1. (a) Definitions.

   1. (1) "Telehealth service" shall have the meaning defined by Texas Occupations Code §111.001(3).
   2. (2) "Telemedicine medical service" shall have the meaning defined by Texas Occupations Code §111.001(4).
2. (b) The same standards discussed in this rule are applicable to telehealth services and telemedicine medical services regardless of whether the patient interaction occurs in a video format or an audio-only format.
3. (c) A nurse must document informed consent for either telehealth services or telemedicine medical services in the medical record. Consent is acceptable either in written format or verbally. If the informed consent is obtained verbally, it must be documented in the patient's medical record and must include the date that the verbal consent is given. If the informed consent is provided by a responsible party of the patient, the name and relationship to the patient must be included.
4. (d) Informed consent records must be retained at least seven years from the date of last treatment by a nurse or longer if required by other federal or state law. If a patient is under 18 years old, informed consent records must be retained until the patient reaches 21 years old or seven years from the date of last treatment, whichever is longer.
5. (e) Issuance of Prescriptions. The validity of a prescription issued as a result of a telemedicine medical service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting.
6. (f) This rule does not limit the professional judgment, discretion, or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a telemedicine medical service.

7. (g) A valid prescription must:

   1. (1) be issued for a legitimate medical purpose by a practitioner as part of a patient-practitioner relationship as set out in §111.005, Texas Occupations Code; and
   2. (2) meet all other applicable laws before prescribing, dispensing, delivering, or administering a dangerous drug or controlled substance.
8. (h) Any prescription drug orders issued as the result of a telemedicine medical service are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act, and any other applicable federal and state law.

9. (i) Limitation on Treatment of Chronic Pain. Chronic pain is a legitimate medical condition that needs to be treated, but must be balanced with concerns over patient safety and the public health crisis involving overdose deaths. The Legislature has already put into place laws regarding the treatment of pain and requirements for registration and inspection of pain management clinics. Therefore, the Board has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service.

   1. (1) For purposes of this rule, chronic pain has the same definition as used in 22 Texas Administrative Code §172.1(2).

      1. (A) Telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way communication is prohibited, unless a patient:

         1. (i) is an established patient of the APRN being treated for chronic pain;
         2. (ii) is receiving a prescription that is identical to a prescription issued at the previous visit; and

         3. (iii) has been seen by the prescribing APRN, physician, or other health professional as defined in Tex. Occ. Code §111.001(1) in the last 90 days, either:

            1. (I) in-person; or
            2. (II) via telemedicine medical service using audio and video two-way communication.
      2. (B) An APRN, when determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances as permitted by paragraph (1)(A) of this subsection, shall give due consideration to factors that include, at a minimum, the date of the patient's last in-person visit, patient co-morbidities, and occupational related COVID risks. These are not the sole, exclusive, or exhaustive factors an APRN should consider under this rule.
      3. (C) If a patient is treated for chronic pain with scheduled drugs through the use of telemedicine medical services as permitted by paragraph (1)(A) of this subsection, the medical records must document the exception and the reason that a telemedicine medical service visit was conducted instead of an in-person visit.
   2. (2) For purposes of this rule, acute pain has the same definition as used in 22 Texas Administrative Code §172.1(1). Telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law.

Source Note:The provisions of this §217.24 adopted to be effective November 25, 2018, 43 TexReg 7534; amended to be effective November 25, 2021, 46 TexReg 7881; amended to be effective April 9, 2026, 51 TexReg 2251.