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A BILL TO BE ENTITLED
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AN ACT
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relating to the reimbursement and payment of claims by certain |
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health benefit plan issuers for telemedicine medical services and |
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telehealth services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1455.001(1), Insurance Code, is amended |
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to read as follows: |
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(1) "Health professional" means: |
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(A) a physician; |
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(B) an individual who is: |
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(i) licensed or certified in this state to |
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perform health care services; and |
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(ii) authorized to assist a physician in |
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providing telemedicine medical services that are delegated and |
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supervised by the physician; [or] |
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(C) a licensed or certified health professional, |
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including a mental health professional, acting within the scope of |
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the license or certification who does not perform a telemedicine |
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medical service; or |
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(D) an individual who is credentialed to provide |
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qualified mental health professional community services, has |
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demonstrated and documented competency in the work to be performed, |
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and: |
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(i) holds a bachelor's or more advanced |
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degree from an accredited institution of higher education with a |
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minimum number of hours that is equivalent to a major in psychology, |
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social work, medicine, nursing, rehabilitation, counseling, |
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sociology, human growth and development, physician assistant |
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studies, gerontology, special education, educational psychology, |
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early childhood education, or early childhood intervention; |
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(ii) is a registered nurse; or |
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(iii) completes an alternative |
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credentialing process identified by the Department of State Health |
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Services. |
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SECTION 2. Chapter 1455, Insurance Code, is amended by |
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adding Sections 1455.007 and 1455.008 to read as follows: |
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Sec. 1455.007. REIMBURSEMENT AND PAYMENT. (a) A health |
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benefit plan issuer must reimburse a preferred or contracted health |
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professional for providing a covered health care service or |
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procedure to a covered patient as a telemedicine medical service or |
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telehealth service on the same basis and at least at the same rate |
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that the issuer provides reimbursement to that health professional |
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for the service or procedure in an in-person setting. |
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(b) Notwithstanding Subsection (a), a health benefit plan |
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issuer is not required to pay more than the billed charge on a claim |
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for payment by a preferred or contracted health professional. |
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(c) For purposes of processing payment of a claim, a health |
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benefit plan issuer may not require a preferred or contracted |
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health professional to provide documentation of a covered health |
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care service or procedure delivered by the health professional to a |
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covered patient as a telemedicine medical service or telehealth |
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service beyond that which is required for the service or procedure |
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in an in-person setting. |
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Sec. 1455.008. WAIVER PROHIBITED. The provisions of this |
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chapter may not be waived, voided, or nullified by contract. |
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SECTION 3. Chapter 1455, Insurance Code, as amended by this |
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Act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2022. A health benefit |
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plan delivered, issued for delivery, or renewed before January 1, |
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2022, is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2021. |