HB 160 — AN ACT TO AMEND TITLES 18 AND 24 OF THE DELAWARE CODE RELATING TO PRESERVING TELEHEALTH AND ADOPTING THE INTERSTATE MEDICAL LICENSURE COMPACT.

(a) As used in this section:

(1) “Distant site” means a site at which a health-care provider legally allowed to practice in the State state is located while providing health-care services by means of telemedicine or telehealth.

(2) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her the patient by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding used.

Notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(4) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, health-care provider consultation, patient and professional health-related education, public health, health administration, and other services as authorized in Chapter 60 of Title 24.

and described in regulation.

(5) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services, and other services, as authorized in Chapter 60 of Title 24, by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care health-care by a health-care provider legally allowed to practice in the state and practicing within his or her the health-care provider’s scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the State while such patient is at an originating site and the health-care provider is at a distant site.

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04/27/202104/14/2021 01:0102:38 PM 2141510252Section 4.

Amend Title 24 of the Delaware Code inserting a new chapter 60 by making insertions as shown by underline and deletions as shown by strike through as follows:

Chapter 60.

Provisions Applicable to Telehealth and Telemedicine.

§ 6001.

Definitions.

As used in this chapter:

(1) “Distant site” means a site at which a health-care provider legally allowed to practice in the state is located while providing health-care services by means of telemedicine.

(2) “Health-care provider” means any person authorized to deliver clinical health-care services by telemedicine and participate in telehealth pursuant to this chapter and regulations promulgated by the respective professional boards listed in § 6002.

(3) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to the patient by means of telemedicine or telehealth.

Notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(4) “Store and forward transfer” means the synchronous or asychronous transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(5) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(6) “Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health-care.

§ 6002.

Authorization to practice by telehealth and telemedicine.

(a) Health-care providers licensed by the following professional boards existing under this title are authorized to deliver health-care services by telehealth and telemedicine subject to the provisions of this chapter:

(1) The Board of Podiatry created pursuant to Chapter 5 of this title.

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04/14/2021 02:38 PM 82 (2) The Board of Chiropractic created pursuant to Chapter 7 of this title.

(3) The Board of Medical Practice created pursuant Chapter 17 of this title.

(4) The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.

(5) The Delaware Board of Nursing created pursuant to Chapter 19 of this title.

(6) The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.

(7) The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.

(8) The Board of Pharmacy created pursuant to Chapter 25 of this title.

(9) The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.

(10) The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.

(11) The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.

(12) The Board of Social Work Examiners created pursuant to Chapter 39 of this title.

(b) A professional board listed in § 6002(a) of this title may promulgate or revise regulations and establish or revise rules applicable to health-care providers under the professional Board’s jurisdiction in order to facilitate the provision of telehealth and telemedicine services consistent with this chapter.

§ 6003.

Scope of practice;

provider-patient relationship required.

(a) Except for the instances listed in this chapter, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship.

A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include the following:

(1) Thorough verification and authentication of the location and, to the extent possible, identity of the patient.

(2) Disclosure and validation of the provider’s identity and credentials.

(3) Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.

(4) Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contra-indications, or both, for treatment recommended or provided.

(5) Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.

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04/14/2021 02:38 PM (6) The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.

(7) A written visit summary provided to the patient.

(b) Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology.

Telehealth and telemedicine services may be used to establish a provider-patient relationship only if 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.

(c) Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings.

In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

§ 6004.

Practice requirements.

(a) A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least one of the following:

(1) Provide an appropriate examination in-person.

(2) Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.

(3) Make a diagnosis using audio or visual communication.

(4) Meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

(b) After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.

(c) A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

(d) Telehealth and telemedicine services shall include, if required by the applicable professional board listed in §6002(a) of this title, use of the Delaware Health Information Network (DHIN) in connection with the practice.

(e) Nothing in this section shall be construed to limit the practice of radiology or pathology.

§ 6005.

Exceptions.

(a) Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

(1) Informal consultation performed by a health-care provider outside the context of a contractual relationship HD :

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04/14/2021 02:38 PM and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.

(2) Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.

(3) Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.

(4) Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

(b) A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services.

The Division of Professional Regulation shall require any out-of-state health- care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

Section 5.

Amend Chapter 17, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 17.

Medical Practice Act Subchapter I.

General Provisions §1702.

Definitions [Effective July 1, 2021].

(4) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine.

