RS C.S.H.B. 2033 75(R) BILL ANALYSIS INSURANCE C.S.H.B. 2033 By: Gray 4-14-97 Committee Report (Substituted) BACKGROUND Health care costs continue to spiral out of control, yet according to the Texas Hospital Association, in the last five years over 67 Texas hospitals have closed their doors. The availability of any form of health care in these undeserved urban and rural areas is reaching crisis proportions. Telemedicine has the proven capability to simultaneously lower the cost and raise the quality of the health care delivered to the citizens of Texas. Yet, Texas health benefit plans do not currently provide reimbursement for telemedicine, and this impedes the development of telemedicine. The Health Care Financing Administration (HCFA) has authorized money to allow other states to reimburse telemedicine consultations. However, Texas did not receive any HCFA funding although Texas possesses some of the best telemedicine infrastructure, research and product development capabilities in the nation. PURPOSE The purpose of this bill is to ensure coverage from health benefit plans for services provided through telemedicine. RULEMAKING AUTHORITY It is the opinion of the committee that there is express rulemaking authority in SECTION 1 of this bill (Section 6, Article 21.53F, Insurance Code). SECTION BY SECTION ANALYSIS SECTION 1 - Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53F as follows: Art. 21.53F - TELEMEDICINE Sec. 1. - DEFINITIONS. - Defines "Health benefit plan" and "Telemedicine." Sec. 2. - SCOPE OF ARTICLE - Sets what types of benefit plans this article does and does not apply to. Sec. 3. - COVERAGE FOR TELEMEDICINE SERVICES. - (a) A health benefit plan may not exclude a service covered under the plan just because it is provided through telemedicine. (b) Benefits provided through telemedicine may be made subject to deductible, copayment, or coinsurance requirement, and may not exceed the deductible, copayment, or coinsurance premium of a face-to-face consultation. Sec. 4. - INFORMED CONSENT - A treating physician shall obtain permission for the use of telemedicine prior to its use. Sec. 5. - CONFIDENTIALITY - Confidentiality shall be maintained in facilities where telemedicine is employed. Sec. 6. - RULES - The commissioner shall adopt rules as necessary to enforce this article. SECTION 2. - Act takes effect September 1, 1997, and applies to policies issued on or after January 1, 1998. SECTION 3. - Emergency Clause COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute incorporates the following major changes from the original bill: 1) Deletes provision to the extent permitted by ERISA those plans contracting directly for health care on a risk-sharing basis, including those on a capitated basis. 2) Provides that a treating physician require informed consent from either the patient or a guardian prior to consultation. 3) Requires the physician comply with the confidentiality guidelines established in the X:\HBA\ANALYSIS\75R\HB2033HS.20 Medical Practices Act.