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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                            CHAPTER 361-S.F.No. 3026 
                  An act relating to health; regulating the provision of 
                  interstate telemedicine services; appropriating money; 
                  amending Minnesota Statutes 2000, sections 147.081, 
                  subdivision 1; 147.091, subdivision 1; 147.141; 
                  proposing coding for new law in Minnesota Statutes, 
                  chapter 147. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  [147.032] [INTERSTATE PRACTICE OF 
        TELEMEDICINE.] 
           Subdivision 1.  [REQUIREMENTS; REGISTRATION.] (a) A 
        physician not licensed to practice medicine in this state may 
        provide medical services to a patient located in this state 
        through interstate telemedicine if the following conditions are 
        met: 
           (1) the physician is licensed without restriction to 
        practice medicine in the state from which the physician provides 
        telemedicine services; 
           (2) the physician has not had a license to practice 
        medicine revoked or restricted in any state or jurisdiction; 
           (3) the physician does not open an office in this state, 
        does not meet with patients in this state, and does not receive 
        calls in this state from patients; and 
           (4) the physician annually registers with the board, on a 
        form provided by the board. 
           (b) To register with the board, a physician must: 
           (1) state the physician's intention to provide interstate 
        telemedicine services in this state; 
           (2) provide complete information on: 
           (i) all states and jurisdictions in which the physician is 
        currently licensed; 
           (ii) any states or jurisdictions in which the physician was 
        previously licensed; 
           (iii) any negative licensing actions taken previously 
        against the physician in any state or jurisdiction; and 
           (iv) other information requested by the board; and 
           (3) pay a registration fee of $75 annually and an initial 
        application fee of $100. 
           (c) A physician registered to provide interstate 
        telemedicine services under this section must immediately notify 
        the board of restrictions placed on the physician's license to 
        practice in any state or jurisdiction. 
           (d) In registering to provide interstate telemedicine 
        services to state residents under this section, a physician 
        agrees to be subject to state laws, the state judicial system, 
        and the board with respect to providing medical services to 
        state residents. 
           (e) For the purposes of this section, telemedicine means 
        the practice of medicine as defined in section 147.081, 
        subdivision 3, when the physician is not in the physical 
        presence of the patient. 
           Subd. 2.  [EXEMPTIONS FROM REGISTRATION.] A physician who 
        is not licensed to practice medicine in this state, but who 
        holds a valid license to practice medicine in another state or 
        jurisdiction, and who provides interstate telemedicine services 
        to a patient located in this state is not subject to the 
        registration requirement of subdivision 1, paragraph (a), clause 
        (4), if: 
           (1) the services are provided in response to an emergency 
        medical condition.  For the purposes of this section, an 
        emergency medical condition means a condition, including 
        emergency labor and delivery, that manifests itself by acute 
        symptoms of sufficient severity, including severe pain, that the 
        absence of immediate medical attention could reasonably be 
        expected to result in placing the patient's health in serious 
        jeopardy, serious impairment to bodily functions, or serious 
        dysfunction of any body organ or part; 
           (2) the services are provided on an irregular or infrequent 
        basis.  For the purposes of this section, a person provides 
        services on an irregular or infrequent basis if the person 
        provides the services less than once a month or provides the 
        services to fewer than ten patients annually; or 
           (3) the physician provides interstate telemedicine services 
        in this state in consultation with a physician licensed in this 
        state and the Minnesota physician retains ultimate authority 
        over the diagnosis and care of the patient. 
           Subd. 3.  [NOTIFICATION TO OTHER STATES.] The board shall 
        obtain confirmation of licensure from all states and 
        jurisdictions in which a physician registered under subdivision 
        1 has ever been licensed to verify statements made by the 
        physician and to be notified if any future adverse action is 
        taken against the physician's license in another state or 
        jurisdiction.  This requirement does not replace the reporting 
        obligation under section 147.111. 
           Subd. 4.  [HEALTH RECORDS.] A physician who provides 
        interstate telemedicine services to a patient located in this 
        state must comply with section 144.335 with respect to the 
        provision of those services. 
           Sec. 2.  Minnesota Statutes 2000, section 147.081, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [UNLAWFUL PRACTICE OF MEDICINE.] It is 
        unlawful for any person not holding a valid license issued in 
        accordance with this chapter to practice medicine as defined in 
        subdivision 3 in this state unless:  
           (1) the person holds a valid license issued according to 
        this chapter; or 
           (2) the person is registered to provide interstate 
        telemedicine services according to section 147.032. 
           Sec. 3.  Minnesota Statutes 2000, section 147.091, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [GROUNDS LISTED.] The board may refuse to 
        grant a license, may refuse to grant registration to perform 
        interstate telemedicine services, or may impose disciplinary 
        action as described in section 147.141 against any physician.  