(11) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(17) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

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04/14/2021 02:38 PM (18) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health-care provider practicing within his or her scope of practice as would be practiced in- person with a patient, legally allowed to practice in the State, while such patient is at an originating site and the health- care provider is at a distant site.

Section 6.

Amend §1769D, Title 24 of the Delaware Code by making deletions as shown by strike through as follows:

§ 1769D Telemedicine and telehealth [Effective July 1, 2021].

(a) Physicians may practice telemedicine and telehealth.

Provided that telemedicine shall not be utilized by a physician with respect to any patient in the absence of a physician-patient relationship, except for the instances in subsection (k) of this section.

(b) Physicians who utilize telemedicine shall, if such action would otherwise be required in the provision of the same service not delivered via telemedicine, ensure that a proper physician-patient relationship is established either in- person or through telehealth which includes but is not limited to:

(1) Fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient;

(2) Disclosing and validating the provider’s identity and applicable credential or credentials;

(3) Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including informed consents regarding the use of telemedicine technologies as indicated in paragraph (b)(5) of this section;

(4) Establishing a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identify underlying conditions or contra-indications, or both, to treatment recommended or provided;

(5) Discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options;

(6) Ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care;

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04/14/2021 02:38 PM (7) Providing a written visit summary to the patient.

(c) Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.

(d) The physician treating a patient through telemedicine must maintain a complete record of the patient’s care which must follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

(e) Telemedicine shall include, at such time as feasible and when appropriate, utilizing the Delaware Health Information Network (DHIN) in connection with the practice.

(f) Without a prior and proper patient-provider relationship, as provided in subsection (b) of this section, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

(g) Prescriptions made through telemedicine and under a physician-patient relationship may include controlled substances, subject to limitations as set by the Board.

(h) Physicians using telemedicine technologies to provide medical care to patients located in Delaware must, prior to a diagnosis and treatment, either provide:

(1) An appropriate examination in-person;

(2) Have another Delaware-licensed practitioner at the originating site with the patient at the time of the diagnosis;

(3) The diagnosis must be based using both audio and visual communication;

or (4) The service meets standards of establishing a patient-physician relationship included as part of evidenced- based clinical practice guidelines in telemedicine developed by major medical specialty societies.

(i) After a physician-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient with the same physician need not satisfy the limitations of this section.

(j) Nothing in this section shall be construed to limit the practice of radiology or pathology.

(k) Telemedicine may be practiced without a physician-patient relationship during:

(1) Informal consultation performed by a physician outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;

(2) Furnishing of medical assistance by a physician in case of an emergency or disaster if no charge is made for the medical assistance;

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04/14/2021 02:38 PM (3) Episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a licensed health-care professional.

Section 7.

Chapter 5, Title 24 of the Delaware Code by making deletions as shown by strike through and re- designating accordingly:

Chapter 5.

Podiatry Subchapter I.

Board of Podiatry.

§ 502.

Definitions [Effective July 1, 2021].

The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them under this section, except when the context clearly indicates a different meaning:

(3) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(11) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(15) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(18) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(19) “Telemedicine” means the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 8.

Amend Chapter 7, Title 24 of the Delaware Code by making deletions as shown by strike through as follows:

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04/14/2021 02:38 PM Chapter 7.

Board of Chiropractic § 701.

Chiropractic defined;

limitation of chiropractic license [Effective July 1, 2021].

(2) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(3) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(4) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(5) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.(6) “Telemedicine” means a form of telehealth which the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self- management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

(b) The practice of chiropractic includes, but is not limited to, the diagnosing and locating of misaligned or displaced vertebrae (subluxation complex), using x-rays and other diagnostic test procedures.

The practice includes the use of telemedicine and may also include the practice of and participation in telehealth, as further defined in regulation.

Practice of chiropractic includes the treatment through manipulation/adjustment of the spine and other skeletal structures and the use of adjunctive procedures not otherwise prohibited by this chapter.

Section 9.

Amend Chapter 11, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 11.

Dentistry and Dental Hygiene Subchapter I.

State Board of Dentistry and Dental Hygiene § 1101.

Definitions [Effective July 1, 2021].

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04/14/2021 02:38 PM The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them under this section, except when the context clearly indicates a different meaning:

(8) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(12) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(15) “Practice of dentistry” is defined as the evaluation, diagnosis, prevention and/or and treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or and conditions of the oral cavity, maxillofacial area and/or and the adjacent and associated structures and their impact on the human body provided by a dentist within the scope of the dentist’s education, training and experience, in accordance with the ethics of the profession and applicable law.

