82R8146 SLB-D
  By: Hardcastle H.B. No. 2333
  relating to the practice of telemedicine.
         SECTION 1.  Chapter 111, Occupations Code, is amended to
  read as follows:
         Sec. 111.001.  DEFINITIONS. In this chapter:
               (1)  "Advanced telecommunications technology" means
  technology used for the transfer of data, not including telephone
  or facsimile technology.  The term includes:
                     (A)  compressed digital interactive video, audio,
  or data transmission;
                     (B)  data transmission using computer imaging;
                     (C)  other technology that facilitates access to
               (2)  "Board" means the Texas Medical Board.
               (3)  "Telemedicine medical service" means a health care
  service that is provided through the use of advanced
  telecommunications technology for the purpose of:
                     (A)  patient assessment, diagnosis, consultation,
  or treatment; or
                     (B)  the transfer of medical data.
               (4)  "Telemedicine provider" means:
                     (A)  a physician who provides telemedicine
  medical services; or
                     (B)  a physician assistant or advanced practice
  nurse who:
                           (i)  provides telemedicine medical
  services; and
                           (ii)  is supervised by and has delegated
  authority from a physician licensed in this state ['Health
  professional' and 'physician' have the meanings assigned by Section
  1455.001, Insurance Code.
               [(2)     'Telehealth service' and 'telemedicine medical
  service' have the meanings assigned by Section 57.042, Utilities
         Sec. 111.002.  INFORMED CONSENT. A telemedicine provider
  must [treating physician or health professional who provides or
  facilitates the use of telemedicine medical services or telehealth
  services shall] ensure that the informed consent of the patient, or
  another appropriate individual authorized to make health care
  treatment decisions for the patient, is obtained before
  telemedicine medical services [or telehealth services] are
         Sec. 111.003.  CONFIDENTIALITY. A telemedicine provider
  [treating physician or health professional who provides or
  facilitates the use of telemedicine medical services or telehealth
  services] shall ensure that the confidentiality of the patient's
  medical information is maintained as required by Chapter 159 or
  other applicable law.
         Sec. 111.004.  RULES. The board [Texas State Board of
  Medical Examiners], in consultation with the commissioner of
  insurance, as appropriate, may adopt rules necessary to implement
  this chapter.  The board may not adopt a rule to limit the provision
  of telemedicine medical services by a telemedicine provider who
  meets the requirements of this chapter and other applicable law[:
               [(1)     ensure that patients using telemedicine medical
  services receive appropriate, quality care;
               [(2)     prevent abuse and fraud in the use of
  telemedicine medical services, including rules relating to the
  filing of claims and records required to be maintained in
  connection with telemedicine medical services;
               [(3)     ensure adequate supervision of health
  professionals who are not physicians and who provide telemedicine
  medical services;
               [(4)     establish the maximum number of health
  professionals who are not physicians that a physician may supervise
  through a telemedicine medical service; and
               [(5)     require a face-to-face consultation between a
  patient and a physician providing a telemedicine medical service
  within a certain number of days following an initial telemedicine
  medical service only if the physician has never seen the patient].
  (a)  A telemedicine provider may provide telemedicine medical
  services in this state only if the provider:
               (1)  is licensed in this state;
               (2)  has established a physician-patient relationship
  with the recipient of the services;
               (3)  advises the patient to see a physician or other
  health care professional in person within a reasonable time if the
  patient's symptoms do not improve;
               (4)  provides only services that are medically
               (5)  adopts protocols to prevent fraud and abuse;
               (6)  does not violate state or federal laws relating to
  patient privacy;
               (7)  maintains medical records for all telemedicine
  medical services;
               (8)  does not treat chronic pain with a controlled
  substance listed on Schedule II, III, IV, or V under Chapter 481,
  Health and Safety Code, at a site other than a site normally used
  for the provision of medical care; and
               (9)  practices the same standard of care as in a
  traditional clinical setting.
         (b)  A telemedicine provider may establish a
  physician-patient relationship in an initial encounter using
  telemedicine medical services.
         SECTION 2.  Section 531.02161(a), Government Code, is
  amended to read as follows:
         (a)  In this section, "telemedicine medical service" has the
  meaning assigned by Section 111.001, Occupations [57.042,
  Utilities] Code.
         SECTION 3.  The Texas Medical Board shall adopt rules to
  implement Chapter 111, Occupations Code, as amended by this Act,
  not later than December 1, 2011.
         SECTION 4.  (a)  Except as provided by Subsection (b) of this
  section, this Act takes effect December 1, 2011.
         (b)  Section 3 of this Act takes effect September 1, 2011.