        The following conduct is prohibited and is grounds for 
        disciplinary action: 
           (a) Failure to demonstrate the qualifications or satisfy 
        the requirements for a license contained in this chapter or 
        rules of the board.  The burden of proof shall be upon the 
        applicant to demonstrate such qualifications or satisfaction of 
        such requirements. 
           (b) Obtaining a license by fraud or cheating, or attempting 
        to subvert the licensing examination process.  Conduct which 
        subverts or attempts to subvert the licensing examination 
        process includes, but is not limited to:  (1) conduct which 
        violates the security of the examination materials, such as 
        removing examination materials from the examination room or 
        having unauthorized possession of any portion of a future, 
        current, or previously administered licensing examination; (2) 
        conduct which violates the standard of test administration, such 
        as communicating with another examinee during administration of 
        the examination, copying another examinee's answers, permitting 
        another examinee to copy one's answers, or possessing 
        unauthorized materials; or (3) impersonating an examinee or 
        permitting an impersonator to take the examination on one's own 
        behalf. 
           (c) Conviction, during the previous five years, of a felony 
        reasonably related to the practice of medicine or osteopathy.  
        Conviction as used in this subdivision shall include a 
        conviction of an offense which if committed in this state would 
        be deemed a felony without regard to its designation elsewhere, 
        or a criminal proceeding where a finding or verdict of guilt is 
        made or returned but the adjudication of guilt is either 
        withheld or not entered thereon.  
           (d) Revocation, suspension, restriction, limitation, or 
        other disciplinary action against the person's medical license 
        in another state or jurisdiction, failure to report to the board 
        that charges regarding the person's license have been brought in 
        another state or jurisdiction, or having been refused a license 
        by any other state or jurisdiction.  
           (e) Advertising which is false or misleading, which 
        violates any rule of the board, or which claims without 
        substantiation the positive cure of any disease, or professional 
        superiority to or greater skill than that possessed by another 
        physician. 
           (f) Violating a rule promulgated by the board or an order 
        of the board, a state, or federal law which relates to the 
        practice of medicine, or in part regulates the practice of 
        medicine including without limitation sections 148A.02, 609.344, 
        and 609.345, or a state or federal narcotics or controlled 
        substance law. 
           (g) Engaging in any unethical conduct; conduct likely to 
        deceive, defraud, or harm the public, or demonstrating a willful 
        or careless disregard for the health, welfare or safety of a 
        patient; or medical practice which is professionally 
        incompetent, in that it may create unnecessary danger to any 
        patient's life, health, or safety, in any of which cases, proof 
        of actual injury need not be established. 
           (h) Failure to supervise a physician's assistant or failure 
        to supervise a physician under any agreement with the board. 
           (i) Aiding or abetting an unlicensed person in the practice 
        of medicine, except that it is not a violation of this paragraph 
        for a physician to employ, supervise, or delegate functions to a 
        qualified person who may or may not be required to obtain a 
        license or registration to provide health services if that 
        person is practicing within the scope of that person's license 
        or registration or delegated authority. 
           (j) Adjudication as mentally incompetent, mentally ill or 
        mentally retarded, or as a chemically dependent person, a person 
        dangerous to the public, a sexually dangerous person, or a 
        person who has a sexual psychopathic personality by a court of 
        competent jurisdiction, within or without this state.  Such 
        adjudication shall automatically suspend a license for the 
        duration thereof unless the board orders otherwise. 
           (k) Engaging in unprofessional conduct.  Unprofessional 
        conduct shall include any departure from or the failure to 
        conform to the minimal standards of acceptable and prevailing 
        medical practice in which proceeding actual injury to a patient 
        need not be established. 
           (l) Inability to practice medicine with reasonable skill 
        and safety to patients by reason of illness, drunkenness, use of 
        drugs, narcotics, chemicals or any other type of material or as 
        a result of any mental or physical condition, including 
        deterioration through the aging process or loss of motor skills. 
           (m) Revealing a privileged communication from or relating 
        to a patient except when otherwise required or permitted by law. 
           (n) Failure by a doctor of osteopathy to identify the 
        school of healing in the professional use of the doctor's name 
        by one of the following terms:  osteopathic physician and 
        surgeon, doctor of osteopathy, or D.O. 
           (o) Improper management of medical records, including 
        failure to maintain adequate medical records, to comply with a 
        patient's request made pursuant to section 144.335 or to furnish 
        a medical record or report required by law.  
