1.1                          A bill for an act 
  1.2             relating to health; establishing a Minnesota 
  1.3             telemedicine network; regulating the provision of 
  1.4             interstate telemedicine services; making permanent the 
  1.5             medical assistance reimbursement of telemedicine 
  1.6             services; providing grants to establish and maintain a 
  1.7             telemedicine network; appropriating money; amending 
  1.8             Minnesota Statutes 1998, sections 144.335, subdivision 
  1.9             1; 147.081, subdivision 1; 147.091, subdivision 1; and 
  1.10            147.141; Minnesota Statutes 1999 Supplement, section 
  1.11            256B.0625, subdivision 3b; proposing coding for new 
  1.12            law in Minnesota Statutes, chapters 144; and 147. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  [144.1462] [TELEMEDICINE NETWORK.] 
  1.15     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
  1.16  section, "telemedicine" means the practice of medicine as 
  1.17  defined in section 147.081, subdivision 3, when the physician is 
  1.18  not in the physical presence of the patient. 
  1.19     Subd. 2.  [NETWORK ESTABLISHED.] (a) The commissioner shall 
  1.20  make grants, within the limit of available appropriations, to 
  1.21  establish and maintain a Minnesota telemedicine network.  The 
  1.22  network is an interoperable linkage between hospitals.  The goal 
  1.23  of the grant program is to create and maintain a network 
  1.24  initially connecting all Minnesota hospitals and eventually 
  1.25  connecting a wide variety of health care service delivery sites 
  1.26  to encourage and foster the delivery of telemedicine services. 
  1.27     (b) The commissioner may make grants to: 
  1.28     (1) groups of two or more hospitals to connect them with 
  1.29  each other and with the telemedicine network.  Grants to 
  2.1   hospitals that are not in an existing network shall be for 50 
  2.2   percent of the cost of necessary premises, premises equipment, 
  2.3   network equipment, and fixed annual transmission costs; and 
  2.4      (2) existing networks for up to 50 percent of fixed annual 
  2.5   equipment leasing costs, network upgrade costs, fixed annual 
  2.6   transmission costs, premises equipment, and network equipment 
  2.7   and fixed annual transmission costs of network expansion to 
  2.8   additional hospitals, provided the network makes an 
  2.9   interoperable connection with the Minnesota telemedicine network.
  2.10     (c) In making grants, the commissioner shall give 
  2.11  preference to applicants that emphasize using telemedicine to 
  2.12  forge community linkages, including connections between school 
  2.13  nurses and other community-based health care providers and local 
  2.14  hospitals or other educational and community medical resources. 
  2.15     (d) Grantees must use internationally approved standards 
  2.16  for operation of the network adopted by the commissioner in 
  2.17  consultation with the office of technology. 
  2.18     (e) The commissioner may establish an advisory council to 
  2.19  assist the commissioner in awarding grants, establishing the 
  2.20  network, and monitoring network operation. 
  2.21     Sec. 2.  Minnesota Statutes 1998, section 144.335, 
  2.22  subdivision 1, is amended to read: 
  2.23     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
  2.24  section, the following terms have the meanings given them: 
  2.25     (a) "Patient" means a natural person who has received 
  2.26  health care services from a provider for treatment or 
  2.27  examination of a medical, psychiatric, or mental condition, the 
  2.28  surviving spouse and parents of a deceased patient, or a person 
  2.29  the patient appoints in writing as a representative, including a 
  2.30  health care agent acting pursuant to chapter 145C, unless the 
  2.31  authority of the agent has been limited by the principal in the 
  2.32  principal's health care directive.  Except for minors who have 
  2.33  received health care services pursuant to sections 144.341 to 
  2.34  144.347, in the case of a minor, patient includes a parent or 
  2.35  guardian, or a person acting as a parent or guardian in the 
  2.36  absence of a parent or guardian. 
  3.1      (b) "Provider" means (1) any person who furnishes health 
  3.2   care services and is regulated to furnish the services pursuant 
  3.3   to chapter 147, 147A, 147B, 147C, 148, 148B, 148C, 150A, 151, 
  3.4   153, or 153A, or Minnesota Rules, chapter 4666; (2) a home care 
  3.5   provider licensed under section 144A.46; (3) a health care 
  3.6   facility licensed pursuant to this chapter or chapter 144A; (4) 
  3.7   a physician assistant registered under chapter 147A; and (5) an 
  3.8   unlicensed mental health practitioner regulated pursuant to 
  3.9   sections 148B.60 to 148B.71. 
