A.R.S. tit. 36 ch. 36 — Arizona Revised Statutes Title 36 Chapter 36 — Telehealth

36-3601. Definitions In this chapter, unless the context otherwise requires: 1. "Health care decision maker" has the same meaning prescribed in section 12-2801. 2. "Health care provider": (a) Means a person who is licensed pursuant to title 32, chapter 7, 8, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 25, 27, 29, 33, 34, 35, 39, 41 or 42, or chapter 4, article 6 of this title, chapter 6, article 7 of this title or chapter 17 of this title. (b) Includes: (i) A health care institution that is licensed pursuant to chapter 4 of this title. (ii) A person who holds a training permit pursuant to title 32, chapter 13 or 17. 3. "Health care provider regulatory board or agency" means a board or agency that regulates one or more health care provider professions in this state. 4. "Telehealth" means: (a) The interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the practice of health care, assessment, diagnosis, consultation or treatment and the transfer of medical data. (b) Includes the use of an audio-only telephone encounter between the patient or client and health care provider if an audio-visual telehealth encounter is not reasonably available due to the patient's functional status, the patient's lack of technology or telecommunications infrastructure limits, as determined by the health care provider. (c) Does not include the use of a fax machine, instant messages, voicemail or email. 36-3602. Delivery of health care through telehealth; requirements; exceptions A. Except as provided in subsection G of this section, before a health care provider delivers health care through telehealth, the treating health care provider shall obtain verbal or written informed consent, including by electronic means, from the patient or the patient's health care decision maker. If the informed consent is obtained verbally, the health care provider shall document the consent on the patient's medical record. B. The patient is entitled to all existing confidentiality protections pursuant to section 12-2292. C. All medical reports resulting from a telehealth consultation are part of a patient's medical record as defined in section 12-2291. D. Dissemination of any images or information identifiable to a specific patient for research or educational purposes shall not occur without the patient's consent, unless authorized by state or federal law. E. Except as provided in subsection F of this section and for schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law. F. Services provided through telehealth are subject to this state's laws and rules governing the health care provider's scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607. G. The consent requirements of this section do not apply: 1. If the telehealth interaction does not take place in the physical presence of the patient. 2. In an emergency situation in which the patient or the patient's health care decision maker is unable to give informed consent. 3. To the transmission of diagnostic images to a health care provider serving as a consultant or the reporting of diagnostic test results by that consultant. 36-3603. State jurisdiction; scope This article applies to the practice of telehealth within this state. This article does not expand, reduce or otherwise amend the health care provider licensing requirements of title 32. 36-3604. Use of telehealth for abortion prohibited; penalty; definition A. A health care provider shall not use telehealth to provide an abortion. B. A health care provider who knowingly violates this section commits an act of unprofessional conduct and is subject to license suspension or revocation pursuant to title 32. C. For the purposes of this section, "abortion" has the same meaning prescribed in section 36-2151. 36-3605. Health care providers; determination of telehealth medium Consistent with the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607, a health care provider shall make a good faith effort in determining both of the following: 1. Whether a health care service should be provided through telehealth instead of in person. The health care provider shall use the health care provider's clinical judgment in considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the patient, including diagnosis, symptoms, history, age, physical location and access to telehealth. 2. The communication medium of telehealth and, whenever reasonably practicable, the telehealth communication medium that allows the health care provider to most effectively assess, diagnose and treat the patient. Factors the health care provider may consider in determining the communication medium include the patient's lack of access to or inability to use technology or limits in telecommunication infrastructure necessary to support interactive telehealth encounters. 36-3606. Interstate telehealth services; registration; requirements; venue; exceptions A. A health care provider who is not licensed in this state may provide telehealth services to a person located in this state if the health care provider complies with all of the following: 1. Registers with this state's applicable health care provider regulatory board or agency that licenses comparable health care providers in this state on an application prescribed by the board or agency that contains all of the following: (a) The health care provider's name. (b) Proof of the health care provider's professional licensure, including all United States jurisdictions in which the provider is licensed and the license numbers. Verification of licensure in another state shall be made through information obtained from the applicable regulatory board's website. (c) The health care provider's address, email address and telephone number, including information if the provider needs to be contacted urgently. (d) Evidence of professional liability insurance coverage. (e) Designation of a duly appointed statutory agent for service of process in this state. 2. Before prescribing a controlled substance to a patient in this state, registers with the controlled substances prescription monitoring program established pursuant to chapter 28 of this title. 3. Pays the registration fee as determined by the applicable health care provider regulatory board or agency. 4. Holds a current, valid and unrestricted license to practice in another state that is substantially similar to a license issued in this state to a comparable health care provider and is not subject to any past or pending disciplinary proceedings in any jurisdiction. The health care provider shall notify the applicable health care provider regulatory board or agency within five days after any restriction is placed on the health care provider's license or any disciplinary action is initiated or imposed. The health care provider regulatory board or agency registering the health care provider may use the national practitioner databank to verify the information submitted pursuant to this paragraph. 5. Acts in full compliance with all applicable laws and rules of this state, including scope of practice, laws and rules governing prescribing, dispensing and administering prescription drugs and devices, telehealth requirements and the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607. 6. Complies with all existing requirements of this state and any other state in which the health care provider is licensed regarding maintaining professional liability insurance, including coverage for telehealth services provided in this state. 