The practice includes the use of telemedicine and may also include participation in telehealth as further defined in regulation.

A person shall be construed to practice dentistry who by verbal claim, sign, advertisement, opening of an office, or in any other way, including use of the words “dentist,” “dental surgeon,” the letters “D.D.S.,” “D.M.D.,” or other letters or titles, represents the person to be a dentist or who holds himself or herself out as able to perform, or who does perform, dental services or work.

A person shall be regarded as practicing dentistry who is a manager, proprietor, operator or conductor of a place for performing dental operations or who for a fee, salary or other reward paid, or to be paid either to himself or herself or to another person, performs or advertises to perform dental operations of any kind.

(17) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(19) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(20) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which HD :

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04/14/2021 02:38 PM facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 10.

Amend Chapter 19, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 19.

Nursing § 1902.

Definitions [Effective July 1, 2021].

(i) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(t) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to the patient by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(v) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(x) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices, or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(y) “Telemedicine” means the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

(z) “The practice of practical nursing” as a licensed practical nurse means the performance for compensation of nursing services by a person who holds a valid license pursuant to the terms of this chapter and who bears accountability for nursing practices which require basic knowledge of physical, social, and nursing sciences.

These services, at the direction of a registered nurse or a person licensed to practice medicine, surgery, or dentistry, include:

(8) The use of telemedicine, as defined in this chapter, and practice of and participation in telehealth as further HD :

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04/14/2021 02:38 PM defined in regulation.

(aa) “The practice of professional nursing” as a registered nurse means the performance of professional nursing services by a person who holds a valid license pursuant to the terms of this chapter, and who bears primary responsibility and accountability for nursing practices based on specialized knowledge, judgment, and skill derived from the principles of biological, physical, and behavioral sciences.

The registered nurse practices in the profession of nursing by the performance of activities, among which are:

(8) The use of telemedicine, as defined in this chapter, and participation in telehealth, as further defined in regulation.

Section 11.

Amend §1933, Title 24 of the Delaware Code by making deletions as shown by strike through as follows:

§ 1933 Telemedicine [Effective July 1, 2021].

(a) Telemedicine shall not be utilized by an advanced practice registered nurse (APRN) with respect to any patient in the absence of an APRN-patient relationship.

(b) APRNs who utilize telemedicine shall, if such action would otherwise be required in the provision of the same service not delivered via telemedicine, ensure that a proper APRN-patient relationship is established which includes but is not limited to:

(1) Fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient;

(2) Disclosing and validating the provider’s identity and applicable credential or credentials;

(3) Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including informed consents regarding the use of telemedicine technologies as indicated in paragraph (b)(5) of this section;

(4) Establishing a diagnosis through the use of acceptable medical practices, as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identify underlying conditions or contra-indications, or both, to treatment recommended or provided;

(5) Discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options;

(6) Ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care;

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04/14/2021 02:38 PM (7) Providing a written visit summary to the patient.

(c) Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.

(d) The APRN treating a patient through telemedicine must maintain a complete record of the patient’s care which must follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

(e) Telemedicine shall include, at such time as feasible and when appropriate, utilizing the Delaware Health Information Network (DHIN) in connection with the practice.

(f) Without a prior and proper patient-provider relationship, as provided in paragraph (b)(5) of this section, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

(g) Prescriptions made through telemedicine and under an APRN-patient relationship may include controlled substances, subject to limitations as set by the Board.

(h) This section does not apply to any of the following:

(1) Informal consultation performed by a APRN outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;

(2) Furnishing of medical assistance by a APRN in case of an emergency or disaster if no charge is made for the medical assistance;

(3) Episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a person licensed in this State.

Section 12.

Amend Chapter 20, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 20.

Occupational Therapy.

Subchapter I.

Board of Occupational Therapy Practice.

§ 2002.

Definitions [Effective July 1, 2021].

As used in this chapter:

(3) “Distant site” means a site at which a health-care provider legally allowed to practice in this State is located while providing health-care services by means of telemedicine or telehealth.

(9) a.

“Occupational therapy services” includes any of the following:

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04/14/2021 02:38 PM c.

“Occupational therapy services” or “practice of occupational therapy” may be provided through the use of telemedicine in a manner deemed appropriate by regulation and may include participation in telehealth as further defined in regulation.

