Are you an Ohio physician who may from time to time provide a prescription to a patient without personally conducting a physical examination? Or are you a physician practice or other organization with physicians who engage in such activity? If so, listen up.
As you may be aware, the State Medical Board of Ohio (the “Board”) recently changed its requirements governing when physicians may prescribe non-controlled and controlled substances to a patient without conducting a physical examination of the patient. (See OH ADC 4731-11-09 and OH ADC 4731-11-01.) The new regulation (the “New Rule”) is more stringent than both its predecessor rule and the parallel federal requirements in some respects. Although much of the publicity surrounding these changes focuses on the telemedicine context, the New Rule has a much broader scope. It has significantly impacted some of our clients’ call coverage programs—even those arrangements within physician groups. The rule has also impacted the operations of nursing homes and hospices.
The New Rule became effective March 23, 2017 and is currently being enforced by the Board. There is no grace period. Ohio physicians need to understand these new requirements now and ensure that their organizations immediately update existing policies and procedures to reflect these changes as appropriate.
Broadly summarized, the New Rule requires that physicians satisfy each of the following before providing a prescription (even a refill authorization) of a non-controlled substance to a person on whom the physician has not conducted a physical examination:
(1) establish the patient’s identity and physical location;
(2) obtain the patient’s informed consent for treatment through a remote examination;
(3) request the patient’s consent and, if granted, forward the medical record to the patient’s primary care provider or other health care provider, if applicable, or refer the patient to an appropriate health care provider or health care facility;
(4) through interaction with the patient, complete a medical evaluation that is appropriate for the patient and the condition with which the patient presents and that meets the minimal standards of care;
(5) establish or confirm, as applicable, a diagnosis and treatment plan (including documentation of the necessity for the utilization of a prescription drug and identification of any underlying conditions or contraindications);
(6) document in the patient’s medical record the patient’s consent to treatment through a remote evaluation, pertinent history, evaluation, diagnosis, treatment plan, underlying conditions, any contraindications, and any referrals to appropriate health care providers, including primary care providers or health care facilities;
(7) provide appropriate follow-up care or recommend follow-up care in accordance with the minimal standards of care;
(8) make the medical record of the visit available to the patient; and
(9) use appropriate technology that is sufficient for the physician to conduct all steps described above as if the medical evaluation occurred in an in-person visit.
Additional new requirements apply for the provision of controlled substance prescriptions when the physician has not conducted a physical examination.