  3.10     (c) "Individually identifiable form" means a form in which 
  3.11  the patient is or can be identified as the subject of the health 
  3.12  records. 
  3.13     (d) "Telemedicine" means the practice of medicine as 
  3.14  defined in section 147.081, subdivision 3, when the physician is 
  3.15  not in the physical presence of the patient. 
  3.16     (e) "Health record" includes any data or record in any 
  3.17  format that is created, stored, or transmitted during the 
  3.18  delivery of health care through telemedicine. 
  3.19     Sec. 3.  [147.032] [INTERSTATE PRACTICE OF TELEMEDICINE.] 
  3.20     Subdivision 1.  [REQUIREMENTS REGISTRATION.] (a) A 
  3.21  physician not licensed to practice medicine in this state may 
  3.22  provide medical services to a patient located in this state 
  3.23  through interstate telemedicine if the following conditions are 
  3.24  met: 
  3.25     (1) the physician is licensed without restriction to 
  3.26  practice medicine in the state from which the physician provides 
  3.27  telemedicine services; 
  3.28     (2) the physician has not had a license to practice 
  3.29  medicine revoked or restricted in any state or jurisdiction; 
  3.30     (3) the physician does not open an office in this state, 
  3.31  does not meet with patients in this state, and does not receive 
  3.32  calls in this state from patients; and 
  3.33     (4) the physician annually registers with the board, on a 
  3.34  form provided by the board. 
  3.35     (b) To register with the board, a physician must: 
  3.36     (1) state the physician's intention to provide interstate 
  4.1   telemedicine services in this state; 
  4.2      (2) provide complete information on: 
  4.3      (i) all states and jurisdictions in which the physician is 
  4.4   currently licensed; 
  4.5      (ii) any states or jurisdictions in which the physician was 
  4.6   previously licensed; 
  4.7      (iii) any negative licensing actions taken previously 
  4.8   against the physician in any state or jurisdiction; and 
  4.9      (iv) other information requested by the board; and 
  4.10     (3) pay a registration fee to be established by the board 
  4.11  at the minimum level necessary to recoup the costs of the 
  4.12  registration program. 
  4.13     (c) A physician registered to provide interstate 
  4.14  telemedicine services under this section must immediately notify 
  4.15  the board of restrictions placed on the physician's license to 
  4.16  practice in any state or jurisdiction. 
  4.17     (d) In registering to provide interstate telemedicine 
  4.18  services to state residents under this section, a physician is 
  4.19  agreeing to be subject to state laws, the state judicial system, 
  4.20  and the board with respect to the provision of medical services 
  4.21  to state residents. 
  4.22     (e) For the purposes of this section, telemedicine means 
  4.23  the practice of medicine defined in section 147.081, subdivision 
  4.24  3, when the physician is not in the physical presence of the 
  4.25  patient. 
  4.26     Subd. 2.  [EXEMPTIONS FROM REGISTRATION.] A physician who 
  4.27  is not licensed to practice medicine in this state, but who 
  4.28  holds a valid license to practice medicine in another state or 
  4.29  jurisdiction, and who provides interstate telemedicine services 
  4.30  to a patient located in this state is not subject to the 
  4.31  registration requirement of subdivision 1, paragraph (a), clause 
  4.32  (4), if: 
  4.33     (1) the services are provided in response to an emergency 
  4.34  medical condition.  For the purposes of this section, an 
  4.35  emergency medical condition means a condition, including 
  4.36  emergency labor and delivery, that manifests itself by acute 
  5.1   symptoms of sufficient severity, including severe pain, that the 
  5.2   absence of immediate medical attention could reasonably be 
  5.3   expected to result in placing the patient's health in serious 
  5.4   jeopardy, serious impairment to bodily functions, or serious 
  5.5   dysfunction of any body organ or part; 
  5.6      (2) the services are provided on an irregular or infrequent 
  5.7   basis.  For the purposes of this section, a person provides 
  5.8   services on an irregular or infrequent basis if the person 
  5.9   provides the services less than once a month or provides the 
  5.10  services to fewer than ten patients annually; or 
  5.11     (3) the physician provides interstate telemedicine services 
  5.12  in this state in consultation with a physician licensed in this 
  5.13  state and the Minnesota physician retains ultimate authority 
  5.14  over the diagnosis and care of the patient. 
