| |
| |
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A BILL TO BE ENTITLED
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AN ACT
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relating to the practice of dentistry and the provision of |
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teledentistry dental services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 111, Occupations Code, is |
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amended to read as follows: |
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CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH |
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SECTION 2. Section 111.001, Occupations Code, is amended by |
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amending Subdivisions (1) and (3) and adding Subdivision (2-a) to |
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|
read as follows: |
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(1) "Dentist," "health [Health] professional," and |
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"physician" have the meanings assigned by Section 1455.001, |
|
|
Insurance Code. |
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(2-a) "Teledentistry dental service" means a health |
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|
care service delivered by a dentist, or a health professional |
|
|
acting under the delegation and supervision of a dentist, acting |
|
|
within the scope of the dentist's or health professional's license |
|
|
or certification to a patient at a different physical location than |
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|
the dentist or health professional using telecommunications or |
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|
information technology. |
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(3) "Telehealth service" means a health service, other |
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|
than a telemedicine medical service or a teledentistry dental |
|
|
service, delivered by a health professional licensed, certified, or |
|
|
otherwise entitled to practice in this state and acting within the |
|
|
scope of the health professional's license, certification, or |
|
|
entitlement to a patient at a different physical location than the |
|
|
health professional using telecommunications or information |
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|
technology. |
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SECTION 3. Section 111.002, Occupations Code, is amended to |
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|
read as follows: |
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Sec. 111.002. INFORMED CONSENT. (a) A treating physician, |
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|
dentist, or health professional who provides or facilitates the use |
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|
of telemedicine medical services, teledentistry dental services, |
|
|
or telehealth services shall ensure that the informed consent of |
|
|
the patient, or another appropriate individual authorized to make |
|
|
health care treatment decisions for the patient, is obtained before |
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|
telemedicine medical services, teledentistry dental services, or |
|
|
telehealth services are provided. |
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(b) A dentist who delegates a teledentistry dental service |
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|
shall ensure that the informed consent of the patient includes |
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|
disclosure to the patient that the dentist has delegated the |
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|
service. |
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SECTION 4. Section 111.003, Occupations Code, is amended to |
|
|
read as follows: |
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Sec. 111.003. CONFIDENTIALITY. A treating physician, |
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|
dentist, or health professional who provides or facilitates the use |
|
|
of telemedicine medical services, teledentistry dental services, |
|
|
or telehealth services shall ensure that the confidentiality of the |
|
|
patient's clinical [medical] information is maintained as required |
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|
by Chapter 159, by Subchapter C, Chapter 258, or by other applicable |
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|
law. |
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|
SECTION 5. Section 111.004, Occupations Code, is amended |
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|
to read as follows: |
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|
Sec. 111.004. RULES. (a) The Texas Medical Board, in |
|
|
consultation with the commissioner of insurance, as appropriate, |
|
|
may adopt rules necessary to: |
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(1) ensure that patients using telemedicine medical |
|
|
services receive appropriate, quality care; |
|
|
(2) prevent abuse and fraud in the use of telemedicine |
