Chief Sponsor: James A. Dunnigan

Senate Sponsor: ____________


8     General Description:
9          This bill amends the Telehealth Act and the Online Prescribing, Dispensing, and
10     Facilitation Licensing Act.
11     Highlighted Provisions:
12          This bill:
13          ▸     amends definitions;
14          ▸     amends provisions related to a telehealth provider establishing a provider-patient
15     relationship;
16          ▸     amends provisions related to a telehealth provider providing a patient's medical
17     record to another health care provider;
18          ▸     addresses prescribing by a provider who uses only asynchronous interaction to
19     establish a provider-patient relationship with a patient;
20          ▸     repeals an obsolete reporting requirement; and
21          ▸     makes technical changes.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None
26     Utah Code Sections Affected:
27     AMENDS:

28          26-60-102, as last amended by Laws of Utah 2020, Chapter 119
29          26-60-103, as last amended by Laws of Utah 2021, Chapter 64
30          58-83-102, as enacted by Laws of Utah 2010, Chapter 180
31          58-83-301, as enacted by Laws of Utah 2010, Chapter 180
32     REPEALS:
33          26-60-105, as last amended by Laws of Utah 2019, Chapter 249

35     Be it enacted by the Legislature of the state of Utah:
36          Section 1. Section 26-60-102 is amended to read:
37          26-60-102. Definitions.
38          As used in this chapter:
39          (1) "Asynchronous [store and forward transfer] interaction" means the [transmission]
40     exchange of a patient's health care information from an originating site to a provider at a distant
41     site that does not occur in real time.
42          (2) "Controlled substance" means the same as that term is defined in Section 58-37-2.
43          [(2)] (3) "Distant site" means the physical location of a provider delivering
44     telemedicine services.
45          [(3)] (4) "Originating site" means the physical location of a patient receiving
46     telemedicine services.
47          [(4)] (5) "Patient" means an individual seeking telemedicine services.
48          [(5) (a) "Patient-generated medical history" means medical data about a patient that the
49     patient creates, records, or gathers.]
50          [(b) "Patient-generated medical history" does not include a patient's medical record that
51     a healthcare professional creates and the patient personally delivers to a different healthcare
52     professional.]
53          (6) "Prescription drug" means the same as that term is defined in Section 58-17b-102.
54          [(6)] (7) "Provider" means an individual who is:
55          (a) licensed under [Title 26,] Chapter 21, Health Care Facility Licensing and Inspection
56     Act;
57          (b) licensed under Title 58, Occupations and Professions, to provide health care; or
58          (c) licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities.

59          [(7)] (8) "Synchronous interaction" means real-time communication through interactive
60     technology that enables a provider at a distant site and a patient at an originating site to interact
61     simultaneously through two-way audio and video transmission.
62          [(8)] (9) "Telehealth services" means the transmission of health-related services or
63     information through the use of electronic communication or information technology.
64          [(9)] (10) "Telemedicine services" means telehealth services:
65          (a) including:
66          (i) clinical care;
67          (ii) health education;
68          (iii) health administration;
69          (iv) home health;
70          (v) facilitation of self-managed care and caregiver support; or
71          (vi) remote patient monitoring occurring incidentally to general supervision; and
72          (b) provided by a provider to a patient through a method of communication that uses:
73          [(i) (A) uses asynchronous store and forward transfer; or]
74          (i) (A) asynchronous interaction; or
75          (B) [uses] synchronous interaction; and
76          (ii) meets industry security and privacy standards, including, when applicable,
77     compliance with:
78          (A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.
79     No. 104-191, 110 Stat. 1936, as amended; and
80          (B) the federal Health Information Technology for Economic and Clinical Health Act,
81     Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.
82          Section 2. Section 26-60-103 is amended to read:
83          26-60-103. Scope of telehealth practice.
84          (1) A provider offering telehealth services shall:
85          (a) at all times:
86          (i) act within the scope of the provider's license under Title 58, Occupations and
87     Professions, in accordance with the provisions of this chapter and all other applicable laws and
88     rules; and
89          (ii) be held to the same standards of practice as those applicable in traditional health

90     care settings;
91          (b) if the provider does not already have a provider-patient relationship with the
92     patient, establish a provider-patient relationship during the patient encounter:
93          (i) in a manner consistent with:
94          (A) the same standards of practice[, determined by the Division of Professional
95     Licensing in rule made in accordance with Title 63G, Chapter 3, Utah Administrative
96     Rulemaking Act] as those applicable in traditional health care settings, including providing the
97     provider's licensure and credentials to the patient; and
98          (B) rules made by the division consistent with the standards of practice described in
99     Subsection (1)(a)(ii); and
100          (ii) using synchronous or asynchronous interaction;
101          (c) before providing treatment or prescribing a prescription drug, establish a diagnosis
102     and identify underlying conditions and contraindications to a recommended treatment after:
103          (i) obtaining from the patient or another provider the patient's relevant clinical history;
104     and
105          (ii) documenting the patient's relevant clinical history and current symptoms;
106          (d) be available to a patient who receives telehealth services from the provider for
107     subsequent care related to the initial telemedicine services, in accordance with community
108     standards of practice;
109          (e) be familiar with available medical resources, including emergency resources near
110     the originating site, in order to make appropriate patient referrals when medically indicated;
111          (f) in accordance with any applicable state and federal laws, rules, and regulations,
112     generate, maintain, and make available to each patient receiving telehealth services the patient's
113     medical records; and
114          [(g) if the patient has a designated health care provider who is not the telemedicine
115     provider:]
116          [(i) consult with the patient regarding whether to provide the patient's designated health
117     care provider a medical record or other report containing an explanation of the treatment
118     provided to the patient and the telemedicine provider's evaluation, analysis, or diagnosis of the
119     patient's condition;]
120          [(ii) collect from the patient the contact information of the patient's designated health

121     care provider; and]
122          [(iii) within two weeks after the day on which the telemedicine provider provides
123     services to the patient, and to the extent allowed under HIPAA as that term is defined in
124     Section 26-18-17, provide the medical record or report to the patient's designated health care
125     provider, unless the patient indicates that the patient does not want the telemedicine provider to
126     send the medical record or report to the patient's designated health care provider.]
127          (g) if requested by the patient, provide the patient's medical record to another health
128     care provider designated by the patient, to the extent allowed under HIPAA, as defined in
129     Section 26-18-17.
130          (2) Subsection (1)(g) does not apply to prescriptions for eyeglasses or contacts.
131          [(3) Except as specifically provided in Title 58, Chapter 83, Online Prescribing,
132     Dispensing, and Facilitation Licensing Act, and unless a provider has established a
133     provider-patient relationship with a patient, a provider offering telemedicine services may not
134     diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of
135     the following:]
136          [(a) an online questionnaire;]
137          [(b) an email message; or]
138          [(c) a patient-generated medical history.]
139          (3) (a) Except as provided in Subsection (3)(b), a provider may not prescribe a
140     prescription drug to a patient if the provider:
141          (i) offers telehealth services to the patient; and
142          (ii) uses only asynchronous interaction to establish a provider-patient relationship with
143     the patient.
144          (b) A provider described in Subsection (3)(a) may prescribe a prescription drug to a
145     patient if the prescription drug:
146          (i) is not subject to Title 58, Chapter 83, Online Prescribing, Dispensing, and
147     Facilitation Licensing Act;
148          (ii) is approved by the division by rule under Subsection (4); and
149          (iii) is prescribed to the patient to treat:
150          (A) dermatological conditions;
151          (B) gastrointestinal disorders;

152          (C) infertility;
153          (D) mental health;
154          (E) metabolic disorders;
155          (F) sexual health;
156          (G) sleep disorders; and
157          (H) smoking cessation.
158          (c) A provider described in Subsection (3)(a) may order laboratory-based diagnostic
159     testing for a patient.
160          (4) (a) The division shall make rules in accordance with Title 63G, Chapter 3, Utah
161     Administrative Rulemaking Act, to specify:
162          (i) the prescription drugs that may be prescribed under Subsection (3); and
163          (ii) the conditions for which the prescription drugs described in Subsection (4)(a)(i)
164     may be prescribed.
165          (b) The division shall make rules under this Subsection (4) in collaboration with:
166          (i) the Physicians Licensing Board created in Section 58-67-201; and
167          (ii) the Osteopathic Physician and Surgeon's Licensing Board created in Section
168     58-68-201.
169          (c) The division may not authorize a provider to prescribe a controlled substance under
170     this section.
171          [(4)] (5) A provider may not offer telehealth services if:
172          (a) the provider is not in compliance with applicable laws, rules, and regulations
173     regarding the provider's licensed practice; or
174          (b) the provider's license under Title 58, Occupations and Professions, is not active and
175     in good standing.
176          Section 3. Section 58-83-102 is amended to read:
177          58-83-102. Definitions.
178          In addition to the definitions in Section 58-1-102, as used in this chapter:
179          (1) "Board" means the Online Prescribing, Dispensing, and Facilitation Licensing
180     Board created in Section 58-83-201.
181          (2) "Branching questionnaire" means an adaptive and progressive assessment tool
182     approved by the board.

183          (3) "Delivery of online pharmaceutical services" means the process in which a
184     prescribing practitioner diagnoses a patient and prescribes one or more of the drugs authorized
185     by Section 58-83-306, using:
186          (a) a branching questionnaire or other assessment tool approved by the division for the
187     purpose of diagnosing and assessing a patient's health status;
188          (b) an Internet contract pharmacy to:
189          (i) dispense the prescribed drug; or
190          (ii) transfer the prescription to another pharmacy; and
191          (c) an Internet facilitator to facilitate the practices described in Subsections (3)(a) and
192     (b).
193          [(4) "Division" means the Utah Division of Occupational and Professional Licensing.]
194          [(5)] (4) "Internet facilitator" means a licensed provider of a web-based system for
195     electronic communication between and among an online prescriber, the online prescriber's
196     patient, and the online contract pharmacy.
197          [(6)] (5) "Online contract pharmacy" means a pharmacy licensed and in good standing
198     under Chapter 17b, Pharmacy Practice Act, as either a Class A Retail Pharmacy or a Class B
199     Closed Door Pharmacy and licensed under this chapter to fulfill prescriptions issued by an
200     online prescriber through a specific Internet facilitator.
201          [(7)] (6) "Online prescriber" means a person:
202          (a) licensed under another chapter of this title;
203          (b) whose license under another chapter of this title includes assessing, diagnosing, and
204     prescribing authority for humans; and
205          (c) who has obtained a license under this chapter to engage in online prescribing.
206          [(8)] (7) "Unlawful conduct" [is as defined in Sections 58-1-501 and 58-83-501] means
207     conduct that is defined as unlawful conduct under Section 58-1-501 or 58-83-501.
208          [(9)] (8) "Unprofessional conduct" [is as defined in Sections 58-1-203 and 58-83-502,
209     and as further defined] means conduct that is defined as unprofessional conduct under Section
210     58-1-501, 58-83-502, or by the division by rule made in accordance with Title 63G, Chapter 3,
211     Utah Administrative Rulemaking Act.
212          Section 4. Section 58-83-301 is amended to read:
213          58-83-301. Licensure required -- Issuance of licenses.

214          (1) Beginning July 1, 2010, and except as provided in Section 58-1-307 and Subsection
215     26-60-102
216          (a) a physician licensed under Chapter 67, Utah Medical Practice Act, or Chapter 68,
217     Utah Osteopathic Medical Practice Act, shall be licensed under this chapter to engage in the
218     delivery of online pharmaceutical services;
219          (b) an online contract pharmacy shall be licensed under this chapter to engage in the
220     delivery of online pharmaceutical services; and
221          (c) an Internet facilitator shall be licensed under this chapter to engage in the delivery
222     of online pharmaceutical services.
223          (2) The division shall issue[,] to any person who applies and qualifies for licensure
224     under this chapter[,] a license:
225          (a) to prescribe online;
226          (b) to operate as an online contract pharmacy; or
227          (c) to operate as an Internet facilitator.
228          [(3) (a) A license under this chapter is not required to engage in electronic prescribing
229     under Chapter 82, Electronic Prescribing Act; and]
230          [(b) nothing]
231          (3) Nothing in this chapter shall prohibit a physician licensed under Chapter 67, Utah
232     Medical Practice Act, or Chapter 68, Utah Osteopathic Medical Practice Act, from [electronic
233     prescribing or Internet] prescribing as permitted by:
234          (a) Chapter 67, Utah Medical Practice Act[, or];
235          (b) Chapter 68, Utah Osteopathic Medical Practice Act[, or];
236          (c) Title 26, Chapter 60, Telehealth Act; or
237          (d) other law.
238          Section 5. Repealer.
239          This bill repeals:
240          Section 26-60-105, Study by Public Utilities, Energy, and Technology Interim
241     Committee and Health Reform Task Force.