  5.15     Subd. 3.  [NOTIFICATION TO OTHER STATES.] The board shall 
  5.16  obtain confirmation of licensure from all states and 
  5.17  jurisdictions in which a physician registered under subdivision 
  5.18  1 has ever been licensed for the purpose of verifying statements 
  5.19  made by the physician and in order to be notified if any future 
  5.20  adverse action is taken against the physician's license in 
  5.21  another state or jurisdiction.  This requirement does not 
  5.22  replace the reporting obligation under section 147.111. 
  5.23     Sec. 4.  Minnesota Statutes 1998, section 147.081, 
  5.24  subdivision 1, is amended to read: 
  5.25     Subdivision 1.  [UNLAWFUL PRACTICE OF MEDICINE.] It is 
  5.26  unlawful for any person not holding a valid license issued in 
  5.27  accordance with this chapter to practice medicine as defined in 
  5.28  subdivision 3 in this state unless: 
  5.29     (1) the person holds a valid license issued in accordance 
  5.30  with this chapter; or 
  5.31     (2) the person is registered to provide interstate 
  5.32  telemedicine services according to section 147.032. 
  5.33     Sec. 5.  Minnesota Statutes 1998, section 147.091, 
  5.34  subdivision 1, is amended to read: 
  5.35     Subdivision 1.  [GROUNDS LISTED.] The board may refuse to 
  5.36  grant a license, may refuse to grant registration to perform 
  6.1   interstate telemedicine services, or may impose disciplinary 
  6.2   action as described in section 147.141 against any physician.  
  6.3   The following conduct is prohibited and is grounds for 
  6.4   disciplinary action: 
  6.5      (a) Failure to demonstrate the qualifications or satisfy 
  6.6   the requirements for a license contained in this chapter or 
  6.7   rules of the board.  The burden of proof shall be upon the 
  6.8   applicant to demonstrate such qualifications or satisfaction of 
  6.9   such requirements. 
  6.10     (b) Obtaining a license by fraud or cheating, or attempting 
  6.11  to subvert the licensing examination process.  Conduct which 
  6.12  subverts or attempts to subvert the licensing examination 
  6.13  process includes, but is not limited to:  (1) conduct which 
  6.14  violates the security of the examination materials, such as 
  6.15  removing examination materials from the examination room or 
  6.16  having unauthorized possession of any portion of a future, 
  6.17  current, or previously administered licensing examination; (2) 
  6.18  conduct which violates the standard of test administration, such 
  6.19  as communicating with another examinee during administration of 
  6.20  the examination, copying another examinee's answers, permitting 
  6.21  another examinee to copy one's answers, or possessing 
  6.22  unauthorized materials; or (3) impersonating an examinee or 
  6.23  permitting an impersonator to take the examination on one's own 
  6.24  behalf. 
  6.25     (c) Conviction, during the previous five years, of a felony 
  6.26  reasonably related to the practice of medicine or osteopathy.  
  6.27  Conviction as used in this subdivision shall include a 
  6.28  conviction of an offense which if committed in this state would 
  6.29  be deemed a felony without regard to its designation elsewhere, 
  6.30  or a criminal proceeding where a finding or verdict of guilt is 
  6.31  made or returned but the adjudication of guilt is either 
  6.32  withheld or not entered thereon.  
  6.33     (d) Revocation, suspension, restriction, limitation, or 
  6.34  other disciplinary action against the person's medical license 
  6.35  in another state or jurisdiction, failure to report to the board 
  6.36  that charges regarding the person's license have been brought in 
  7.1   another state or jurisdiction, or having been refused a license 
  7.2   by any other state or jurisdiction.  
  7.3      (e) Advertising which is false or misleading, which 
  7.4   violates any rule of the board, or which claims without 
  7.5   substantiation the positive cure of any disease, or professional 
  7.6   superiority to or greater skill than that possessed by another 
  7.7   physician. 
  7.8      (f) Violating a rule promulgated by the board or an order 
  7.9   of the board, a state, or federal law which relates to the 
  7.10  practice of medicine, or in part regulates the practice of 
  7.11  medicine including without limitation sections 148A.02, 609.344, 
  7.12  and 609.345, or a state or federal narcotics or controlled 
  7.13  substance law. 
  7.14     (g) Engaging in any unethical conduct; conduct likely to 
  7.15  deceive, defraud, or harm the public, or demonstrating a willful 
  7.16  or careless disregard for the health, welfare or safety of a 
  7.17  patient; or medical practice which is professionally 
  7.18  incompetent, in that it may create unnecessary danger to any 
  7.19  patient's life, health, or safety, in any of which cases, proof 
  7.20  of actual injury need not be established. 