|
|
medical services, including rules relating to the filing of claims |
|
|
and records required to be maintained in connection with |
|
|
telemedicine medical services; |
|
|
(3) ensure adequate supervision of health |
|
|
professionals who are not physicians and who provide telemedicine |
|
|
medical services; and |
|
|
(4) establish the maximum number of health |
|
|
professionals who are not physicians that a physician may supervise |
|
|
through a telemedicine medical service. |
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|
(b) The State Board of Dental Examiners, in consultation |
|
|
with the commissioner of insurance, as appropriate, may adopt rules |
|
|
necessary to: |
|
|
(1) ensure that patients using teledentistry dental |
|
|
services receive appropriate, quality care; |
|
|
(2) prevent abuse and fraud in the use of |
|
|
teledentistry dental services, including rules relating to the |
|
|
filing of claims and records required to be maintained in |
|
|
connection with teledentistry dental services; |
|
|
(3) ensure adequate supervision of health |
|
|
professionals who are not dentists and who provide teledentistry |
|
|
dental services under the delegation and supervision of a dentist; |
|
|
and |
|
|
(4) establish that a dentist may delegate to and |
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|
supervise through a teledentistry dental service not more than two |
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|
health professionals who are not dentists. |
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SECTION 6. The heading to Section 111.005, Occupations |
|
|
Code, is amended to read as follows: |
|
|
Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR |
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|
TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES. |
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|
SECTION 7. Section 111.005, Occupations Code, is amended by |
|
|
amending Subsections (a) and (b) and adding Subsection (d) to read |
|
|
as follows: |
|
|
(a) For purposes of Section 562.056, a valid |
|
|
practitioner-patient relationship is present between a |
|
|
practitioner providing a telemedicine medical service or a |
|
|
teledentistry dental service and a patient receiving the |
|
|
[telemedicine medical] service as long as the practitioner complies |
|
|
with the standard of care described in Section 111.007 and the |
|
|
practitioner: |
|
|
(1) has a preexisting practitioner-patient |
|
|
relationship with the patient established in accordance with rules |
|
|
adopted under Section 111.006; |
|
|
(2) communicates, regardless of the method of |
|
|
communication, with the patient pursuant to a call coverage |
|
|
agreement established in accordance with: |
|
|
(A) Texas Medical Board rules with a physician |
|
|
requesting coverage of medical care for the patient; or |
|
|
(B) State Board of Dental Examiners rules with a |
|
|
dentist requesting coverage of dental care for the patient; or |
|
|
(3) provides the telemedicine medical services or |
|
|
teledentistry dental services through the use of one of the |
|
|
following methods, as long as the practitioner complies with the |
|
|
follow-up requirements in Subsection (b), and the method allows the |
|
|
practitioner to have access to, and the practitioner uses, the |
|
|
relevant clinical information that would be required in accordance |
|
|
with the standard of care described in Section 111.007: |
|
|
(A) synchronous audiovisual interaction between |
|
|
the practitioner and the patient in another location; |
|
|
(B) asynchronous store and forward technology, |
|
|
including asynchronous store and forward technology in conjunction |
|
|
with synchronous audio interaction between the practitioner and the |
|
|
patient in another location, as long as the practitioner uses |
|
|
clinical information from: |
|
|
(i) clinically relevant photographic or |
|
|
video images, including diagnostic images; or |
|
|
(ii) the patient's relevant clinical |
|
|
[medical] records, such as the relevant medical or dental history, |
|
|
laboratory and pathology results, and prescriptive histories; or |
|
|
(C) another form of audiovisual |
|
|
telecommunication technology that allows the practitioner to |
|
|
comply with the standard of care described in Section 111.007. |
|
|
(b) A practitioner who provides telemedicine medical |
|
|
services or teledentistry dental services to a patient as described |
|
|
in Subsection (a)(3) shall: |
|
|
(1) provide the patient with guidance on appropriate |
|
|
follow-up care; and |
|
|
(2) subject to Subsection (d), if the patient consents |
|
|
and the patient has a primary care physician or a regular dentist, |
|
|
provide to the patient's primary care physician or regular dentist, |
|
|
as appropriate, within 72 hours after the practitioner provides the |
|
|
services to the patient, a clinical [medical] record or other |
|
|
report containing an explanation of: |
|
|
(A) the treatment provided by the practitioner to |
|
|
the patient; and |
|
|
(B) as authorized by the law under which the |
|
|
practitioner is licensed, certified, or otherwise permitted to |
