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.