By Gray H.B. No. 3785
76R374 AJA-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 plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.53F, Insurance Code, as added by
1-6 Chapter 880, Acts of the 75th Legislature, Regular Session, 1997,
1-7 is redesignated as Article 21.53Z, Insurance Code, and amended to
1-8 read as follows:
1-9 Art. 21.53Z. [21.53F.] TELEMEDICINE
1-10 Sec. 1. DEFINITIONS. In this article:
1-11 (1) "Health benefit plan" means a plan described by
1-12 Section 2 of this article.
1-13 (2) "Telemedicine" means the use of interactive audio,
1-14 video, or other electronic media to deliver health care. The term
1-15 includes the use of electronic media for diagnosis, consultation,
1-16 treatment, transfer of medical data, and medical education. The
1-17 term does not include services performed using a telephone or
1-18 facsimile machine.
1-19 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-20 a health benefit plan that:
1-21 (1) provides benefits for medical or surgical expenses
1-22 incurred as a result of a health condition, accident, [or]
1-23 sickness, or specified disease, including:
1-24 (A) an individual, group, blanket, or franchise
2-1 insurance policy or insurance agreement, a group hospital service
2-2 contract, or an individual or group evidence of coverage that is
2-3 offered by:
2-4 (i) an insurance company;
2-5 (ii) a group hospital service corporation
2-6 operating under Chapter 20 of this code;
2-7 (iii) a fraternal benefit society
2-8 operating under Chapter 10 of this code;
2-9 (iv) a stipulated premium insurance
2-10 company operating under Chapter 22 of this code; [or]
2-11 (v) a health maintenance organization
2-12 operating under the Texas Health Maintenance Organization Act
2-13 (Chapter 20A, Vernon's Texas Insurance Code); or
2-14 (vi) a small employer carrier operating
2-15 under Chapter 26 of this code; or
2-16 (B) to the extent permitted by the Employee
2-17 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-18 seq.), a health benefit plan that is offered by a multiple employer
2-19 welfare arrangement as defined by Section 3, Employee Retirement
2-20 Income Security Act of 1974 (29 U.S.C. Section 1002), or another
2-21 analogous benefit arrangement; [or]
2-22 (2) is offered by an approved nonprofit health
2-23 corporation that is certified under Section 5.01(a), Medical
2-24 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-25 that holds a certificate of authority issued by the commissioner
2-26 under Article 21.52F of this code;
2-27 (3) provides coverage as a supplement to liability
3-1 insurance;
3-2 (4) provides workers' compensation insurance coverage;
3-3 or
3-4 (5) provides medical payment insurance as part of a
3-5 motor vehicle insurance policy.
3-6 (b) This article does not apply to:
3-7 (1) a plan that provides coverage:
3-8 (A) [only for a specified disease;]
3-9 [(B)] only for accidental death or
3-10 dismemberment; or
3-11 (B) [(C)] for wages or payments in lieu of wages
3-12 for a period during which an employee is absent from work because
3-13 of sickness or injury; [or]
3-14 [(D) as a supplement to liability insurance;]
3-15 (2) [a small employer health benefit plan written
3-16 under Chapter 26 of this code;]
3-17 [(3)] a Medicare supplemental policy as defined by
3-18 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-19 [(4) workers' compensation insurance coverage;]
3-20 [(5) medical payment insurance issued as part of a
3-21 motor vehicle insurance policy;] or
3-22 (3) [(6)] a long-term care policy, including a nursing
3-23 home fixed indemnity policy, unless the commissioner determines
3-24 that the policy provides benefit coverage so comprehensive that the
3-25 policy is a health benefit plan as described by Subsection (a) of
3-26 this section.
3-27 Sec. 3. COVERAGE FOR TELEMEDICINE SERVICES. (a) A health
4-1 benefit plan may not exclude a service from coverage under the plan
4-2 solely because the service is provided through telemedicine and not
4-3 provided through a face-to-face consultation.
4-4 (b) Benefits for a service provided through telemedicine
4-5 required under this article may be made subject to a deductible,
4-6 copayment, or coinsurance requirement. A deductible, copayment, or
4-7 coinsurance applicable to a particular service provided through
4-8 telemedicine may not exceed the deductible, copayment, or
4-9 coinsurance required by the health benefit plan for the same
4-10 service provided through a face-to-face consultation.
4-11 Sec. 4. INFORMED CONSENT. A treating physician or other
4-12 health care provider who provides or facilitates the use of
4-13 telemedicine shall ensure that the informed consent of the patient,
4-14 or another appropriate person with authority to make health care
4-15 treatment decisions for the patient, is obtained before services
4-16 are provided through telemedicine.
4-17 Sec. 5. CONFIDENTIALITY. A treating physician or other
4-18 health care provider who provides or facilitates the use of
4-19 telemedicine shall ensure that the confidentiality of the patient's
4-20 medical information is maintained as required by Section 5.08,
4-21 Medical Practice Act (Article 4495b, Vernon's Texas Civil
4-22 Statutes), or other applicable law.
4-23 Sec. 6. RULES. (a) Subject to Subsection (b) of this
4-24 section, the commissioner may adopt rules as necessary to implement
4-25 this article.
4-26 (b) The Texas State Board of Medical Examiners, in
4-27 consultation with the commissioner, as appropriate, may adopt rules
5-1 as necessary to:
5-2 (1) ensure that appropriate care is provided to
5-3 patients who receive services that are provided through
5-4 telemedicine; and
5-5 (2) prevent abuse and fraud through use of
5-6 telemedicine services, including rules relating to filing of claims
5-7 and records required to be maintained in connection with
5-8 telemedicine.
5-9 SECTION 2. Subchapter C, Chapter 26, Insurance Code, is
5-10 amended by adding Article 26.21B to read as follows:
5-11 Art. 26.21B. TELEMEDICINE. A small employer health benefit
5-12 plan is subject to Article 21.53Z of this code.
5-13 SECTION 3. This Act takes effect September 1, 1999, and
5-14 applies only to a health benefit plan that is delivered, issued for
5-15 delivery, or renewed on or after January 1, 2000. A plan
5-16 delivered, issued for delivery, or renewed before January 1, 2000,
5-17 is governed by the law as it existed immediately before the
5-18 effective date of this Act, and that law is continued in effect for
5-19 that purpose.
5-20 SECTION 4. The importance of this legislation and the
5-21 crowded condition of the calendars in both houses create an
5-22 emergency and an imperative public necessity that the
5-23 constitutional rule requiring bills to be read on three several
5-24 days in each house be suspended, and this rule is hereby suspended.