(10) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to the patient by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(13) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present or that the transmission be in real time.

(16) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices, or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(17) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care by a licensee practicing within the licensee’s scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 13.

Amend Chapter 21, Title 24 of the Delaware Code by making deletions as shown by strike through as follows:

Chapter 21.

Optometry.

§ 2101.

Definition of practice of optometry [Effective July 1, 2021].

(e) The practice of optometry also includes services provided by telemedicine and participation in telehealth.

For the purposes of this section, “telehealth” is defined as the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

“Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the HD :

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04/14/2021 02:38 PM application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self- management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in- person with a patient and with other restrictions as defined in regulation.

“Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

“Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

“Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

Section 14.

Amend Chapter 25, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 25.

Pharmacy Subchapter I.

Objectives;

Definitions;

Board of Pharmacy § 2502.

Definitions [Effective July 1, 2021].

The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them under this section, except when the context clearly indicates a different meaning:

(6) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(17) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(23) “Practice of pharmacy” means the interpreting, evaluating, and dispensing of a practitioner’s or prescriber’s order.

The practice of pharmacy includes, but is not limited to, the proper compounding, labeling, packaging, and dispensing of a drug to a patient or the patient’s agent, and administering a drug to a patient.

The practice of pharmacy includes the application of the pharmacist’s knowledge of pharmaceutics, pharmacology, pharmacokinetics, drug and food interactions, drug product selection, and patient counseling.

It also includes:

g.

The use of telemedicine and participation in telehealth in a manner deemed appropriate by regulation;

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04/14/2021 02:38 PM and (30) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(33) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(34) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 15.

Amend Subchapter I, Chapter 30, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 30.

Mental Health and Chemical Dependency Professionals Subchapter I.

Board of Mental Health and Chemical Dependency Professionals § 3002.

Definitions [Effective July 1, 2021].

The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them under this section, except when the context clearly indicates a different meaning:

(3) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(6) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(8) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

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04/14/2021 02:38 PM (10) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(11) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 16.

Amend Subchapter III, Chapter 30, Title 24 of the Delaware Code by making the deletions as shown by strike through as follows:

Subchapter III.

Chemical Dependency Professionals § 3041.

Definitions [Effective July 1, 2021].

As used in this subchapter:

(1) “Chemical dependency professional” is a person who uses addiction counseling methods to assist an individual or group to develop an understanding of alcohol and drug dependency problems, define goals, and plan action reflecting the individual’s or group’s interest, abilities and needs as affected by addiction problems.

Such services may be provided through the use of telemedicine in a manner deemed appropriate by regulation.

Services also may include participation in telehealth as further defined in regulation.

Section 17.

Amend Chapter 35, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 35.

Psychology Subchapter I.

Board of Examiners of Psychologists § 3502.

Definitions [Effective July 1, 2021].

The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them under this section, except when the context clearly indicates a different meaning:

(3) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(5) “Originating site” means a site in Delaware at which a patient is located at the time health-care services HD :

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04/14/2021 02:38 PM are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(7) “Practice of psychology” shall mean the observation, description, evaluation, interpretation and/or and modification of human behavior by the application of psychological principles, methods, and/or procedures, for the purpose of preventing or eliminating symptomatic, maladaptive or undesired behavior, and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health and mental health.

The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes and neuropsychological function;

counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy;

diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as the psychological aspects of physical illness, accident, injury or disability;

and psychoeducational evaluation, therapy, remediation, and consultation.

Psychological services may be rendered to individuals, families, groups, organizations, institutions and the public.

The practice of psychology shall be construed within the meaning of this definition without regard to whether or not payment is received for services rendered.

The practice of psychology may be provided through the use of telemedicine in a manner deemed appropriate by regulation.

Services also may include participation in telehealth as further defined in regulation.

(10) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(14) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(15) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a HD :

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04/14/2021 02:38 PM patient and with other restrictions as defined in regulation.

Section 18.

Amend Chapter 38, Title 24 of the Delaware Code by making deletions as shown by strike through and re-designating accordingly:

Chapter 38.

Dietician/Nutritionist Licensure Act § 3802.

Definitions [Effective July 1, 2021].

(2) “Dietetic and nutrition therapy” shall mean the scope of services utilized in the delivery of preventive nutrition services and/or and nutrition therapy.

