1-1     By:  Gray (Senate Sponsor - Sibley)                   H.B. No. 2033

 1-2           (In the Senate - Received from the House May 2, 1997;

 1-3     May 5, 1997, read first time and referred to Committee on Economic

 1-4     Development; May 16, 1997, reported adversely, with favorable

 1-5     Committee Substitute by the following vote:  Yeas 8, Nays 0;

 1-6     May 16, 1997, sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR H.B. No. 2033                  By:  Sibley

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to coverage for services provided through telemedicine

1-11     under certain health benefit plans.

1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-13           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is

1-14     amended by adding Article 21.53F to read as follows:

1-15           Art. 21.53F.  TELEMEDICINE

1-16           Sec. 1.  DEFINITIONS.  In this article:

1-17                 (1)  "Health benefit plan" means a plan described by

1-18     Section 2 of this article.

1-19                 (2)  "Telemedicine" means the use of interactive audio,

1-20     video, or other electronic media to deliver health care.  The term

1-21     includes the use of electronic media for diagnosis, consultation,

1-22     treatment, transfer of medical data, and medical education.  The

1-23     term does not include services performed using a telephone or

1-24     facsimile machine.

1-25           Sec. 2.  SCOPE OF ARTICLE.  (a)  This article applies only to

1-26     a health benefit plan that:

1-27                 (1)  provides benefits for medical or surgical expenses

1-28     incurred as a result of a health condition, accident, or sickness,

1-29     including:

1-30                       (A)  an individual, group, blanket, or franchise

1-31     insurance policy or insurance agreement, a group hospital service

1-32     contract, or an individual or group evidence of coverage that is

1-33     offered by:

1-34                             (i)  an insurance company;

1-35                             (ii)  a group hospital service corporation

1-36     operating under Chapter 20 of this code;

1-37                             (iii)  a fraternal benefit society

1-38     operating under Chapter 10 of this code;

1-39                             (iv)  a stipulated premium insurance

1-40     company operating under Chapter 22 of this code; or

1-41                             (v)  a health maintenance organization

1-42     operating under the Texas Health Maintenance Organization Act

1-43     (Chapter 20A, Vernon's Texas Insurance Code); or

1-44                       (B)  to the extent permitted by the Employee

1-45     Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et

1-46     seq.), a health benefit plan that is offered by a multiple employer

1-47     welfare arrangement as defined by Section 3, Employee Retirement

1-48     Income Security Act of 1974 (29 U.S.C. Section 1002) or another

1-49     analogous benefit arrangement; or

1-50                 (2)  is offered by an approved nonprofit health

1-51     corporation that is certified under Section 5.01(a), Medical

1-52     Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and

1-53     that holds a certificate of authority issued by the commissioner

1-54     under Article 21.52F of this code.

1-55           (b)  This article does not apply to:

1-56                 (1)  a plan that provides coverage:

1-57                       (A)  only for a specified disease;

1-58                       (B)  only for accidental death or dismemberment;

1-59                       (C)  for wages or payments in lieu of wages for a

1-60     period during which an employee is absent from work because of

1-61     sickness or injury; or

1-62                       (D)  as a supplement to liability insurance;

1-63                 (2)  a small employer health benefit plan written under

1-64     Chapter 26 of this code;

 2-1                 (3)  a Medicare supplemental policy as defined by

 2-2     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

 2-3                 (4)  workers' compensation insurance coverage;

 2-4                 (5)  medical payment insurance issued as part of a

 2-5     motor vehicle insurance policy; or

 2-6                 (6)  a long-term care policy, including a nursing home

 2-7     fixed indemnity policy, unless the commissioner determines that the

 2-8     policy provides benefit coverage so comprehensive that the policy

 2-9     is a health benefit plan as described by Subsection (a) of this

2-10     section.

2-11           Sec. 3.  COVERAGE FOR TELEMEDICINE SERVICES.  (a)  A health

2-12     benefit plan may not exclude a service from coverage under the plan

2-13     solely because the service is provided through telemedicine and not

2-14     provided through a face-to-face consultation.

2-15           (b)  Benefits for a service provided through telemedicine

2-16     required under this article may be made subject to a deductible,

2-17     copayment, or coinsurance requirement.  A deductible, copayment, or

2-18     coinsurance applicable to a particular service provided through

2-19     telemedicine may not exceed the deductible, copayment, or

2-20     coinsurance required by the health benefit plan for the same

2-21     service provided through a face-to-face consultation.

2-22           Sec. 4.  INFORMED CONSENT.  A treating physician or other

2-23     health care provider who provides or facilitates the use of

2-24     telemedicine shall ensure that the informed consent of the patient,

2-25     or another appropriate person with authority to make health care

2-26     treatment decisions for the patient, is obtained before services

2-27     are provided through telemedicine.

2-28           Sec. 5.  CONFIDENTIALITY.  A treating physician or other

2-29     health care provider who provides or facilitates the use of

2-30     telemedicine shall ensure that the confidentiality of the patient's

2-31     medical information is maintained as required by Section 5.08,

2-32     Medical Practice Act (Article 4495b, Vernon's Texas Civil

2-33     Statutes), or other applicable law.

2-34           Sec. 6.  RULES.  (a)  Subject to Subsection (b) of this

2-35     section, the commissioner may adopt rules as necessary to implement

2-36     this article.

2-37           (b)  The Texas State Board of Medical Examiners, in

2-38     consultation with the commissioner, as appropriate, may adopt rules

2-39     as necessary to:

2-40                 (1)  ensure that appropriate care is provided to

2-41     patients who receive services that are provided through

2-42     telemedicine; and

2-43                 (2)  prevent abuse and fraud through use of

2-44     telemedicine services, including rules relating to filing of claims

2-45     and records required to be maintained in connection with

2-46     telemedicine.

2-47           SECTION 2.  This Act takes effect September 1, 1997, and

2-48     applies only to a health benefit plan that is delivered, issued for

2-49     delivery, or renewed on or after January 1, 1998.  A health benefit

2-50     plan that is delivered, issued for delivery, or renewed before

2-51     January 1, 1998, is governed by the law as it existed immediately

2-52     before the effective date of this Act, and that law is continued in

2-53     effect for this purpose.

2-54           SECTION 3.  The importance of this legislation and the

2-55     crowded condition of the calendars in both houses create an

2-56     emergency and an imperative public necessity that the

2-57     constitutional rule requiring bills to be read on three several

2-58     days in each house be suspended, and this rule is hereby suspended.

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