By Gray H.B. No. 2033 75R2119 DLF-D 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: 2-15 (i) a multiple employer welfare 2-16 arrangement as defined by Section 3, Employee Retirement Income 2-17 Security Act of 1974 (29 U.S.C. Section 1002) or another analogous 2-18 benefit arrangement; or 2-19 (ii) any other entity not licensed under 2-20 this code or another insurance law of this state that contracts 2-21 directly for health care services on a risk-sharing basis, 2-22 including an entity that contracts for health care services on a 2-23 capitation basis; or 2-24 (2) is offered by an approved nonprofit health 2-25 corporation that is certified under Section 5.01(a), Medical 2-26 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 2-27 that holds a certificate of authority issued by the commissioner 3-1 under Article 21.52F of this code. 3-2 (b) This article does not apply to: 3-3 (1) a plan that provides coverage: 3-4 (A) only for a specified disease; 3-5 (B) only for accidental death or dismemberment; 3-6 (C) for wages or payments in lieu of wages for a 3-7 period during which an employee is absent from work because of 3-8 sickness or injury; or 3-9 (D) as a supplement to liability insurance; 3-10 (2) a small employer health benefit plan written under 3-11 Chapter 26 of this code; 3-12 (3) a Medicare supplemental policy as defined by 3-13 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 3-14 (4) workers' compensation insurance coverage; 3-15 (5) medical payment insurance issued as part of a 3-16 motor vehicle insurance policy; or 3-17 (6) a long-term care policy, including a nursing home 3-18 fixed indemnity policy, unless the commissioner determines that the 3-19 policy provides benefit coverage so comprehensive that the policy 3-20 is a health benefit plan as described by Subsection (a) of this 3-21 section. 3-22 Sec. 3. COVERAGE FOR TELEMEDICINE SERVICES. (a) A health 3-23 benefit plan may not exclude a service from coverage under the plan 3-24 solely because the service is provided through telemedicine and not 3-25 provided through a face-to-face consultation. 3-26 (b) Benefits for a service provided through telemedicine 3-27 required under this article may be made subject to a deductible, 4-1 copayment, or coinsurance requirement. A deductible, copayment, 4-2 or coinsurance applicable to a particular service provided 4-3 through telemedicine may not exceed the deductible, copayment, or 4-4 coinsurance required by the health benefit plan for the same 4-5 service provided through a face-to-face consultation. 4-6 Sec. 4. RULES. The commissioner may adopt rules as 4-7 necessary to implement this article. 4-8 SECTION 2. This Act takes effect September 1, 1997, and 4-9 applies only to a health benefit plan that is delivered, issued for 4-10 delivery, or renewed on or after January 1, 1998. A health benefit 4-11 plan that is delivered, issued for delivery, or renewed before 4-12 January 1, 1998, is governed by the law as it existed immediately 4-13 before the effective date of this Act, and that law is continued in 4-14 effect for this purpose. 4-15 SECTION 3. The importance of this legislation and the 4-16 crowded condition of the calendars in both houses create an 4-17 emergency and an imperative public necessity that the 4-18 constitutional rule requiring bills to be read on three several 4-19 days in each house be suspended, and this rule is hereby suspended.