It involves an assessment of the individual’s specific nutritional needs and the development and implementation of an intervention plan.

The intervention plan can include nutrition education, counseling, administration and monitoring of specialized nutrition support and/or and referrals for additional services.

This application and practice of “dietetic and nutrition therapy” shall include the following Scope of Practice:

Scope of Practice:

(i) The use of telemedicine in a manner deemed appropriate by regulation.

This also may include participation in telehealth as further defined in regulation.

(5) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(9) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used;

provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(10) “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(12) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(13) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a HD :

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04/14/2021 02:38 PM patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Section 19.

Amend Chapter 39, Title 24 of the Delaware Code by making deletions as shown by strike through as follows:

Chapter 39.

Board of Social Work Examiners § 3902.

Definitions [Effective July 1, 2021].

As used in this chapter:

(13) “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(23) “Originating site” means a site in Delaware at which a client is located at the time health-care services are provided to the client by means of telemedicine or telehealth.

(27) “Store and forward transfer” means the transmission of a client’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the client being present or the transmission to be in real time.

(30) “Telehealth” means the use of information and communications technologies consisting of telephones, remote client monitoring devices, or other electronic means which support clinical health care, provider consultation, client and professional health-related education, public health, health administration, and other services as described in regulation.

(31) “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a client’s health care by a licensee practicing within the licensee’s scope of practice as would be practiced in-person with a client and with other restrictions as defined in regulation.

Section 20.

Amend Chapter 17, Title 24 of the Delaware Code by inserting a new Chapter 17A with insertions shown by underline and deletions shown by strike through as follows:

Chapter 17A.

Interstate Medical Licensure Compact § 1701A.

Interstate Medical Licensure Compact;

findings and declaration of purpose.

(a) The State hereby enters into the Interstate Medical Licensure Compact (IMLC) the text of which is as set forth in this chapter.

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04/14/2021 02:38 PM (b) In order to strengthen access to health-care, and in recognition of the advances in the delivery of health-care, the member states of the Interstate Medical Licensure Compact have allied in common purpose to develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards, provides a streamlined process that allows physicians to become licensed in multiple states, thereby enhancing the portability of a medical license and ensuring the safety of patients.

The Compact creates another pathway for licensure and does not otherwise change a state’s existing Medical Practice Act.

The Compact also adopts the prevailing standard for licensure and affirms that the practice of medicine occurs where the patient is located at the time of the physician-patient encounter, and therefore, requires the physician to be under the jurisdiction of the state medical board where the patient is located.

State medical boards that participate in the Compact retain the jurisdiction to impose an adverse action against a license to practice medicine in that state issued to a physician through the procedures in the Compact.

§ 1702A.

Definitions.

In this compact:

(a) “Bylaws” means those bylaws established by the Interstate Commission pursuant to § 1714A.

(b) “Commissioner” means the voting representative appointed by each member board pursuant to § 1711A.

(c) “Conviction” means a finding by a court that an individual is guilty of a criminal offense through adjudication, or entry of a plea of guilt or no contest to the charge by the offender.

Evidence of an entry of a conviction of a criminal offense by the court shall be considered final for purposes of disciplinary action by a member board.

(d) “Expedited License” means a full and unrestricted medical license granted by a member state to an eligible physician through the process set forth in the Compact.

(e) “Interstate Commission” means the interstate commission created pursuant to § 1711A.

(f) “License” means authorization by a member state for a physician to engage in the practice of medicine, which would be unlawful without authorization.

(g) “Medical Practice Act” means laws and regulations governing the practice of allopathic and osteopathic medicine within a member state.

(h) “Member Board” means a state agency in a member state that acts in the sovereign interests of the state by protecting the public through licensure, regulation, and education of physicians as directed by the state government.

(i) “Member State” means a state that has enacted the Compact.

(j) “Practice of Medicine” means that clinical prevention, diagnosis, or treatment of human disease, injury, or condition requiring a physician to obtain and maintain a license in compliance with the Medical Practice Act of a member state.

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04/14/2021 02:38 PM (k) “Physician” means any person who:

(1) Is a graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, or a medical school listed in the International Medical Education Directory or its equivalent.

(2) Passed each component of the United State Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) within three attempts, or any of its predecessor examinations accepted by a state medical board as an equivalent examination for licensure purposes.

(3) Successfully completed graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association.

(4) Holds specialty certification or a time-unlimited specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists.

