1-1 AN ACT
1-2 relating to coverage for services provided through telemedicine
1-3 under certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53F to read as follows:
1-7 Art. 21.53F. TELEMEDICINE
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Health benefit plan" means a plan described by
1-10 Section 2 of this article.
1-11 (2) "Telemedicine" means the use of interactive audio,
1-12 video, or other electronic media to deliver health care. The term
1-13 includes the use of electronic media for diagnosis, consultation,
1-14 treatment, transfer of medical data, and medical education. The
1-15 term does not include services performed using a telephone or
1-16 facsimile machine.
1-17 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-18 a health benefit plan that:
1-19 (1) provides benefits for medical or surgical expenses
1-20 incurred as a result of a health condition, accident, or sickness,
1-21 including:
1-22 (A) an individual, group, blanket, or franchise
1-23 insurance policy or insurance agreement, a group hospital service
1-24 contract, or an individual or group evidence of coverage that is
2-1 offered by:
2-2 (i) an insurance company;
2-3 (ii) a group hospital service corporation
2-4 operating under Chapter 20 of this code;
2-5 (iii) a fraternal benefit society
2-6 operating under Chapter 10 of this code;
2-7 (iv) a stipulated premium insurance
2-8 company operating under Chapter 22 of this code; or
2-9 (v) a health maintenance organization
2-10 operating under the Texas Health Maintenance Organization Act
2-11 (Chapter 20A, Vernon's Texas Insurance Code); or
2-12 (B) to the extent permitted by the Employee
2-13 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-14 seq.), a health benefit plan that is offered by a multiple employer
2-15 welfare arrangement as defined by Section 3, Employee Retirement
2-16 Income Security Act of 1974 (29 U.S.C. Section 1002) or another
2-17 analogous benefit arrangement; or
2-18 (2) is offered by an approved nonprofit health
2-19 corporation that is certified under Section 5.01(a), Medical
2-20 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-21 that holds a certificate of authority issued by the commissioner
2-22 under Article 21.52F of this code.
2-23 (b) This article does not apply to:
2-24 (1) a plan that provides coverage:
2-25 (A) only for a specified disease;
2-26 (B) only for accidental death or dismemberment;
2-27 (C) for wages or payments in lieu of wages for a
3-1 period during which an employee is absent from work because of
3-2 sickness or injury; or
3-3 (D) as a supplement to liability insurance;
3-4 (2) a small employer health benefit plan written under
3-5 Chapter 26 of this code;
3-6 (3) a Medicare supplemental policy as defined by
3-7 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-8 (4) workers' compensation insurance coverage;
3-9 (5) medical payment insurance issued as part of a
3-10 motor vehicle insurance policy; or
3-11 (6) a long-term care policy, including a nursing home
3-12 fixed indemnity policy, unless the commissioner determines that the
3-13 policy provides benefit coverage so comprehensive that the policy
3-14 is a health benefit plan as described by Subsection (a) of this
3-15 section.
3-16 Sec. 3. COVERAGE FOR TELEMEDICINE SERVICES. (a) A health
3-17 benefit plan may not exclude a service from coverage under the plan
3-18 solely because the service is provided through telemedicine and not
3-19 provided through a face-to-face consultation.
3-20 (b) Benefits for a service provided through telemedicine
3-21 required under this article may be made subject to a deductible,
3-22 copayment, or coinsurance requirement. A deductible, copayment, or
3-23 coinsurance applicable to a particular service provided through
3-24 telemedicine may not exceed the deductible, copayment, or
3-25 coinsurance required by the health benefit plan for the same
3-26 service provided through a face-to-face consultation.
3-27 Sec. 4. INFORMED CONSENT. A treating physician or other
4-1 health care provider who provides or facilitates the use of
4-2 telemedicine shall ensure that the informed consent of the patient,
4-3 or another appropriate person with authority to make health care
4-4 treatment decisions for the patient, is obtained before services
4-5 are provided through telemedicine.
4-6 Sec. 5. CONFIDENTIALITY. A treating physician or other
4-7 health care provider who provides or facilitates the use of
4-8 telemedicine shall ensure that the confidentiality of the patient's
4-9 medical information is maintained as required by Section 5.08,
4-10 Medical Practice Act (Article 4495b, Vernon's Texas Civil
4-11 Statutes), or other applicable law.
4-12 Sec. 6. RULES. (a) Subject to Subsection (b) of this
4-13 section, the commissioner may adopt rules as necessary to implement
4-14 this article.
4-15 (b) The Texas State Board of Medical Examiners, in
4-16 consultation with the commissioner, as appropriate, may adopt rules
4-17 as necessary to:
4-18 (1) ensure that appropriate care is provided to
4-19 patients who receive services that are provided through
4-20 telemedicine; and
4-21 (2) prevent abuse and fraud through use of
4-22 telemedicine services, including rules relating to filing of claims
4-23 and records required to be maintained in connection with
4-24 telemedicine.
4-25 SECTION 2. This Act takes effect September 1, 1997, and
4-26 applies only to a health benefit plan that is delivered, issued for
4-27 delivery, or renewed on or after January 1, 1998. A health benefit
5-1 plan that is delivered, issued for delivery, or renewed before
5-2 January 1, 1998, is governed by the law as it existed immediately
5-3 before the effective date of this Act, and that law is continued in
5-4 effect for this purpose.
5-5 SECTION 3. The importance of this legislation and the
5-6 crowded condition of the calendars in both houses create an
5-7 emergency and an imperative public necessity that the
5-8 constitutional rule requiring bills to be read on three several
5-9 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2033 was passed by the House on May
1, 1997, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 2033 on May 24, 1997, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 2033 was passed by the Senate, with
amendments, on May 22, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor