Note: This is a companion piece to our parallel article discussing the various Delaware commercial insurance coverage requirements in the Act.
Delaware Gov. Jack Merkell signed into law, on July 7, 2015, a bill implementing a variety of telemedicine scope of practice rules and commercial insurance coverage requirements.
Declaring “liberty and independence” from the constraints of brick and mortar health care, Delaware became the 29th state to enact a new telemedicine Act (HB-69), unanimously passing both the House and Senate and reflecting strong bi-partisan support for telehealth in Delaware.
The language of the Act states it takes effect immediately, although as a practical matter, it may take the licensing boards some time to implement regulations underpinning the statutory changes.
The Act amends numerous provisions in Title 24 (health care professions and occupations) of the Delaware Code to account for changes to telemedicine and telehealth scope of practice. The Delaware telemedicine law includes separate, but complementary, definitions for telehealth and telemedicine.
Delaware Telehealth Scope of Practice Requirements
The changes to Delaware’s Medical Practice Act (Title 24, Chapter 17) include a new section 1769D governing the physician practice of telemedicine and telehealth in the State. The law includes the following highlights:
Creating a valid doctor-patient relationship. A valid doctor-patient relationship established through telehealth includes, but is not limited to, the following seven elements:
In-Person Examination Requirement and Exceptions. Physicians using telemedicine technologies to provide medical care to patients located in Delaware must, prior to a diagnosis and treatment, and only if a face-to-face encounter would otherwise be required if same service were not delivered in-person, provide one of the following:
Remote Prescribing. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, are held to the same standards of appropriate practice as those in traditional in-person settings. Without a prior and proper doctor-patient relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult. Prescriptions made through telemedicine under a valid doctor-patient relationship may include controlled substances (subject to any limitations as set by the Board of Medicine).
Record Keeping. The physician treating a patient through telemedicine must maintain a complete record of the patient’s care which must follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.
Exceptions. Telemedicine services may be performed without a doctor-patient relationship under the following exceptions:
Network Use. The law requires that the definition of telemedicine must include, at such time is feasible and when appropriate, utilizing the Delaware Health Information Network (DHIN) in connection with the practice of telemedicine. Presumably, this will be a subject of implementing regulations.
Other Health Care Professionals. In addition to physician practice, the Act empowers the following Delaware professional licensing boards to issue regulations regarding telehealth and telemedicine: psychologists, physician assistants, nurses, pharmacists, genetic counselors, chiropractors, respiratory care practitioners, podiatrists, dentists, occupational therapists, optometrists, mental health counselors and chemical dependency professionals, dietitians and nutritionists, and clinical social workers.
A number of Delaware 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 also indicate health care executives are optimistic on the benefits offered by telehealth. The new provisions can serve as explicit guidance to inform telehealth practitioners on how to operate within Delaware and provide meaningful virtual care services to patients in the State.
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