20 FAQs for Telemedicine Providers in Ohio

The Ohio Medical Council has just published new FAQs and tips on practicing telemedicine directed at physicians and Ohio medical assistants. The FAQs follow Ohio's rules for the prescription of drugs and controlled substances adopted by the Council in March 2017. These tips should be good news for service providers. health by telemedicine. Although often referred to as the "prescription of telemedicine" rule, the rule applies in all situations where the physician or physician assistant is in one place and the patient in another and the doctor or the PA has never personally examined the patient.

FAQ on Telemedicine in Ohio

The guide also includes the following FAQs:

Why does this FAQ include physician assistants in questions and answers when the wording of the rule says only "doctor?"

The rule applies to physician assistants because Rule 4730-1-06 of the Ohio Administrative Code states that all the rules of Chapter 4731-11 of the Administrative Code of the United States of America. Ohio apply to physician assistants. In addition, Section 4730.42 of the Revised Code of Ohio states that a supervising physician shall not confer on a physician assistant the prescriptive power delegated by a physician in a manner that exceeds the prescriptive power the supervising physician.

What is meant by the term "health care provider?"

A "health care provider" is an authorized person acting within the scope of his professional license. The term includes advanced practice nurses and physician assistants who hold normative authority.

When the patient is away from the physician or the physician assistant, does an "assessment" require the use of devices that provide a visual connection to the patient?

No.

Is there a difference between prescribing controlled and uncontrolled drugs to a patient under Rule 4731-11-09?

Yes, Controlled Drugs (or Drug Enforcement Administration [DEA]) can only be prescribed in accordance with the procedures outlined in Rule 4731-11-09 (D). Uncontrolled drugs can only be prescribed following the procedures of Rule 4731-11-09 (C).

Can the physician or the physician assistant prescribe a controlled medication to a patient who is not in the same place as the physician or the physician assistant, even if the physician or physician the physician assistant has never performed a physical exam? the patient?

Yes, paragraph (D) of the Rule lists situations in federal law that authorize an Ohio prescriber to prescribe a controlled substance to a patient that he has not personally reviewed and which is at a different place from the prescriber, as follows:

When the physician or other appropriately licensed health professional receives the patient as an active patient and meets all the requirements of 4731-11-09 (C) for uncontrolled medication prescriptions. On-call coverage or crossover coverage must be done under an agreement between the on-call physician and the health care provider.
The patient is in a hospital or clinic registered with the DEA and the patient is treated by a health care provider holding a DEA registration certificate.
The patient is in the physical presence of a health care provider holding a DEA registration certificate and the patient is being treated by that health care provider.
The doctor or the physician assistant has obtained from the DEA administrator a special DEA registration certificate. (NOTE: At the present time, the special DEA registration certificate is not available, although it may be in the future.)
Does Rule 4731-11-09 recognize the unique prescribing needs presented by patients enrolled in state-run hospice programs?

Yes, rule 4731-11-09 (D) (5) authorizes the medical director, the doctor of the hospital or the doctor treating a palliative care program authorized to prescribe a controlled substance to a distant patient whom they have not personally examined, all the following conditions are met:

Controlled drug is provided to a patient enrolled in the hospice program and
The prescription is passed to the pharmacy by a means consistent with the rules of the Ohio Pharmacy Council.
Does Rule 4731-11-09 recognize the unique prescription needs of patients in an institutional setting?

Yes, Rule 4731-11-09 authorizes a medical director or attending physician in an institutional facility as defined by the Board of Pharmacies Rule 4729-17-01 to prescribe a controlled substance at a patient who is away from the physician and the physician has never undergone a physical examination when the following conditions are met:

Controlled drug is administered to a person hospitalized or residing in that institution and
The prescription is passed to the pharmacy by a means consistent with the rules of the Ohio Pharmacy Council.
What types of institutions are included in the definition of "institutional institution?"

As defined in the Pharmacy Board Rule, an "Institutional Institution" means a hospital as defined in Section Ohio of the Ohio Revised Code, Section 3727.01, or an Ohio State Board of Pharmacy approved facility. and the Ohio Department of Health, Ohio Department of Rehabilitation and Correction, Ohio Department of Disabilities Development, or the Department of Mental Health and Addiction Services of Ohio, where medical care is provided on place and a medical record documenting episodes of care, including medications prescribed and administered. The following facilities are examples of institutional facilities:

Hospitals registered with the Ohio Department of Health
Convalescent homes
Development facilities
Long-term care facilities
Nursing homes
Psychiatric facilities
Rehabilitation facilities
Facilities for people with intellectual disabilities
Sub-level III detoxification facilities
I am a gastroenterologist and I routinely prescribe uncontrolled laxatives to patients before performing a screening colonoscopy. Am I required to interact with the patient before prescribing these uncontrolled substances?

If the patient has been referred for screening colonoscopy by a health professional with prescriptive authority, the information contained in the referral, including medical history and medical history, is sufficient for the gastroenterologist to prescribe controlled substances for the preparation of colonoscopy. The assessment by the referring health care provider with the prescriptive authority would meet the requirements of 4731-11-09 (C) (4).

I am a psychiatrist. Am I able to prescribe Schedule II controlled substance stimulants such as Vyvance or Adderall to a patient who is distant even though I have never performed an in-person examination of the patient?

