United States: Key Takeaways From Indiana's New Telemedicine Law

Indiana Gov. Mike Pence (R) signed into law, on March 21, 2016, a new bill (House Act No. 1263) implementing a variety of telemedicine practice standards and remote prescribing rules in the Hoosier State. Effective July 1, 2016, the new law replaces the old Indiana Telehealth Pilot Program, which is set to self-expire on that same date. The success of Indiana's Telehealth Pilot Program led to the enactment of the new statute, which passed the House and Senate near unanimously, reflecting strong bi-partisan support for telemedicine in Indiana. The new statute may potentially require the Board of Medicine to rewrite some of its current telemedicine regulations to the extent the prior regulations conflict with the controlling provisions of the statute.

The bill creates a new chapter in the Indiana Code (IC 25-1-9.5). Interested telemedicine companies and health care providers looking to offer telemedicine services in Indiana should review the new statute and adjust your policies and processes accordingly.

  • Telemedicine. Telemedicine is defined as the delivery of health care services using electronic communications and information technology between a provider in one location and a patient in another location, including: 1) secure videoconferencing; 2) interactive audio-using store and forward technology; or 3) remote patient monitoring technology. Telemedicine does not include the use of the following: 1) audio-only communication; 2) a telephone call; 3) electronic mail; 4) an instant messaging conversation; 5) facsimile; 6) internet questionnaire; 7) telephone consultation; or 8) internet consultation.
  • Physician-Patient Relationship. Physicians utilizing telemedicine must establish a proper physician-patient relationship by, among other things, conducting an appropriate examination. The examination does not require an in-person visit. However, the examination must at a minimum include the following eight elements:
    • Obtain the patient's name and contact information and: 1) a verbal statement or other data from the patient identifying the patient's location; and 2) to the extent reasonably possible, the identity of the requesting patient.
    • Disclose the provider's name and disclose whether the provider is a physician, physician assistant, advanced practice nurse, or optometrist.
    • Obtain informed consent from the patient.
    • Obtain the patient's medical history and other information necessary to establish a diagnosis.
    • Discuss with the patient the: 1) diagnosis; 2) evidence for the diagnosis; and 3) risks and benefits of various treatment options, including when it is advisable to seek in-person care.
    • Create and maintain a medical record for the patient and, subject to the consent of the patient, notify the patient's primary care provider of any prescriptions the provider has written for the patient if the primary care provider's contact information is provided by the patient. (This requirement does not apply when the provider is using an electronic health record system that the patient's primary care provider is authorized to access.)
    • Issue proper instructions for appropriate follow-up care.
    • Provide a telemedicine visit summary to the patient, including information that indicates any prescription that is being prescribed.
  • Standard of Care. A provider who provides health care services through telemedicine is held to the same standards of appropriate practice as those in traditional in-person settings.
  • Remote Prescribing. Remote prescribing is permitted, subject to certain conditions. A provider may issue a prescription to a patient who is receiving services via telemedicine without any prior in-person exam if the following five conditions are met:
    • The provider has satisfied the applicable standard of care in the treatment of the patient.
    • The issuance of the prescription by the provider is within the provider's scope of practice and certification.
    • The prescription is not for a controlled substance (defined in IC 35-48-1-9).
    • The prescription is not for an abortion inducing drug (defined in IC 16-18-2-1.6).
    • The prescription is not for an ophthalmic device, including: 1) glasses; 2) contact lenses; or 3) low vision devices.
  • Informed Consent. Informed consent to telemedicine services is required.
  • Patient Records. A patient record must be created for every telemedicine visit. The maintenance and confidentiality of the records must be consistent with state and federal law. Subject to the consent of the patient, the telemedicine provider must notify the patient's primary care provider of any prescriptions the provider has written for the patient if the primary care provider's contact information is provided by the patient.
  • Other Health Care Professionals In addition to physicians, the law empowers the following Indiana licensed professionals to provide services via telemedicine: physician assistants, advanced practice nurses, and optometrists.

Certification Requirement for Telemedicine Providers Physically Located Outside Indiana

The new law also imposes a peculiar certification requirement for telemedicine providers physically located outside Indiana. The language suggests it may be targeted at telehealth companies (per the reference to the provider's employer or contractor), rather than individual providers, but it remains unclear absent a review of the legislative history behind this particular provision. The intent seems to formally bring such providers and companies under the State's jurisdiction for enforcement oversight and negligence claims. It may be well-intended, but the requirement to have each provider complete and file a separate certification form with the Board might be considered form over function and an unnecessary administrative burden. We may see further clarity when the Board promulgates underlying regulations, but until then, the statute provides as follows:

  • A provider who is physically located outside Indiana is engaged in the provision of health care services in Indiana when he or she: 1) establishes a provider-patient relationship via telemedicine with; or 2) determines whether to issue a prescription via telemedicine for; an individual who is located in Indiana.
  • Such a provider may not establish a provider-patient relationship via telemedicine or issue a prescription for an individual located in Indiana unless the provider and the provider's employer or the provider's contractor have certified in writing to the Indiana professional licensing agency (e.g., the Board of Medicine), in a manner specified by that agency, that the provider and the provider's employer or provider's contractor agree to be subject to: 1) the jurisdiction of the courts of law of Indiana; and 2) Indiana substantive and procedural laws; concerning any claim asserted against the provider, the provider's employer, or the provider's contractor arising from the provision of health care services via telemedicine to an individual located in Indiana at the time the services were provided.
  • The filing of the certification constitutes a voluntary waiver by the provider, the provider's employer, or the provider's contractor of any respective right to avail themselves of the jurisdiction or laws other than those in Indiana concerning the claim.
  • Note, however, a provider that practices predominately in Indiana is not required to file the certification. The statute does not define what it means to practice predominately in Indiana.
  • A provider shall renew the certification at the time the provider renews his or her license. A provider's employer or contractor is required to file the certification only at the time of initial certification.
  • A provider who violates these rules is subject to disciplinary action, and a provider's employer or contractor that violates these rules commits a Class B infraction for each act in which a certification is not filed as required.

Commercial Insurance Coverage of Telehealth Services

Indiana enacted a telehealth commercial insurance coverage law in 2015, requiring health plans to cover services provided via telehealth to the extent the service is covered in an in-person setting. The law does not include payment parity, nor does it mandate coverage for remote patient monitoring or asynchronous services.  Indiana is among the 29 states plus DC that have enacted a commercial insurance coverage law for telehealth services.

A number of Indiana hospitals and health care providers already offer telehealth services, and patients have been able to access virtual care as part of these health care delivery models. Surveys indicate health care executives are optimistic on the benefits offered by telehealth. The new law serves as express guidance to inform telehealth practitioners on how to operate within Indiana and provide virtual care services to patients in the state.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Similar Articles
Relevancy Powered by MondaqAI
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions