75R11129 DLF-D By Gray H.B. No. 2033 Substitute the following for H.B. No. 2033: By Olivo C.S.H.B. No. 2033 A BILL TO BE ENTITLED 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, 3-23 or 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. The commissioner may adopt rules as 4-13 necessary to implement this article. 4-14 SECTION 2. This Act takes effect September 1, 1997, and 4-15 applies only to a health benefit plan that is delivered, issued for 4-16 delivery, or renewed on or after January 1, 1998. A health benefit 4-17 plan that is delivered, issued for delivery, or renewed before 4-18 January 1, 1998, is governed by the law as it existed immediately 4-19 before the effective date of this Act, and that law is continued in 4-20 effect for this purpose. 4-21 SECTION 3. The importance of this legislation and the 4-22 crowded condition of the calendars in both houses create an 4-23 emergency and an imperative public necessity that the 4-24 constitutional rule requiring bills to be read on three several 4-25 days in each house be suspended, and this rule is hereby suspended.