|
|
provide the service, the practitioner's evaluation, analysis, or |
|
|
diagnosis[, as appropriate,] of the patient's condition. |
|
|
(d) A practitioner who provides teledentistry dental |
|
|
services to a patient as described in Subsection (a)(3): |
|
|
(1) on the date the practitioner first provides the |
|
|
teledentistry dental services, shall inform the patient of the |
|
|
limitation provided by Subdivision (2); and |
|
|
(2) may only provide teledentistry dental services |
|
|
with respect to the patient for 12 months unless: |
|
|
(A) a dentist performs an in-person tactile and |
|
|
visual examination of the hard and soft tissues of the patient's |
|
|
oral cavity; and |
|
|
(B) the practitioner receives notice of the |
|
|
examination described by Paragraph (A). |
|
|
SECTION 8. Section 111.006, Occupations Code, is amended by |
|
|
adding Subsection (c) to read as follows: |
|
|
(c) The State Board of Dental Examiners and the Texas State |
|
|
Board of Pharmacy shall jointly adopt rules that establish the |
|
|
determination of a valid prescription in accordance with Section |
|
|
111.005. Rules adopted under this subsection must allow for the |
|
|
establishment of a practitioner-patient relationship by a |
|
|
teledentistry dental service provided by a dentist to a patient in a |
|
|
manner that complies with Section 111.005(a)(3). The State Board |
|
|
of Dental Examiners and the Texas State Board of Pharmacy shall |
|
|
jointly develop and publish on each respective board's Internet |
|
|
website responses to frequently asked questions relating to the |
|
|
determination of a valid prescription issued in the course of the |
|
|
provision of teledentistry dental services. |
|
|
SECTION 9. Section 111.007, Occupations Code, is amended to |
|
|
read as follows: |
|
|
Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL |
|
|
SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. |
|
|
(a) A health professional providing a health care service or |
|
|
procedure as a telemedicine medical service, a teledentistry dental |
|
|
service, or a telehealth service is subject to the standard of care |
|
|
that would apply to the provision of the same health care service or |
|
|
procedure in an in-person setting. |
|
|
(b) An agency with regulatory authority over a health |
|
|
professional may not adopt rules pertaining to telemedicine medical |
|
|
services, teledentistry dental services, or telehealth services |
|
|
that would impose a higher standard of care than the standard |
|
|
described in Subsection (a). |
|
|
SECTION 10. Chapter 111, Occupations Code, is amended by |
|
|
adding Section 111.0075 to read as follows: |
|
|
Sec. 111.0075. LICENSING FOR TELEDENTISTRY DENTAL |
|
|
SERVICES. A health professional providing a health care service or |
|
|
procedure as a teledentistry dental service is subject to the |
|
|
licensing requirements that would apply to the provision of the |
|
|
same health care service or procedure in an in-person setting. |
|
|
SECTION 11. Chapter 111, Occupations Code, is amended by |
|
|
adding Sections 111.009, 111.010, and 111.011 to read as follows: |
|
|
Sec. 111.009. CERTAIN PRESCRIPTIONS PROHIBITED. (a) In |
|
|
this section, "controlled substance" and "prescribe" have the |
|
|
meanings assigned by Section 481.002, Health and Safety Code. |
|
|
(b) A dentist may not prescribe a controlled substance to a |
|
|
patient as a teledentistry dental service. |
|
|
Sec. 111.010. DENTIST'S DUTY REGARDING FOLLOW-UP CARE FOR |
|
|
ACUTE DENTAL CONDITION. (a) A dentist who treats a patient for an |
|
|
acute dental condition as a teledentistry dental service shall, not |
|
|
later than six weeks after the date of the service: |
|
|
(1) contact or attempt to contact the patient to |
|
|
schedule an in-person dental service for the patient in connection |
|
|
with the acute dental condition; or |
|
|
(2) refer the patient to another dentist for the |
|
|
service described by Subdivision (1). |
|
|
(b) A violation of Subsection (a) constitutes a ground for |
|
|
disciplinary action under Section 263.002. |
|
|
Sec. 111.011. STUDY AND REPORT. (a) The State Board of |
|
|
Dental Examiners shall study the extent to which teledentistry |
|
|
dental services may be used to substantially increase access to |
|
|
dental care for the children of low-income families, including the |
|
|
use of teledentistry dental services to perform a consultation |
|
|
before referring the child's parents or legal guardians to |
|
|
charitable organizations providing access to affordable dental |
|
|
care. |
|
|
(b) Not later than December 1, 2022, the board shall report |
|
|
the results of the study conducted under Subsection (a) to the |
|
|
standing committee of each house of the legislature with primary |
|
|
jurisdiction over the board. |
|
|
(c) This section expires January 1, 2023. |
|
|
SECTION 12. Section 251.003, Occupations Code, is amended |
|
|
by adding Subsection (d) to read as follows: |
|
|
(d) For purposes of this subtitle, a person located in |
|
|
another state practices dentistry in this state and is required to |
|
|
hold a license to practice dentistry in this state if the person |
