Senate committee hears bill to expand telemedicine prescribing for incarcerated patients

State senators opened a hearing on Senate Bill 252 on telemedicine rules for incarcerated people, with prime sponsor Sen. Sue Prentice saying the measure would let providers establish a primary care relationship before release so patients have continuity of care after reentry.

"The purpose here is to establish that relationship while they are incarcerated so that when they come out of being incarcerated, they have that point of contact with the primary care provider," Sen. Sue Prentice said, introducing the bill.

Supporters and experts told the Senate Health and Human Services Committee that expanded telemedicine access can reduce costly emergency-department use and improve access to medication-assisted treatment for people leaving custody. Jonathan Ballard, chief medical officer at the New Hampshire Department of Health and Human Services and chair of the legislative telehealth commission, said the commission's unanimous recommendation was to align state statutes that currently prohibit prescribing controlled medications via telehealth without an in-person visit with applicable federal rules.

"The committee really only had one final recommendation. It was the recommendation of this commission to amend current New Hampshire statutes that prohibit the prescribing of controlled medications via telehealth without the need for an in person visit and to align state statutes with applicable federal laws and regulations," Ballard said.

Erin Thirbelson of the Council of State Governments Justice Center, a national nonprofit that studies justice and behavioral health intersections, urged support for SB 252 on the grounds that delaying or disrupting medication and care at release increases overdose and recidivism risks. Thirbelson cited the Justice Center's findings that many people leaving custody rely on Medicaid for behavioral health services and that establishing prerelease and postrelease care connections is urgent: "71 percent use Medicaid within one month of release with a median of 9 days between release and their first Medicaid claim."

Senators asked how the bill would treat opioid prescribing and hospice patients, and whether nurse practitioners and physician assistants should be explicitly included. Ballard and other witnesses said the current federal flexibilities (extensions of emergency-era waivers) allow teleprescribing in many cases and that New Hampshire law is presently stricter than federal rules. Ballard noted the December federal action that extended teleprescribing flexibilities through December 2025, while warning that the DEA and HHS could change federal rules before then.

Sen. Prentice told the committee she plans to remove eye-care prescriptions from the bill because eyewear and many ophthalmic prescriptions require an in-person exam. Representatives of nurse practitioners asked that the Nurse Practice Act (RSA 3:26) be considered alongside physician statutes to ensure nonphysician prescribers are included.

Committee members and witnesses also discussed New Hampshire's Medicaid reentry waiver, which allows Medicaid coverage to begin before a person is released and could be used to schedule prerelease telehealth appointments that would continue into the community. Ballard and others characterized those prerelease connections as a way to reduce transportation costs and avoid care interruptions.

The committee did not take a vote during the hearing. Supporters asked lawmakers to consider narrowly drawn safeguards—such as maintaining in-person requirements for certain opioid prescriptions outside of hospice or well-established clinical relationships—while aligning state statute with federal practice to preserve access for rural and homebound patients.