A2193 2R

An Act concerning telemedicine, telehealth, and emergency care services and amending P.L.2017, c.117 ¹and P.L.2022, c.35¹.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

¹[1. Section 2 of P.L.2017, c.117 (C.45:1-62) is amended to read as follows:

b. Any health care provider who uses telemedicine or engages in telehealth while providing health care services to a patient, shall: (1) be validly licensed, certified, or registered, pursuant to Title 45 of the Revised Statutes, to provide such services in the State of New Jersey; (2) remain subject to regulation by the appropriate New Jersey State licensing board or other New Jersey State professional regulatory entity; (3) act in compliance with existing requirements regarding the maintenance of liability insurance; and (4) remain subject to New Jersey jurisdiction if either the patient or the provider is located in New Jersey at the time services are provided.

c. (1) Telemedicine services shall be provided using interactive, real-time, two-way communication technologies.

(2) A health care provider engaging in telemedicine or telehealth may use asynchronous store-and-forward technology to allow for the electronic transmission of images, diagnostics, data, and medical information; except that the health care provider may use interactive, real-time, two-way audio in combination with asynchronous store-and-forward technology, without video capabilities, if, after accessing and reviewing the patient's medical records, the provider determines that the provider is able to meet the same standard of care as if the health care services were being provided in person.

(3) The identity, professional credentials, and contact information of a health care provider providing telemedicine or telehealth services shall be made available to the patient during and after the provision of services. The contact information shall enable the patient to contact the health care provider, or a substitute health care provider authorized to act on behalf of the provider who provided services, for at least 72 hours following the provision of services.

(4) A health care provider engaging in telemedicine or telehealth shall review the medical history and any medical records provided by the patient. For an initial encounter with the patient, the provider shall review the patient's medical history and medical records prior to initiating contact with the patient, as required pursuant to paragraph (3) of subsection a. of section 3 of P.L.2017, c.117 (C.45:1-63). In the case of a subsequent telemedicine or telehealth encounter conducted pursuant to an ongoing provider-patient relationship, the provider may review the information prior to initiating contact with the patient or contemporaneously with the telemedicine or telehealth encounter.

(5) Following the provision of services using telemedicine or telehealth, the patient's medical information shall be made available to the patient upon the patient's request, and, with the patient's affirmative consent, forwarded directly to the patient's primary care provider or health care provider of record, or, upon request by the patient, to other health care providers. For patients without a primary care provider or other health care provider of record, the health care provider engaging in telemedicine or telehealth may advise the patient to contact a primary care provider, and, upon request by the patient, assist the patient with locating a primary care provider or other in-person medical assistance that, to the extent possible, is located within reasonable proximity to the patient. The health care provider engaging in telemedicine or telehealth shall also refer the patient to appropriate follow up or complimentary care where necessary, [including making appropriate referrals for emergency or complimentary care, if needed] and shall make a good faith effort to directly contact and coordinate with emergency services in accordance with the standard of care and the written emergency care plan that is appropriate to the situation and to the services rendered through the telemedicine or telehealth visit. The emergency care plan shall pertain to areas where patients are located during a telemedicine or telehealth visit. A healthcare provider engaging in telemedicine or telehealth shall make a good faith effort to: provide the name and location of the patient to emergency services in oral and written form; determine the location of a patient if a patient is unaware of his or her location; and provide his or her contact information to emergency services. A healthcare provider engaging in telemedicine or telehealth shall report suicide attempts of patient during a telehealth or telemedicine visit to the Department of Health in a manner that is consistent with federal and State privacy laws emergency and document emergencies which occur during a telehealth or telemedicine visit. Consent may be implied, oral, written, or digital in nature, provided that the chosen method of consent is deemed appropriate under the standard of care.

d. (1) Any health care provider providing health care services using telemedicine or telehealth shall be subject to the same standard of care or practice standards as are applicable to in-person settings. If telemedicine or telehealth services would not be consistent with this standard of care, the health care provider shall direct the patient to seek in-person care.

(2) Diagnosis, treatment, and consultation recommendations, including discussions regarding the risk and benefits of the patient's treatment options, which are made through the use of telemedicine or telehealth, including the issuance of a prescription based on a telemedicine or telehealth encounter, shall be held to the same standard of care or practice standards as are applicable to in-person settings. Unless the provider has established a proper provider-patient relationship with the patient, a provider shall not issue a prescription to a patient based solely on the responses provided in an online questionnaire.

e. The prescription of Schedule II controlled dangerous substances through the use of telemedicine or telehealth shall be authorized only after an initial in-person examination of the patient, as provided by regulation, and a subsequent in-person visit with the patient shall be required every three months for the duration of time that the patient is being prescribed the Schedule II controlled dangerous substance. However, the provisions of this subsection shall not apply, and the in-person examination or review of a patient shall not be required, when a health care provider is prescribing a stimulant which is a Schedule II controlled dangerous substance for use by a minor patient under the age of 18, provided that the health care provider is using interactive, real-time, two-way audio and video technologies when treating the patient and the health care provider has first obtained written consent for the waiver of these in-person examination requirements from the minor patient's parent or guardian.

f. A mental health screener, screening service, or screening psychiatrist subject to the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.):

(1) shall not be required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes; and

(2) shall not be required to request and obtain a waiver from existing regulations, prior to engaging in telemedicine or telehealth.

g. A health care provider who engages in telemedicine or telehealth, as authorized by P.L.2017, c.117 (C.45:1-61 et al.), shall maintain a complete record of the patient's care, and shall comply with all applicable State and federal statutes and regulations for recordkeeping, confidentiality, and disclosure of the patient's medical record.

h. A health care provider shall not be subject to any professional disciplinary action under Title 45 of the Revised Statutes solely on the basis that the provider engaged in telemedicine or telehealth pursuant to P.L.2017, c.117 (C.45:1-61 et al.).

i. (1) In accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), the State boards or other entities that, pursuant to Title 45 of the Revised Statutes, are responsible for the licensure, certification, or registration of health care providers in the State, shall each adopt rules and regulations that are applicable to the health care providers under their respective jurisdictions, as may be necessary to implement the provisions of this section and facilitate the provision of telemedicine and telehealth services. Such rules and regulations shall, at a minimum:

(a) include best practices for the professional engagement in telemedicine and telehealth;

(b) ensure that the services patients receive using telemedicine or telehealth are appropriate, medically necessary, and meet current quality of care standards;

(c) include measures to prevent fraud and abuse in connection with the use of telemedicine and telehealth, including requirements concerning the filing of claims and maintaining appropriate records of services provided; [and]

(d) provide substantially similar metrics for evaluating quality of care and patient outcomes in connection with services provided using telemedicine and telehealth as currently apply to services provided in person; and

(e) establish requirements for emergency care plans to be used by providers who determine that a patient who is receiving services using telemedicine or telehealth is in need of emergency care services, which emergency care plans shall include standards and protocols for activating and coordinating with emergency care services providers serving the area in which the patient is located at the time of the telemedicine or telehealth encounter.

(2) In no case shall the rules and regulations adopted pursuant to paragraph (1) of this subsection require a provider to conduct an initial in-person visit with the patient as a condition of providing services using telemedicine or telehealth.

(3) The failure of any licensing board to adopt rules and regulations pursuant to this subsection shall not have the effect of delaying the implementation of this act, and shall not prevent health care providers from engaging in telemedicine or telehealth in accordance with the provisions of this act and the practice act applicable to the provider's professional licensure, certification, or registration.

(cf: P.L.2017, c.117, s.2)]¹

¹1. Section 2 of P.L.2017, c.117 (C.45:1-62) is amended to read as follows:

2. a. Unless specifically prohibited or limited by federal or State law, a health care provider who establishes a proper provider-patient relationship with a patient may remotely provide health care services to a patient through the use of telemedicine. A health care provider may also engage in telehealth as may be necessary to support and facilitate the provision of health care services to patients. Nothing in P.L.2017, c.117 (C.45:1-61 et al.) shall be construed to allow a provider to require a patient to use telemedicine or telehealth in lieu of receiving services from an in-network provider.

c. (1) Telemedicine services may be provided using interactive, real-time, two-way communication technologies or, subject to the requirements of paragraph (2) of this paragraph, asynchronous store-and-forward technology.

(2) A health care provider engaging in telemedicine or telehealth may use asynchronous store-and-forward technology to provide services with or without the use of interactive, real-time, two-way audio if, after accessing and reviewing the patient's medical records, the provider determines that the provider is able to meet the same standard of care as if the health care services were being provided in person and informs the patient of this determination at the outset of the telemedicine or telehealth encounter.

(3) (a) At the time the patient requests health care services to be provided using telemedicine or telehealth, the patient shall be clearly advised that the telemedicine or telehealth encounter may be with a health care provider who is not a physician, and that the patient may specifically request that the telemedicine or telehealth encounter be scheduled with a physician. If the patient requests that the telemedicine or telehealth encounter be with a physician, the encounter shall be scheduled with a physician.

(b) The identity, professional credentials, and contact information of a health care provider providing telemedicine or telehealth services shall be made available to the patient at the time the patient schedules services to be provided using telemedicine or telehealth, if available, or upon confirmation of the scheduled telemedicine or telehealth encounter, and shall be made available to the patient during and after the provision of services. The contact
information shall enable the patient to contact the health care provider, or a substitute health care provider authorized to act on behalf of the provider who provided services, for at least 72 hours following the provision of services. If the health care provider is not a physician, and the patient requests that the services be provided by a physician, the health care provider shall assist the patient with scheduling a telemedicine or telehealth encounter with a physician.

(5) (a)Following the provision of services using telemedicine or telehealth, the patient's medical information shall be entered into the patient's medical record, whether the medical record is a physical record, an electronic health record, or both, and, if so requested to by the patient, forwarded directly to the patient's primary care provider, health care provider of record or any other health care providers as may be specified by the patient. For patients without a primary care provider or other health care provider of record, the health care provider engaging in telemedicine or telehealth may advise the patient to contact a primary care provider, and, upon request by the patient, shall assist the patient with locating a primary care provider or other in-person medical assistance that, to the extent possible, is located within reasonable proximity to the patient. The health care provider engaging in telemedicine or telehealth shall also refer the patient to appropriate follow up care, emergency care, or complementary care where necessary [, including making appropriate referrals for in-person care or emergency or complementary care, if needed] ²[and shall make a good faith effort to directly contact and coordinate with emergency services in accordance with the standard of care and the written emergency care plan that is appropriate to the situation and to the services rendered through the telemedicine or telehealth visit. The emergency care plan shall pertain to areas where patients are located during a telemedicine or telehealth visit. A health care provider engaging in telemedicine or telehealth shall make a good faith effort to: provide the name and location of the patient to emergency services in oral, digital, or written form; determine the location of a patient if the patient is unaware of the
patient’s location; provide the provider’s and the patient’s contact information to emergency services; and obtain emergency services contact information for the patient’s location prior to the provider’s scheduled visit with the patient.], including making appropriate referrals for in-person care or emergency or complementary care, if needed. If a health care provider observes a patient experiencing a health care emergency while the patient is engaged in a telemedicine or telehealth encounter, the health care provider shall make a good faith effort to: facilitate contact and coordination with local emergency services; and remain on a synchronous connection with the patient, if the emergency arises during a synchronous connection, until emergency services have reached the patient’s location, or in the health care provider’s clinical judgment, the situation is resolved. Health care providers shall have a written emergency protocol that is appropriate pursuant to the standard of care. The written emergency protocol shall include good faith methods of enabling the health care provider to facilitate the following, if reasonably feasible: furnishing relevant information known by the provider regarding the patient to emergency services to assist in the deployment of emergency services, including the patient’s name and location; attempting to learn the patient’s approximate location at the time of the observed emergency, if the patient is not within the patient’s primary residence and is unaware of his or her current location; and furnishing the patient’s contact information to emergency services if the patient’s contact information is known and accessible to the healthcare provider.²

In a manner that is consistent with federal and State privacy laws, a health care provider engaging in telemedicine or telehealth shall document emergencies ²observed by the health care provider²which occur ²[during] while a patient is engaged in² a telemedicine or telehealth encounter ²in the patient’s medical record, and, if applicable² , report suicide attempts ²observed by the health care provider and² made by a patient during a telemedicine or telehealth encounter ²[to the Department of Health, and, if necessary, contact the 9-8-8 suicide prevention and behavioral health crisis hotline in the case of a patient experiencing a mental health emergency] , in accordance with applicable State mandatory reporting laws. The health care provider shall, if appropriate, provide a patient with contact information for the 9-8-8 suicide prevention and behavioral health crisis hotline². Consent may be implied, oral, written, or digital in nature, provided that the chosen method of consent is deemed appropriate under the standard of care.

(b) The Department of Human Services shall compile and publish on its Internet website emergency services contact information for each municipality and county in this State to effectuate the purposes of subparagraph (a) of paragraph (5) of subsection c. of this section.

(3) In the event that a mental health screener, screening service, or screening psychiatrist subject to the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.) determines that an in-person psychiatric evaluation is necessary to meet standard of care requirements, or in the event that a patient requests an in-person psychiatric evaluation in lieu of a psychiatric evaluation performed using telemedicine or telehealth, the mental health screener, screening service, or screening psychiatrist may nevertheless perform a psychiatric evaluation using telemedicine and telehealth if it is determined that the patient cannot be scheduled for an in-person psychiatric evaluation within the next 24 hours. Nothing in this paragraph shall be construed to prevent a patient who receives a psychiatric evaluation using telemedicine and telehealth as provided in this paragraph from receiving a subsequent, in-person psychiatric evaluation in connection with the same treatment event, provided that the subsequent in-person psychiatric evaluation is necessary to meet standard of care requirements for that patient.

f. A mental health screener, screening service, or screening psychiatrist subject to the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.):

(1) shall not be required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes; and

(2) shall not be required to request and obtain a waiver from existing regulations, prior to engaging in telemedicine or telehealth.

(a) include best practices for the professional engagement in telemedicine and telehealth;

(b) ensure that the services patients receive using telemedicine or telehealth are appropriate, medically necessary, and meet current quality of care standards;

(e) establish requirements for emergency care plans to be used by providers who determine that a patient who is receiving services using telemedicine or telehealth is in need of emergency care
services, which emergency care plans shall include standards and protocols for activating and coordinating with emergency care services providers serving the area in which the patient is located at the time of the telemedicine or telehealth encounter]².

(cf: P.L.2021, c.310, s.4)

¹2. Section 2 of P.L.2022, c.35 (C.26:2MM-6) is amended to read as follows:

2. a. No later than six months after the effective date of this act, the Commissioner of Human Services shall conduct a public solicitation and procurement process to contract for the services of one or more crisis hotline centers to provide crisis intervention services and crisis care coordination to individuals accessing the 9-8-8 suicide prevention and behavioral health crisis hotline. In contracting for the services of crisis hotline centers pursuant to this subsection, the commissioner shall ensure that the selected centers will provide a comprehensive, Statewide network of access 24 hours per day, seven days per week.

b. The commissioner shall not contract with a crisis hotline center pursuant to subsection a. of this section unless the center meets the standards of the National Suicide Prevention Lifeline and participates in, or has the demonstrated ability to obtain an agreement with, the National Suicide Prevention Hotline network.

c. A contracted crisis hotline center shall be responsible for receiving 9-8-8 calls and providing crisis intervention services to 9-8-8 callers, including, as appropriate:

(1) requesting the dispatch of mobile crisis teams;

(2) coordinating crisis care responses and interventions;

(3) referring callers to crisis stabilization services; and

(4) providing, or facilitating and coordinating, the provision of appropriate follow-up services, including specialized follow up services and health care provider coordination for a patient experiencing a mental health emergency, as reported to the crisis hotline center by a health care provider engaged in telemedicine or telehealth.

d. To the extent possible, and when it would not interfere with
responding to an emergency, a contracted crisis hotline center shall attempt to ascertain whether a 9-8-8 caller has children. If the caller has children and the center deems it appropriate, the center shall make a referral to services offered by the Department of Children and Families such as the Children's System of Care or any other referral agency, as appropriate.

e. A contracted crisis hotline center shall comply with all standards, operational and equipment requirements, training and qualification requirements for crisis hotline center staff, requirements concerning geolocation capacity, best practices, and other standards and requirements as are established under the "National Suicide Hotline Designation Act of 2020," Pub.L.116-172, as are established under rules and regulations adopted by the Federal Communications Commission, as applicable, and by any other federal authority having jurisdiction, and as are established under rules and regulations promulgated by the Commissioner of Human Services.

f. The commissioner shall collaborate with other State executive branch departments, offices, and agencies to ensure full communication, information sharing, and coordination among crisis and emergency response systems throughout the State for the purpose of ensuring real-time crisis care coordination including, but not limited to, the deployment of linked, flexible services specific to each crisis response. Executive branch departments, offices, and agencies shall issue any waivers as shall be necessary to implement the provisions of this subsection.

g. (1) The commissioner shall collaborate with appropriate behavioral health care providers in the State, including, but not limited to, mental health and substance use disorder treatment providers, local community mental health centers, community-based and hospital emergency departments, and inpatient psychiatric settings, to ensure the coordination of service linkages with contracted hotline centers and mobile crisis response teams and the provision of crisis stabilization services and follow-up services, as appropriate, following the crisis response for a 9-8-8 caller.

(2) The commissioner shall establish agreements and information sharing procedures, as appropriate, with behavioral health care providers as shall be necessary to implement the provisions of this subsection. Such information sharing procedures shall include, but not be limited to, the sharing of information concerning the availability of services provided by a behavioral health care provider.

h. The commissioner shall develop an informational campaign to promote awareness of the nature and availability of the 9-8-8 hotline to respond to behavioral health crises. The commissioner shall consult with the National Suicide Prevention Lifeline and the Veterans Crisis Line networks to foster consistency in public messaging concerning 9-8-8 services.¹

(cf: P.L.2022, c.35, s.2.)

¹[2.] 3.¹ This act shall take effect immediately.