|
|
through the use of any medium, including an electronic medium, |
|
|
performs an act that constitutes the practice of dentistry on a |
|
|
patient in this state. |
|
|
SECTION 13. Chapter 254, Occupations Code, is amended by |
|
|
adding Section 254.0035 to read as follows: |
|
|
Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS. |
|
|
The board shall adopt rules governing a call coverage agreement |
|
|
between dentists. |
|
|
SECTION 14. Section 258.001, Occupations Code, is amended |
|
|
to read as follows: |
|
|
Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not |
|
|
delegate: |
|
|
(1) an act to an individual who, by board order, is |
|
|
prohibited from performing the act; |
|
|
(2) any of the following acts to a person not licensed |
|
|
as a dentist or dental hygienist: |
|
|
(A) the removal of calculus, deposits, or |
|
|
accretions from the natural and restored surfaces of exposed human |
|
|
teeth and restorations in the human mouth; |
|
|
(B) root planing or the smoothing and polishing |
|
|
of roughened root surfaces or exposed human teeth; or |
|
|
(C) any other act the delegation of which is |
|
|
prohibited by board rule; |
|
|
(3) any of the following acts to a person not licensed |
|
|
as a dentist: |
|
|
(A) comprehensive examination or diagnosis and |
|
|
treatment planning; |
|
|
(B) a surgical or cutting procedure on hard or |
|
|
soft tissue; |
|
|
(C) the prescription of a drug, medication, or |
|
|
work authorization; |
|
|
(D) the taking of an impression for a final |
|
|
restoration, appliance, or prosthesis; |
|
|
(E) the making of an intraoral occlusal |
|
|
adjustment; |
|
|
(F) direct pulp capping, pulpotomy, or any other |
|
|
endodontic procedure; |
|
|
(G) the final placement and intraoral adjustment |
|
|
of a fixed or removable appliance; or |
|
|
(H) the placement of any final restoration; or |
|
|
(4) the authority to an individual to administer a |
|
|
local anesthetic agent, inhalation sedative agent, parenteral |
|
|
sedative agent, or general anesthetic agent, including as a |
|
|
teledentistry dental service as that term is defined by Section |
|
|
111.001, if the individual is not licensed as: |
|
|
(A) a dentist with a permit issued by the board |
|
|
for the procedure being performed, if a permit is required; |
|
|
(B) a certified registered nurse anesthetist |
|
|
licensed by the Texas Board of Nursing, only if the delegating |
|
|
dentist holds a permit issued by the board for the procedure being |
|
|
performed, if a permit is required; or |
|
|
(C) a physician anesthesiologist licensed by the |
|
|
Texas Medical Board. |
|
|
SECTION 15. Section 262.152, Occupations Code, is amended |
|
|
to read as follows: |
|
|
Sec. 262.152. PERFORMANCE OF DELEGATED DUTIES. (a) Except |
|
|
as provided by Section 262.1515, a dental hygienist shall practice |
|
|
dental hygiene: |
|
|
(1) in the dental office of a supervising dentist |
|
|
licensed by the board; or |
|
|
(2) in an alternate setting, including a nursing home, |
|
|
the patient's home, a school, a hospital, a state institution, a |
|
|
public health clinic, or another institution, under the supervision |
|
|
of a supervising dentist. |
|
|
(b) For purposes of this section, a dental hygienist who |
|
|
practices dental hygiene as a teledentistry dental service, as |
|
|
defined by Section 111.001, is practicing in an alternate setting |
|
|
in compliance with Subsection (a)(2). |
|
|
SECTION 16. Section 562.056(c), Occupations Code, is |
|
|
amended to read as follows: |
|
|
(c) For purposes of this section and Section 562.112, a |
|
|
valid practitioner-patient relationship is present between a |
|
|
practitioner providing telemedicine medical services or |
|
|
teledentistry dental services and the patient receiving the |
|
|
[telemedicine medical] services if the practitioner has complied |
|
|
with the requirements for establishing such a relationship in |
|
|
accordance with Section 111.005. |
|
|
SECTION 17. Section 531.001, Government Code, is amended by |
|
|
amending Subdivision (4-d) and adding Subdivision (6-a) to read as |
|
|
follows: |
|
|
(4-d) "Platform" means the technology, system, |
|
|
software, application, modality, or other method through which a |
|
|
health professional remotely interfaces with a patient when |
|
|
providing a health care service or procedure as a telemedicine |
|
|
medical service, teledentistry dental service, or telehealth |
|
|
service. |
|
|
(6-a) "Teledentistry dental service" has the meaning |
|
|
assigned by Section 111.001, Occupations Code. |
|
|
SECTION 18. Section 531.0216, Government Code, is amended |
|
|
to read as follows: |
|
|
Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF |
|
|
TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL |
|
|
SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER |
|
|
MEDICAID. (a) The executive commissioner by rule shall develop and |
|
|
implement a system to reimburse providers of services under |
|
|
Medicaid for services performed using telemedicine medical |
|
|
services, teledentistry dental services, or telehealth services. |
|
|
(c) The commission shall encourage health care providers |
|
|
and health care facilities to provide telemedicine medical |
|
|
services, teledentistry dental services, and telehealth services |
|
|
in the health care delivery system. The commission may not require |
|
|
that a service be provided to a patient through telemedicine |
|
|
medical services, teledentistry dental services, or telehealth |
|
|
services. |
|
|
(c-1) Subsection (c) does not prohibit the authorization of |
|
|
the provision of any service to a patient through teledentistry |
|
|
dental services if: |
|
|
(1) the patient requests the service; and |
|
|
(2) the provision of the service through teledentistry |
|
|
does not violate the standard of care applicable to the service. |
|
|
(c-2) The commission shall explore opportunities to |
|
|
increase STAR Health program providers' use of telemedicine medical |
|
|
services in medically underserved areas of this state. |
|
|
(d) Subject to Sections 111.004 and [Section] 153.004, |
|
|
Occupations Code, the executive commissioner may adopt rules as |
|
|
necessary to implement this section. In the rules adopted under |
|
|
this section, the executive commissioner shall: |
|
|
(1) refer to the site where the patient is physically |
|
|
located as the patient site; and |
|
|
(2) refer to the site where the physician, dentist, or |
|
|
health professional providing the telemedicine medical service, |
|
|
teledentistry dental service, or telehealth service is physically |
|
|
located as the distant site. |
|
|
(f) Not later than December 1 of each even-numbered year, |
|
|
the commission shall report to the speaker of the house of |
|
|
representatives and the lieutenant governor on the effects of |
|
|
telemedicine medical services, teledentistry dental services, |
|
|
telehealth services, and home telemonitoring services on Medicaid |
|
|
in the state, including the number of physicians, dentists, health |
|
|
professionals, and licensed health care facilities using |
|
|
telemedicine medical services, teledentistry dental services, |
|
|
telehealth services, or home telemonitoring services, the |
|
|
geographic and demographic disposition of the physicians, |
|
|
dentists, and health professionals, the number of patients |
|
|
receiving telemedicine medical services, teledentistry dental |
|
|
services, telehealth services, and home telemonitoring services, |
|
|
the types of services being provided, the cost of utilization, and |
|
|
the cost savings of telemedicine medical services, teledentistry |
|
|
dental services, telehealth services, and home telemonitoring |
|
|
services to Medicaid. |
|
|
(g) The commission shall ensure that a Medicaid managed care |
|
|
organization: |
|
|
(1) does not deny reimbursement for a covered health |
|
|
care service or procedure delivered by a health care provider with |
|
|
whom the managed care organization contracts to a Medicaid |
|
|
recipient as a telemedicine medical service, a teledentistry dental |
|
|
service, or a telehealth service solely because the covered service |
|
|
or procedure is not provided through an in-person consultation; |
|
|
(2) does not limit, deny, or reduce reimbursement for |
|
|
a covered health care service or procedure delivered by a health |
|
|
care provider with whom the managed care organization contracts to |
|
|
a Medicaid recipient as a telemedicine medical service, a |
|
|
teledentistry dental service, or a telehealth service based on the |
|
|
health care provider's choice of platform for providing the health |
|
|
care service or procedure; and |
|
|
(3) ensures that the use of telemedicine medical |
|
|
services, teledentistry dental services, or telehealth services |
|
|
promotes and supports patient-centered medical homes by allowing a |
|
|
Medicaid recipient to receive a telemedicine medical service, |
|
|
teledentistry dental service, or telehealth service from a provider |
|
|
other than the recipient's primary care physician or provider, |
|
|
except as provided by Section 531.0217(c-4), only if: |
|
|
(A) the telemedicine medical service, |
|
|
teledentistry dental service, or telehealth service is provided in |
|
|
accordance with the law and contract requirements applicable to the |
|
|
provision of the same health care service in an in-person setting, |
|
|
including requirements regarding care coordination; and |
|
|
(B) the provider of the telemedicine medical |
|
|
service, teledentistry dental service, or telehealth service gives |
|
|
notice to the Medicaid recipient's primary care physician or |
|
|
provider regarding the [telemedicine medical service or |
|
|
telehealth] service, including a summary of the service, exam |
|
|
findings, a list of prescribed or administered medications, and |
|
|
patient instructions, for the purpose of sharing medical |
|
|
information, provided that the recipient has a primary care |
|
|
physician or provider and the recipient or, if appropriate, the |
|
|
recipient's parent or legal guardian, consents to the notice. |
|
|
(h) The commission shall develop, document, and implement a |
|
|
monitoring process to ensure that a Medicaid managed care |
|
|
organization ensures that the use of telemedicine medical services, |