(5) Possesses a full and unrestricted license to engage in the practice of medicine issued by a member board.

(6) Has never been convicted, received adjudication, deferred adjudication, community supervision, or deferred disposition for any offense by a court of appropriate jurisdiction.

(7) Has never held a license authorizing the practice of medicine subjected to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to non-payment of fees related to a license.

(8) Has never had a controlled substance license or permit suspended or revoked by a state or the United States Drug Enforcement Administration.

(9) Is not under active investigation by a licensing agency or law enforcement authority in any state, federal, or foreign jurisdiction.

(l) “Offense” means a felony, gross misdemeanor, or crime of moral turpitude.

(m) “Rule” means a written statement by the Interstate Commission promulgated pursuant to § 1712A of this chapter that is of general applicability, implements, interprets, or prescribes a policy or provision of the Compact, or an organizational, procedural, or practice requirement of the Interstate Commission, and has the force and effect of statutory law in a member state, and includes the amendment, repeal, or suspension of an existing rule.

(n) “State” means any state, commonwealth, district, or territory of the United States.

(o) “State of Principal License” means a member state where a physician holds a license to practice medicine and which has been designated as such by the physician for purposes of registration and participation in the Compact.

§ 1703A.

Eligibility.

(a) A physician must meet the eligibility requirements as defined in §1702A(k) to receive an expedited license HD :

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04/14/2021 02:38 PM under the terms and provisions of the Compact.

(b) A physician who does not meet the requirements of §1702A(k) may obtain a license to practice medicine in a member state if the individual complies with all laws and requirements, other than the Compact, relating to the issuance of a license to practice medicine in that state.

§ 1704A.

Designation of state of principal license.

(a) A physician shall designate a member state as the state of principal license for purposes of registration for expedited licensure through the Compact if the physician possesses a full and unrestricted license to practice medicine in that state, and the state is any of the following:

(1) The state of principal residence for the physician.

(2) The state where at least 25% of the practice of medicine occurs.

(3) The location of the physician’s employer.

(4) If no state qualifies under subsection (1), subsection (2), or subsection (3), the state designated as state of residence for purpose of federal income tax.

(b) A physician may re-designate a member state as state of principal license at any time, as long as the state meets the requirements of subsection (a).

(c) The Interstate Commission is authorized to develop rules to facilitate re-designation of another member state as the state of principal license.

§ 1705A.

Application and issuance of expedited licensure.

(a) A physician seeking licensure through the Compact shall file an application for an expedited license with the member board of the state selected by the physician as the state of principal license.

(b) Upon receipt of an application for an expedited license, the member board within the state selected as the state of principal license shall evaluate whether the physician is eligible for expedited licensure and issue a letter of qualification, verifying or denying the physician’s eligibility, to the Interstate Commission.

(1) Static qualifications, which include verification of medical education, graduate medical education, results of any medical or licensing examination, and other qualifications as determined by the Interstate Commission through rule, shall not be subject to additional primary source verification where already primary source verified by the state of principal license.

(2) The member board within the state selected as the state of principal license shall, in the course of verifying eligibility, perform a criminal background check of an applicant, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation, with the exception of HD :

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§731.202.

(3) Appeal on the determination of eligibility shall be made to the member state where the application was filed and shall be subject to the law of that state.

(c) Upon verification in subsection (b), physicians eligible for an expedited license shall complete the registration process established by the Interstate Commission to receive a license in a member state selected pursuant to subsection (a), including the payment of any applicable fees.

(d) After receiving verification of eligibility under subsection (b) and any fees under subsection (c), a member board shall issue an expedited license to the physician.

This license shall authorize the physician to practice medicine in the issuing state consistent with the Medical Practice Act and all applicable laws and regulations of the issuing member board and member state.

(e) An expedited license shall be valid for a period consistent with the licensure period in the member state and in the same manner as required for other physicians holding a full and unrestricted license within the member state.

(f) An expedited license obtained through the Compact shall be terminated if a physician fails to maintain a license in the state of principal licensure for a non-disciplinary reason, without re-designation of a new state of principal licensure.

(g) The Interstate Commission is authorized to develop rules regarding the application process, including payment of any applicable fees, and the issuance of an expedited license.

§ 1706A.

Fees for expedited licensure.

(a) A member state issuing an expedited license authorizing the practice of medicine in that state may impose a fee for a license issued or renewed through the Compact.