them to prescribe for certain conditions without a physical or "hands on" exam. Are there resources to this and what information ought I to seek out to determine those answers? I intend to initiate the venture with nurse practitioners and am not sure if this is what helps to navigate the practicing board.
Thanks so much.
That explanation is very helpful. Now as the medical board rules govern medicine, does the nursing board not govern midlevels differently? Just clarifying my understanding of such.
Now, I read the definition of telemedicine and prescribing rights as one that was only inclusive if you had previous care or "hands om" time for it to be telemedicine. As your scenario describes, this will not be required when run as a clinic format and descriptions of plans of care are appropriate and not merely drug mills?
Are there also currently any stipulations on requirements for policy and procedures, malpractice, etc? Additionally, are there any EHR requirements that will need to be addressed? We are considering creating a login based system that also allows stored video conference for provider and patient (their own of course) use. Are there any issues with that?
This has been very informative so far and I appreciate that.
I am not sure if this follow up question will go to you or not. Current Arizona law dictates or allows insurances to pay for rural telemedicine. If the model of my business venture is one of an "online clinic" - an online Minute Clinic of sorts, what are the insurance billing implications? As this is not directly a telemedicine, what are the steps to take to ensure insurance eligibility or ascertain coverage by Medicare / Medicaid? (Legalities or where to go to find answers...)
Hope you had a great week! We are still moving forward. I have been contemplating on how to protect the company. As we hire health care providers on a contract basis and require them to hold their own malpractice insurance, how do we protect ourselves from being sued for liability of practice? We will also require a contract of HIPPA understanding and compliance. Do you know if it is possible to require them to be responsible if they are contracted employees? I have been wondering if we will be required to develop our own protocols for practice. My knowledge of medical negligence extends towards treatment plans consistent with an individual of the same background engaging in the same prudent plan. Are there situations where a suit can be directed at us in this situation?
Additionally, what are the odds that you are local to Arizona or Tucson? As we move forward, and as much as I truly love this service, I imagine we will need a local lawyer. If not, do you recommend a lawyer in these areas or how do find one? I have done quite a few searches for lawyers with these qualifications and find only medical malpractice lawyers and have been told they can't help with this type of project.
Because these practitioners are online and not physically in contact with the patients, will we still be required to hold employee health records for immunizations, etc?
I also keep getting investors telling me that they believe this type of business is illegal in our state. Do you have any suggestions on what I can say to clarify this better? I have tried discussion of what we have already discussed and often find I am met with more, "I'm still not so sure..." In fact, I had one investor tell me this was completely illegal and he worked in the medical field!
Had another thought! For medical billing, we use ICD-9 coding. If we are offering a beta service of a 20 minute consult with option to prescription for a straight fee (no insurance, no billing, etc) will we still need to report ICD-9 codes to someone or are those only required with Medicard/Insurance?
Hi there Gloria,
I hope this note finds you doing well!
You pose a number of excellent additional questions. I would be pleased to consider your logical points about retaining local counsel, managing legal liability, billing and so forth if you would post here: LawHelpNow
Doing so puts your question directly to my attention, and it would be an honor to be of service to you again.
Best regards XXXXX XXXXX thanks,
Ben, J.D., R.N.
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