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.