Little Health Law Blog
Our healthcare and business law firm previously published a blog post on the federal telemedicine rules. Both Federal and State rules govern the provision of telemedicine. Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance code, and when applicable, Medicaid rules. This post focuses specifically on North Carolina’s telemedicine prescribing rules. Our firm previously posted an overview of North Carolina’s general telemedicine rules. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
North Carolina Rules on Prescribing Based on a Telemedicine Visit
North Carolina has yet to pass any laws on telemedicine, but the North Carolina Medical Board (“Medical Board” or “NCMB”) has published telemedicine policies available on its website, here. Below is an overview of some requirements currently in North Carolina governing prescribing practices from a telemedicine visit.
Licensees are expected to practice in accordance with the Board’s Position Statement “Contact with Patients Before Prescribing,” which provides: “It is the position of the Board that prescribing drugs to an individual the prescriber has not examined to the extent necessary for an accurate diagnosis is inappropriate except as noted in the paragraphs below. Before prescribing a drug, a licensee should make an informed medical judgment based on the circumstances of the situation and on his or her training and experience. Ordinarily, this will require that the licensee perform an appropriate history and physical examination, make a diagnosis, and formulate a therapeutic plan, a part of which might be a prescription. This process must be documented appropriately.”
The Medical Board finds that a prescriber may examine a patient sufficiently to prescribe based on a telemedicine encounter. Covid-19 Telemedicine FAQ.
However, “[i]t is the position of the Board that prescribing drugs to individuals the licensee has never met based solely on answers to a set of questions, as is common in Internet or toll-free telephone prescribing, is inappropriate and unprofessional.”
The Medical Board provides that physicians prescribing controlled substances should comply with all relevant federal and state laws. Position Statement 5.1.4: Telemedicine, NCMB.
Although the federal rules typically require an in-person visit, “From NCMB’s perspective, if it is possible to gather sufficient clinical information during a telemedicine encounter to provide care that meets at least the minimum accepted standards of care, NCMB considers it appropriate to prescribe following that encounter.” Covid-19 Telemedicine FAQ.
Further, physicians prescribing in North Carolina are expected to participate in the Controlled Substances Reporting System. For more information about North Carolina’s Controlled Substances Reporting System, click here.
- Pain Management Prescriptions Prohibited
The Medical Board finds it inconsistent “with the current standard of care to prescribe controlled substances for the treatment of pain in which the only patient encounter is by means of telemedicine and there are no other licensed healthcare providers involved in the initial and ongoing evaluations of the patient.” Position Statement 5.1.4: Telemedicine, NCMB.
As is clear from the above, medical practices must be thoughtful before prescribing from a telemedicine visit. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.