|
|
teledentistry dental services, or telehealth services promotes and |
|
|
supports patient-centered medical homes and care coordination in |
|
|
accordance with Subsection (g)(3). The process must include |
|
|
monitoring of the rate at which a telemedicine medical service, |
|
|
teledentistry dental service, or telehealth service provider gives |
|
|
notice in accordance with Subsection (g)(3)(B). |
|
|
(i) The executive commissioner by rule shall ensure that a |
|
|
federally-qualified [federally qualified] health center as defined |
|
|
by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the |
|
|
originating site facility fee or the distant site practitioner fee |
|
|
or both, as appropriate, for a covered telemedicine medical |
|
|
service, teledentistry dental service, or telehealth service |
|
|
delivered by a health care provider to a Medicaid recipient. The |
|
|
commission is required to implement this subsection only if the |
|
|
legislature appropriates money specifically for that purpose. If |
|
|
the legislature does not appropriate money specifically for that |
|
|
purpose, the commission may, but is not required to, implement this |
|
|
subsection using other money available to the commission for that |
|
|
purpose. |
|
|
(j) In complying with state and federal requirements to |
|
|
provide access to medically necessary services under the Medicaid |
|
|
managed care program, a Medicaid managed care organization |
|
|
determining whether reimbursement for a telemedicine medical |
|
|
service, teledentistry dental service, or telehealth service is |
|
|
appropriate shall continue to consider other factors, including |
|
|
whether reimbursement is cost-effective and whether the provision |
|
|
of the service is clinically effective. |
|
|
SECTION 19. The heading to Section 531.02162, Government |
|
|
Code, is amended to read as follows: |
|
|
Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH |
|
|
TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND |
|
|
TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS. |
|
|
SECTION 20. Section 531.02162, Government Code, is amended |
|
|
by amending Subsections (b) and (c) and adding Subsection (d) to |
|
|
read as follows: |
|
|
(b) The executive commissioner by rule shall establish |
|
|
policies that permit reimbursement under Medicaid and the child |
|
|
health plan program for services provided through telemedicine |
|
|
medical services, teledentistry dental services, and telehealth |
|
|
services to children with special health care needs. |
|
|
(c) The policies required under this section must: |
|
|
(1) be designed to: |
|
|
(A) prevent unnecessary travel and encourage |
|
|
efficient use of telemedicine medical services, teledentistry |
|
|
dental services, and telehealth services for children with special |
|
|
health care needs in all suitable circumstances; and |
|
|
(B) ensure in a cost-effective manner the |
|
|
availability to a child with special health care needs of services |
|
|
appropriately performed using telemedicine medical services, |
|
|
teledentistry dental services, and telehealth services that are |
|
|
comparable to the same types of services available to that child |
|
|
without the use of telemedicine medical services, teledentistry |
|
|
dental services, and telehealth services; and |
|
|
(2) provide for reimbursement of multiple providers of |
|
|
different services who participate in a single session of |
|
|
telemedicine medical services, teledentistry dental services, |
|
|
[and] telehealth services, or any combination of those services, |
|
|
[session] for a child with special health care needs, if the |
|
|
commission determines that reimbursing each provider for the |
|
|
session is cost-effective in comparison to the costs that would be |
|
|
involved in obtaining the services from providers without the use |
|
|
of telemedicine medical services, teledentistry dental services, |
|
|
and telehealth services, including the costs of transportation and |
|
|
lodging and other direct costs. |
|
|
(d) The policies established under this section may |
|
|
authorize the provision of a service as a teledentistry dental |
|
|
service only if the provision of the service through teledentistry |
|
|
does not violate the standard of care applicable to the service. |
|
|
SECTION 21. Subchapter B, Chapter 531, Government Code, is |
|
|
amended by adding Section 531.02172 to read as follows: |
|
|
Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL |
|
|
SERVICES. (a) The commission by rule shall require each health and |
|
|
human services agency that administers a part of the Medicaid |
|
|
program to provide Medicaid reimbursement for teledentistry dental |
|
|
services provided by a dentist licensed to practice dentistry in |
|
|
this state. |
|
|
(b) The commission shall require reimbursement for a |
|
|
teledentistry dental service at the same rate as the Medicaid |
|
|
program reimburses for the same in-person dental service. A |
|
|
request for reimbursement may not be denied solely because an |
|
|
in-person dental service between a dentist and a patient did not |
|