7. Consents to this state's jurisdiction for any disciplinary action or legal proceeding related to the health care provider's acts or omissions under this article. 8. Follows this state's standards of care for that particular licensed health profession. 9. Annually updates the health care provider's registration for accuracy and submits to the applicable health care provider regulatory board or agency a report with the number of patients the provider served in this state and the total number and type of encounters in this state for the preceding year. B. A health care provider who is registered pursuant to this section may not: 1. Open an office in this state, except as part of a multistate provider group that includes at least one health care provider who is licensed in this state through the applicable health care provider regulatory board or agency. 2. Provide in-person health care services to persons located in this state without first obtaining a license through the applicable health care provider regulatory board or agency. C. A health care provider who fails to comply with the applicable laws and rules of this state is subject to investigation and both nondisciplinary and disciplinary action by the applicable health care provider regulatory board or agency in this state. For the purposes of disciplinary action by the applicable health care provider regulatory board or agency in this state, all statutory authority regarding investigating, rehabilitating and educating health care providers may be used. If a health care provider fails to comply with the applicable laws and rules of this state, the applicable health care provider regulatory board or agency in this state may revoke or prohibit the health care provider's privileges in this state, report the action to the national practitioner database and refer the matter to the licensing authority in the state or states where the health care provider possesses a professional license. In any matter or proceeding arising from such a referral, the applicable health care provider regulatory board or agency in this state may share any related disciplinary and investigative information in its possession with another state licensing board. D. The venue for any civil or criminal action arising from a violation of this section is the patient's county of residence in this state. E. A health care provider who is not licensed to provide health care services in this state but who holds an active license to provide health care services in another jurisdiction and who provides telehealth services to a person located in this state is not subject to the registration requirements of this section if either of the following applies: 1. The services are provided under one of the following circumstances: (a) In response to an emergency medication condition. (b) In consultation with a health care provider who is licensed in this state and who has the ultimate authority over the patient's diagnosis and treatment. (c) To provide after-care specifically related to a medical procedure that was delivered in person in another state. (d) To a person who is a resident of another state and the telehealth provider is the primary care provider or behavioral health provider located in the person's state of residence. 2. The health care provider provides fewer than ten telehealth encounters in a calendar year. 36-3607. Telehealth advisory committee on telehealth best practices; membership; reports A. The telehealth advisory committee on telehealth best practices is established consisting of the following members who are appointed by the governor: 1. One physician who is licensed pursuant to title 32, chapter 13. 2. One physician who is licensed pursuant to title 32, chapter 17 and who is practicing primary care in this state. 3. Two advanced practice registered nurses who are licensed pursuant to title 32, chapter 15. 4. One physician who is licensed pursuant to title 32, chapter 13 or 17 and who specializes in pain management. 5. One psychiatrist who is licensed pursuant to title 32, chapter 13 or 17. 6. One psychologist who is licensed pursuant to title 32, chapter 19.1. 7. Two behavioral health professionals who are licensed pursuant to title 32, chapter 33, one of whom is employed by an outpatient treatment center. 8. One physician who is licensed pursuant to title 32, chapter 14. 9. One health care professional whose primary area of focus is treating persons with developmental disabilities. 10. One health care professional whose primary area of focus is industrial injuries. 11. One speech-language pathologist who is licensed pursuant to chapter 17 of this title. 12. One occupational therapist who is licensed pursuant to title 32, chapter 34. 13. One hospital administrator. 14. One physician assistant who is licensed pursuant to title 32, chapter 25. 15. One representative of the Arizona commission for the deaf and the hard of hearing. 16. Two representatives of health care insurers who are licensed health care providers. 17. One optometrist who is licensed pursuant to title 32, chapter 16. 18. One representative of a vertically integrated telemedicine technology manufacturer of hardware and compatible software. 19. One behavior analyst who is licensed pursuant to title 32, chapter 19.1. 20. One representative from each of the following: (a) The Arizona health care cost containment system. (b) The department of health services. (c) The department of economic security. (d) The department of insurance and financial institutions. (e) The industrial commission of Arizona. B. The advisory committee: 1. Shall review national and other standards for telehealth best practices and relevant peer-reviewed literature. 2. May conduct public meetings at which testimony may be taken regarding the efficacy of various communications media and the types of services and populations for which telehealth is appropriate. 3. Shall adopt telehealth best practice guidelines and recommendations regarding the health care services that may be appropriately provided through an audio-only telehealth format and make updates, when applicable. Before making its recommendations, the advisory committee shall analyze medical literature and national practice guidelines, consider the comparative effectiveness and safety and the benefit to the patient of performing a service through an audio-only telehealth format instead of in person or through an audio-visual telehealth format, and the appropriate frequency and duration of audio-only telehealth encounters. 4. May authorize subcommittees to address select issues or services and report to the advisory committee as directed. 5. On or before December 1, 2021, shall submit a report to the governor, the president of the senate and the speaker of the house of representatives with the advisory committee's recommendations regarding the specific health care services that are appropriate to provide through an audio-only telehealth format as a substitute for an in-person or audio-visual telehealth encounter. 6. On or before June 30, 2022, shall submit a report to the governor, the president of the senate and the speaker of the house of representatives with the advisory committee's recommendations regarding telehealth best practice guidelines for health care providers. C. The Arizona health care cost containment system shall staff the advisory committee and provide meeting space.