  7.21     (h) Failure to supervise a physician's assistant or failure 
  7.22  to supervise a physician under any agreement with the board. 
  7.23     (i) Aiding or abetting an unlicensed person in the practice 
  7.24  of medicine, except that it is not a violation of this paragraph 
  7.25  for a physician to employ, supervise, or delegate functions to a 
  7.26  qualified person who may or may not be required to obtain a 
  7.27  license or registration to provide health services if that 
  7.28  person is practicing within the scope of that person's license 
  7.29  or registration or delegated authority. 
  7.30     (j) Adjudication as mentally incompetent, mentally ill or 
  7.31  mentally retarded, or as a chemically dependent person, a person 
  7.32  dangerous to the public, a sexually dangerous person, or a 
  7.33  person who has a sexual psychopathic personality by a court of 
  7.34  competent jurisdiction, within or without this state.  Such 
  7.35  adjudication shall automatically suspend a license for the 
  7.36  duration thereof unless the board orders otherwise. 
  8.1      (k) Engaging in unprofessional conduct.  Unprofessional 
  8.2   conduct shall include any departure from or the failure to 
  8.3   conform to the minimal standards of acceptable and prevailing 
  8.4   medical practice in which proceeding actual injury to a patient 
  8.5   need not be established. 
  8.6      (l) Inability to practice medicine with reasonable skill 
  8.7   and safety to patients by reason of illness, drunkenness, use of 
  8.8   drugs, narcotics, chemicals or any other type of material or as 
  8.9   a result of any mental or physical condition, including 
  8.10  deterioration through the aging process or loss of motor skills. 
  8.11     (m) Revealing a privileged communication from or relating 
  8.12  to a patient except when otherwise required or permitted by law. 
  8.13     (n) Failure by a doctor of osteopathy to identify the 
  8.14  school of healing in the professional use of the doctor's name 
  8.15  by one of the following terms:  osteopathic physician and 
  8.16  surgeon, doctor of osteopathy, or D.O. 
  8.17     (o) Improper management of medical records, including 
  8.18  failure to maintain adequate medical records, to comply with a 
  8.19  patient's request made pursuant to section 144.335 or to furnish 
  8.20  a medical record or report required by law.  
  8.21     (p) Fee splitting, including without limitation: 
  8.22     (1) paying, offering to pay, receiving, or agreeing to 
  8.23  receive, a commission, rebate, or remuneration, directly or 
  8.24  indirectly, primarily for the referral of patients or the 
  8.25  prescription of drugs or devices; 
  8.26     (2) dividing fees with another physician or a professional 
  8.27  corporation, unless the division is in proportion to the 
  8.28  services provided and the responsibility assumed by each 
  8.29  professional and the physician has disclosed the terms of the 
  8.30  division; 
  8.31     (3) referring a patient to any health care provider as 
  8.32  defined in section 144.335 in which the referring physician has 
  8.33  a significant financial interest unless the physician has 
  8.34  disclosed the physician's own financial interest; and 
  8.35     (4) dispensing for profit any drug or device, unless the 
  8.36  physician has disclosed the physician's own profit interest. 
  9.1   The physician must make the disclosures required in this clause 
  9.2   in advance and in writing to the patient and must include in the 
  9.3   disclosure a statement that the patient is free to choose a 
  9.4   different health care provider.  This clause does not apply to 
  9.5   the distribution of revenues from a partnership, group practice, 
  9.6   nonprofit corporation, or professional corporation to its 
  9.7   partners, shareholders, members, or employees if the revenues 
  9.8   consist only of fees for services performed by the physician or 
  9.9   under a physician's direct supervision, or to the division or 
  9.10  distribution of prepaid or capitated health care premiums, or 
  9.11  fee-for-service withhold amounts paid under contracts 
  9.12  established under other state law.  
  9.13     (q) Engaging in abusive or fraudulent billing practices, 
  9.14  including violations of the federal Medicare and Medicaid laws 
  9.15  or state medical assistance laws.  
  9.16     (r) Becoming addicted or habituated to a drug or intoxicant.
  9.17     (s) Prescribing a drug or device for other than medically 
  9.18  accepted therapeutic or experimental or investigative purposes 
  9.19  authorized by a state or federal agency or referring a patient 
  9.20  to any health care provider as defined in section 144.335 for 
  9.21  services or tests not medically indicated at the time of 
  9.22  referral.  
  9.23     (t) Engaging in conduct with a patient which is sexual or 
  9.24  may reasonably be interpreted by the patient as sexual, or in 
  9.25  any verbal behavior which is seductive or sexually demeaning to 
  9.26  a patient.  