|
occur. The commission may not limit a dentist's choice of platform |
|
|
for providing a teledentistry dental service by requiring that the |
|
|
dentist use a particular platform to receive reimbursement for the |
|
|
service. |
|
|
(c) The State Board of Dental Examiners, in consultation |
|
|
with the commission and the commission's office of inspector |
|
|
general, as appropriate, may adopt rules as necessary to: |
|
|
(1) ensure that appropriate care, including quality of |
|
|
care, is provided to patients who receive teledentistry dental |
|
|
services; and |
|
|
(2) prevent abuse and fraud through the use of |
|
|
teledentistry dental services, including rules relating to filing |
|
|
claims and the records required to be maintained in connection with |
|
|
teledentistry dental services. |
|
|
SECTION 22. The heading to Section 62.157, Health and |
|
|
Safety Code, is amended to read as follows: |
|
|
Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY |
|
|
DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL |
|
|
HEALTH CARE NEEDS. |
|
|
SECTION 23. Sections 62.157(a) and (b), Health and Safety |
|
|
Code, are amended to read as follows: |
|
|
(a) In providing covered benefits to a child with special |
|
|
health care needs, a health plan provider must permit benefits to be |
|
|
provided through telemedicine medical services, teledentistry |
|
|
dental services, and telehealth services in accordance with |
|
|
policies developed by the commission. |
|
|
(b) The policies must provide for: |
|
|
(1) the availability of covered benefits |
|
|
appropriately provided through telemedicine medical services, |
|
|
teledentistry dental services, and telehealth services that are |
|
|
comparable to the same types of covered benefits provided without |
|
|
the use of telemedicine medical services, teledentistry dental |
|
|
services, and telehealth services; and |
|
|
(2) the availability of covered benefits for different |
|
|
services performed by multiple health care providers during a |
|
|
single [telemedicine medical services and telehealth services] |
|
|
session of telemedicine medical services, teledentistry dental |
|
|
services, telehealth services, or any combination of those |
|
|
services, if the executive commissioner determines that delivery of |
|
|
the covered benefits in that manner is cost-effective in comparison |
|
|
to the costs that would be involved in obtaining the services from |
|
|
providers without the use of telemedicine medical services, |
|
|
teledentistry dental services, and telehealth services, including |
|
|
the costs of transportation and lodging and other direct costs. |
|
|
SECTION 24. Section 62.1571, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND |
|
|
TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits |
|
|
to a child, a health plan provider must permit benefits to be |
|
|
provided through telemedicine medical services and teledentistry |
|
|
dental services in accordance with policies developed by the |
|
|
commission. |
|
|
(b) The policies must provide for: |
|
|
(1) the availability of covered benefits |
|
|
appropriately provided through telemedicine medical services and |
|
|
teledentistry dental services that are comparable to the same types |
|
|
of covered benefits provided without the use of telemedicine |
|
|
medical services and teledentistry dental services; and |
|
|
(2) the availability of covered benefits for different |
|
|
services performed by multiple health care providers during a |
|
|
single session of telemedicine medical services, teledentistry |
|
|
dental services, or both services, if the executive commissioner |
|
|
determines that delivery of the covered benefits in that manner is |
|
|
cost-effective in comparison to the costs that would be involved in |
|
|
obtaining the services from providers without the use of |
|
|
telemedicine medical services or teledentistry dental services, |
|
|
including the costs of transportation and lodging and other direct |
|
|
costs. |
|
|
(c) [(d)] In this section, "teledentistry dental service" |
|
|
and "telemedicine medical service" have [has] the meanings |
|
|
[meaning] assigned by Section 531.001, Government Code. |
|
|
SECTION 25. The heading to Chapter 1455, Insurance Code, is |
|
|
amended to read as follows: |
|
|
CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH |
|
|
SECTION 26. Section 1455.001, Insurance Code, is amended by |
|
|
amending Subdivisions (1) and (3) and adding Subdivision (1-a) to |
|
|
read as follows: |
|
|
(1) "Dentist" means a person licensed to practice |
|
|
dentistry in this state under Subtitle D, Title 3, Occupations |
|
|
Code. |
|
|
(1-a) "Health professional" means: |
|
|
(A) a physician; |
|
|
(B) an individual who is: |
|
|
(i) licensed or certified in this state to |
|
|
perform health care services; and |
|
|
(ii) authorized to assist: |
|
|
(a) a physician in providing |
|
|
telemedicine medical services that are delegated and supervised by |
|
|
the physician; or |
|
|
(b) a dentist in providing |
|
|
teledentistry dental services that are delegated and supervised by |
|
|
the dentist; |
|
|
(C) a licensed or certified health professional |
