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. 2-59 * * * * *