  9.27     (u) Failure to make reports as required by section 147.111 
  9.28  or to cooperate with an investigation of the board as required 
  9.29  by section 147.131. 
  9.30     (v) Knowingly providing false or misleading information 
  9.31  that is directly related to the care of that patient unless done 
  9.32  for an accepted therapeutic purpose such as the administration 
  9.33  of a placebo. 
  9.34     (w) Aiding suicide or aiding attempted suicide in violation 
  9.35  of section 609.215 as established by any of the following: 
  9.36     (1) a copy of the record of criminal conviction or plea of 
 10.1   guilty for a felony in violation of section 609.215, subdivision 
 10.2   1 or 2; 
 10.3      (2) a copy of the record of a judgment of contempt of court 
 10.4   for violating an injunction issued under section 609.215, 
 10.5   subdivision 4; 
 10.6      (3) a copy of the record of a judgment assessing damages 
 10.7   under section 609.215, subdivision 5; or 
 10.8      (4) a finding by the board that the person violated section 
 10.9   609.215, subdivision 1 or 2.  The board shall investigate any 
 10.10  complaint of a violation of section 609.215, subdivision 1 or 2. 
 10.11     (x) Practice of a board-regulated profession under lapsed 
 10.12  or nonrenewed credentials. 
 10.13     (y) Failure to repay a state or federally secured student 
 10.14  loan in accordance with the provisions of the loan. 
 10.15     (z) Providing interstate telemedicine services other than 
 10.16  according to section 147.032. 
 10.17     Sec. 6.  Minnesota Statutes 1998, section 147.141, is 
 10.18  amended to read: 
 10.19     147.141 [FORMS OF DISCIPLINARY ACTION.] 
 10.20     When the board finds that a licensed physician or a 
 10.21  physician registered under section 147.032 has violated a 
 10.22  provision or provisions of sections 147.01 to 147.22, it may do 
 10.23  one or more of the following:  
 10.24     (1) revoke the license; 
 10.25     (2) suspend the license; 
 10.26     (3) revoke or suspend registration to perform interstate 
 10.27  telemedicine; 
 10.28     (4) impose limitations or conditions on the physician's 
 10.29  practice of medicine, including the limitation of scope of 
 10.30  practice to designated field specialties; the imposition of 
 10.31  retraining or rehabilitation requirements; the requirement of 
 10.32  practice under supervision; or the conditioning of continued 
 10.33  practice on demonstration of knowledge or skills by appropriate 
 10.34  examination or other review of skill and competence; 
 10.35     (4) (5) impose a civil penalty not exceeding $10,000 for 
 10.36  each separate violation, the amount of the civil penalty to be 
 11.1   fixed so as to deprive the physician of any economic advantage 
 11.2   gained by reason of the violation charged or to reimburse the 
 11.3   board for the cost of the investigation and proceeding; 
 11.4      (5) (6) order the physician to provide unremunerated 
 11.5   professional service under supervision at a designated public 
 11.6   hospital, clinic, or other health care institution; or 
 11.7      (6) (7) censure or reprimand the licensed physician. 
 11.8      Sec. 7.  Minnesota Statutes 1999 Supplement, section 
 11.9   256B.0625, subdivision 3b, is amended to read: 
 11.10     Subd. 3b.  [TELEMEDICINE CONSULTATIONS.] (a) Medical 
 11.11  assistance covers telemedicine consultations.  Telemedicine 
 11.12  consultations must be made via two-way, interactive video or 
 11.13  store-and-forward technology.  Store-and-forward technology 
 11.14  includes telemedicine consultations that do not occur in real 
 11.15  time via synchronous transmissions, and that do not require a 
 11.16  face-to-face encounter with the patient for all or any part of 
 11.17  any such telemedicine consultation.  The patient record must 
 11.18  include a written opinion from the consulting physician 
 11.19  providing the telemedicine consultation.  A communication 
 11.20  between two physicians that consists solely of a telephone 
 11.21  conversation is not a telemedicine consultation.  Coverage is 
 11.22  limited to three telemedicine consultations per recipient per 
 11.23  calendar week.  Telemedicine consultations shall be paid at the 
 11.24  full allowable rate. 
 11.25     (b) This subdivision expires July 1, 2001. 
 11.26     Sec. 8.  [APPROPRIATION.] 
 11.27     $....... is appropriated from the general fund to the 
 11.28  commissioner of health for the fiscal year beginning July 1, 
 11.29  2000, for grants under section 1.