|
|
acting within the scope of the license or certification who does not |
|
|
perform a telemedicine medical service or a teledentistry dental |
|
|
service; or |
|
|
(D) a dentist. |
|
|
(3) "Teledentistry dental service," "telehealth |
|
|
["Telehealth] service," and "telemedicine medical service" have |
|
|
the meanings assigned by Section 111.001, Occupations Code. |
|
|
SECTION 27. Section 1455.004, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES, |
|
|
TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A |
|
|
health benefit plan: |
|
|
(1) must provide coverage for a covered health care |
|
|
service or procedure delivered by a preferred or contracted health |
|
|
professional to a covered patient as a telemedicine medical |
|
|
service, teledentistry dental service, or telehealth service on the |
|
|
same basis and to the same extent that the plan provides coverage |
|
|
for the service or procedure in an in-person setting; and |
|
|
(2) may not: |
|
|
(A) exclude from coverage a covered health care |
|
|
service or procedure delivered by a preferred or contracted health |
|
|
professional to a covered patient as a telemedicine medical |
|
|
service, a teledentistry dental service, or a telehealth service |
|
|
solely because the covered health care service or procedure is not |
|
|
provided through an in-person consultation; and |
|
|
(B) subject to Subsection (c), limit, deny, or |
|
|
reduce coverage for a covered health care service or procedure |
|
|
delivered as a telemedicine medical service, teledentistry dental |
|
|
service, or telehealth service based on the health professional's |
|
|
choice of platform for delivering the service or procedure. |
|
|
(b) A health benefit plan may require a deductible, a |
|
|
copayment, or coinsurance for a covered health care service or |
|
|
procedure delivered by a preferred or contracted health |
|
|
professional to a covered patient as a telemedicine medical |
|
|
service, a teledentistry dental service, or a telehealth service. |
|
|
The amount of the deductible, copayment, or coinsurance may not |
|
|
exceed the amount of the deductible, copayment, or coinsurance |
|
|
required for the covered health care service or procedure provided |
|
|
through an in-person consultation. |
|
|
(b-1) Subsection (b) does not authorize a health benefit |
|
|
plan to charge a separate deductible that applies only to a covered |
|
|
health care service or procedure delivered as a telemedicine |
|
|
medical service, teledentistry dental service, or telehealth |
|
|
service. |
|
|
(c) Notwithstanding Subsection (a), a health benefit plan |
|
|
is not required to provide coverage for a telemedicine medical |
|
|
service, a teledentistry dental service, or a telehealth service |
|
|
provided by only synchronous or asynchronous audio interaction, |
|
|
including: |
|
|
(1) an audio-only telephone consultation; |
|
|
(2) a text-only e-mail message; or |
|
|
(3) a facsimile transmission. |
|
|
(d) A health benefit plan may not impose an annual or |
|
|
lifetime maximum on coverage for covered health care services or |
|
|
procedures delivered as telemedicine medical services, |
|
|
teledentistry dental services, or telehealth services other than |
|
|
the annual or lifetime maximum, if any, that applies in the |
|
|
aggregate to all items and services and procedures covered under |
|
|
the plan. |
|
|
SECTION 28. Section 1455.006, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES, |
|
|
TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES STATEMENT. |
|
|
(a) Each issuer of a health benefit plan shall adopt and display in |
|
|
a conspicuous manner on the health benefit plan issuer's Internet |
|
|
website the issuer's policies and payment practices for |
|
|
telemedicine medical services, teledentistry dental services, and |
|
|
telehealth services. |
|
|
(b) This section does not require an issuer of a health |
|
|
benefit plan to display negotiated contract payment rates for |
|
|
health professionals who contract with the issuer to provide |
|
|
telemedicine medical services, teledentistry dental services, or |
|
|
telehealth services. |
|
|
SECTION 29. Not later than March 1, 2022: |
|
|
(1) the State Board of Dental Examiners and the Texas |
|
|
State Board of Pharmacy shall jointly adopt rules as required by |
|
|
Section 111.006(c), Occupations Code, as added by this Act; |
|
|
(2) the State Board of Dental Examiners shall adopt: |
|
|
(A) rules necessary to implement Chapter 111, |
|
|
Occupations Code, as amended by this Act; and |
|
|
(B) rules as required by Section 254.0035, |
|
|
Occupations Code, as added by this Act; and |
|
|
(3) the Health and Human Services Commission shall |
|
|
adopt rules as required by Section 531.02172, Government Code, as |
|
|
added by this Act. |
|
|
SECTION 30. If before implementing any provision of this |
|
|
Act a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 31. (a) Except as provided by Subsection (b) of |
|
|
this section, this Act takes effect September 1, 2021. |
|
|
(b) Sections 1455.004 and 1455.006, Insurance Code, as |
|
|
amended by this Act, take effect January 1, 2022. |