In general, no. However, if the prescribing situation matches one of the exceptions listed in paragraph (D) of the rule, then the answer is yes.

I am a psychiatrist. Am I able to prescribe Schedule II controlled substance stimulants such as Vyvance or Adderall to a patient under a crossover agreement with an advanced practice nurse who can only prescribe medications of Annex II for a period of seventy-two hours?

It depends. "Crossover coverage" under Rule 4731-11-09 and Federal Law is defined as a practitioner who performs a medical assessment at the request of another practitioner who has performed a medical assessment of the patient over the course of twenty- previous four months and is temporarily unavailable to conduct an ongoing assessment. Therefore, the Advanced Practice Nurse would not be considered "unavailable" for crossover purposes if the reason given by the physician is that the registered nurse in advanced practice has not the power to prescribe controlled substances from Schedule II to the patient in question. . The advanced practice nurse should be really unavailable.

I am a physician who has entered into a collaborative agreement with a registered nurse in advanced practice or a supervisory agreement with a physician assistant. Can I rely solely on the assessment done by the registered nurse or the physician's assistant of the advanced practice for evaluation before prescribing a controlled substance to the patient?

No, not just about the assessment of the registered nurse or the physician assistant in advanced practice. Federal law recognizes that part of the assessment can be performed by a nurse or medical assistant in advanced practice. However, federal law still requires that the collaborating physician or supervisor has performed at least one in-person or telemedicine assessment of the patient in the previous twenty-four months, unless one of the situations referred to in paragraph D) of Rule 4731-11-09 applies.

In a crossover or custody situation, I plan to prescribe an uncontrolled substance to a patient that I have never physically examined. Can I rely on the patient's assessment by the nursing staff to comply with 4731-11-09 (C) (4)?

Yes, in a crossover situation, the interaction with the patient required by paragraph (C) (4) of the rule may be coordinated by another licensed health care provider acting in the framework of his professional license. Examples of licensed health care providers include a nurse, pharmacist or physician assistant. "Crossover" is defined in Rule 4731-11-01 to include "on-call coverage".

Before prescribing an uncontrolled substance to a new patient through a telemedicine meeting, do I personally perform all of the steps in 4731-11-09 (C) (1) to (C) ( 9)?

The physician or the physician assistant must interact with the patient to perform a medical evaluation, as required by 4731-11-09 (C) (4), and to establish or confirm a diagnosis and a treatment plan, including the use of any prescription medication, as required by 4731-1109 (C) (5). However, all documentation and other requirements may be delegated to the appropriate personnel.

I am in a crossover arrangement with another health care provider and I cover this health care provider who is on vacation. What should I do if I consider prescribing a controlled medication to a patient of the health care provider on vacation?

The prescription of controlled substances must comply with 4731-11-09 (D):

Under (D) (1), you must comply with the requirements of paragraph (C) of the rule. See questions 15 and 16 for more information regarding compliance with the requirements of paragraph (C).
Under (D) (2) – (6), you must have sufficient information to prescribe in the minimum standards of care.
I am in a crossover arrangement as described above. What should I do if I consider prescribing an uncontrolled medicine to the same patient?

You must comply with the requirements of 4731-11-09 (C), whether or not the patient is hospitalized. However, the interaction with the patient required by subsection (C) (4) may be coordinated by another licensed health professional working under his or her professional license.

I am medical director of a hospice. Can I prescribe a drug as a controlled substance to an inpatient patient that I have never personally examined?

Yes, 4731-11-09 (D) (5) allows you to do this when you comply with the requirements of this paragraph.

I am the medical director of a hospice. Can I prescribe an uncontrolled medicine at a hospice that I have never personally examined?

Yes, but you must follow all the requirements of 4731-11-09 (C). However, the interaction with the patient required by paragraph (C) (4) of the rule may be coordinated by another licensed health care provider acting under his professional license.

I am a doctor dealing with a hospice program. I plan to prescribe an uncontrolled substance to a hospice patient that I have never examined. Do I have to follow all the requirements of 4731-11-09 (C) if the patient is in a home care setting?

Yes. However, the interaction with the patient required by paragraph (C) (4) of the rule may be coordinated by another accredited health care provider acting under his professional license.

What happens if the patient is hospitalized? Do I still have to follow all the requirements of 4731-11-09 (C) in a crossover situation?

Yes. However, the interaction with the patient required by paragraph (C) (4) of the rule may be coordinated by another accredited health care provider acting under his professional license.

I am the doctor for a home health program. I am the physician collaborator for advanced practice registered nurses and the supervising physician for physician assistants who perform home visits. Many patients require controlled substances listed in Schedule II, but the situation is not one where the nurse or the advanced practice nurse is allowed by the Code revised Ohio to prescribe an Schedule II drug. Even if I have never personally examined the patient, can I prescribe an Schedule II drug to the patient based on physical examinations and assessments done by the registered nurse or the nurse? Assistant Physician Advanced Practice?

No. Although federal law recognizes that a part of the physical examination may have been performed by another licensed health professional acting as part of his or her professional license, the home health situation does not occur. is not an exception to the requirement that the prescriber have personally examined the patient before prescribing a controlled substance.

For more information on telemedicine, telehealth, virtual care and other health innovations, including the team, publications and other documents, visit the website. of Foley Telemedicine and Virtual Care .

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