practice of telemedicine
(54) The term “practice of telemedicine” means, for purposes of this subchapter, the practice of medicine in accordance with applicable Federal and State laws by a practitioner (other than a pharmacist) who is at a location remote from the patient and is communicating with the patient, or health care professional who is treating the patient, using a telecommunications system referred to in section 1395m(m) of title 42 , which practice— (A) is being conducted— (i) while the patient is being treated by, and physically located in, a hospital or clinic registered under section 823(g) of this title ; and (ii) by a practitioner— (I) acting in the usual course of professional practice; (II) acting in accordance with applicable State law; and (III) registered under section 823(g) of this title in the State in which the patient is located, unless the practitioner— (aa) is exempted from such registration in all States under section 822(d) of this title ; or (bb) is— (AA) an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract; and (BB) registered under section 823(g) of this title in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 823(g) of this title ; (B) is being conducted while the patient is being treated by, and in the physical presence of, a practitioner— (i) acting in the usual course of professional practice; (ii) acting in accordance with applicable State law; and (iii) registered under section 823(g) of this title in the State in which the patient is located, unless the practitioner— (I) is exempted from such registration in all States under section 822(d) of this title ; or (II) is— (aa) an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract; and (bb) registered under section 823(g) of this title in any State or is using the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 823(g) of this title ; (C) is being conducted by a practitioner— (i) who is an employee or contractor of the Indian Health Service, or is working for an Indian tribe or tribal organization under its contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act [ 25 U.S.C. 5301 et seq.]; (ii) acting within the scope of the employment, contract, or compact described in clause (i); and (iii) who is designated as an Internet Eligible Controlled Substances Provider by the Secretary under section 831(g)(2) of this title ; (D) (i) is being conducted during a public health emergency declared by the Secretary under section 247d of title 42 ; and (ii) involves patients located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates, provided that such designation shall not be subject to the procedures prescribed by subchapter II of chapter 5 of title 5; (E) is being conducted by a practitioner who has obtained from the Attorney General a special registration under section 831(h) of this title ; (F) is being conducted— (i) in a medical emergency situation— (I) that prevents the patient from being in the physical presence of a practitioner registered under section 823(g) of this title who is an employee or contractor of the Veterans Health Administration acting in the usual course of business and employment and within the scope of the official duties or contract of that employee or contractor; (II) that prevents the patient from being physically present at a hospital or clinic operated by the Department of Veterans Affairs registered under section 823(g) of this title ; (III) during which the primary care practitioner of the patient or a practitioner otherwise practicing telemedicine within the meaning of this paragraph is unable to provide care or consultation; and (IV) that requires immediate intervention by a health care practitioner using controlled substances to prevent what the practitioner reasonably believes in good faith will be imminent and serious clinical consequences, such as further injury or death; and (ii) by a practitioner that— (I) is an employee or contractor of the Veterans Health Administration acting within the scope of that employment or contract; (II) is registered under section 823(g) of this title in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 823(g) of this title ; and (III) issues a controlled substance prescription in this emergency context that is limited to a maximum of a 5-day supply which may not be extended or refilled; or (G) is being conducted under any other circumstances that the Attorney General and the Secretary have jointly, by regulation, determined to be consistent with effective controls against diversion and otherwise consistent with the public health and safety.