           (p) Fee splitting, including without limitation: 
           (1) paying, offering to pay, receiving, or agreeing to 
        receive, a commission, rebate, or remuneration, directly or 
        indirectly, primarily for the referral of patients or the 
        prescription of drugs or devices; 
           (2) dividing fees with another physician or a professional 
        corporation, unless the division is in proportion to the 
        services provided and the responsibility assumed by each 
        professional and the physician has disclosed the terms of the 
        division; 
           (3) referring a patient to any health care provider as 
        defined in section 144.335 in which the referring physician has 
        a significant financial interest unless the physician has 
        disclosed the physician's own financial interest; and 
           (4) dispensing for profit any drug or device, unless the 
        physician has disclosed the physician's own profit interest. 
        The physician must make the disclosures required in this clause 
        in advance and in writing to the patient and must include in the 
        disclosure a statement that the patient is free to choose a 
        different health care provider.  This clause does not apply to 
        the distribution of revenues from a partnership, group practice, 
        nonprofit corporation, or professional corporation to its 
        partners, shareholders, members, or employees if the revenues 
        consist only of fees for services performed by the physician or 
        under a physician's direct supervision, or to the division or 
        distribution of prepaid or capitated health care premiums, or 
        fee-for-service withhold amounts paid under contracts 
        established under other state law.  
           (q) Engaging in abusive or fraudulent billing practices, 
        including violations of the federal Medicare and Medicaid laws 
        or state medical assistance laws.  
           (r) Becoming addicted or habituated to a drug or intoxicant.
           (s) Prescribing a drug or device for other than medically 
        accepted therapeutic or experimental or investigative purposes 
        authorized by a state or federal agency or referring a patient 
        to any health care provider as defined in section 144.335 for 
        services or tests not medically indicated at the time of 
        referral.  
           (t) Engaging in conduct with a patient which is sexual or 
        may reasonably be interpreted by the patient as sexual, or in 
        any verbal behavior which is seductive or sexually demeaning to 
        a patient.  
           (u) Failure to make reports as required by section 147.111 
        or to cooperate with an investigation of the board as required 
        by section 147.131. 
           (v) Knowingly providing false or misleading information 
        that is directly related to the care of that patient unless done 
        for an accepted therapeutic purpose such as the administration 
        of a placebo. 
           (w) Aiding suicide or aiding attempted suicide in violation 
        of section 609.215 as established by any of the following: 
           (1) a copy of the record of criminal conviction or plea of 
        guilty for a felony in violation of section 609.215, subdivision 
        1 or 2; 
           (2) a copy of the record of a judgment of contempt of court 
        for violating an injunction issued under section 609.215, 
        subdivision 4; 
           (3) a copy of the record of a judgment assessing damages 
        under section 609.215, subdivision 5; or 
           (4) a finding by the board that the person violated section 
        609.215, subdivision 1 or 2.  The board shall investigate any 
        complaint of a violation of section 609.215, subdivision 1 or 2. 
           (x) Practice of a board-regulated profession under lapsed 
        or nonrenewed credentials. 
           (y) Failure to repay a state or federally secured student 
        loan in accordance with the provisions of the loan. 
           (z) Providing interstate telemedicine services other than 
        according to section 147.032. 
           Sec. 4.  Minnesota Statutes 2000, section 147.141, is 
        amended to read: 
           147.141 [FORMS OF DISCIPLINARY ACTION.] 
           When the board finds that a licensed physician or a 
        physician registered under section 147.032 has violated a 
        provision or provisions of sections 147.01 to 147.22, it may do 
        one or more of the following:  
           (1) revoke the license; 
           (2) suspend the license; 
           (3) revoke or suspend registration to perform interstate 
        telemedicine; 
           (4) impose limitations or conditions on the physician's 
        practice of medicine, including the limitation of scope of 
        practice to designated field specialties; the imposition of 
        retraining or rehabilitation requirements; the requirement of 
        practice under supervision; or the conditioning of continued 
        practice on demonstration of knowledge or skills by appropriate 
        examination or other review of skill and competence; 
           (4) (5) impose a civil penalty not exceeding $10,000 for 
        each separate violation, the amount of the civil penalty to be 
        fixed so as to deprive the physician of any economic advantage 
        gained by reason of the violation charged or to reimburse the 
        board for the cost of the investigation and proceeding; 
           (5) (6) order the physician to provide unremunerated 
        professional service under supervision at a designated public 
        hospital, clinic, or other health care institution; or 
           (6) (7) censure or reprimand the licensed physician. 
           Sec. 5.  [APPROPRIATION.] 
           $4,000 is appropriated in fiscal year 2003 from the state 
        government special revenue fund to the board of medical practice 
        to implement the telemedicine registration requirements under 
        Minnesota Statutes, section 147.032. 
           Presented to the governor May 6, 2002 
           Signed by the governor May 8, 2002, 11:30 a.m.