SECTION 2. Section 1455.001,
Insurance Code, is amended by amending Subdivision (3) and adding
Subdivision (4) to read as follows:
(3) "Telemedicine
["Telehealth service" and "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 [have the meanings assigned by Section 57.042,
Utilities Code].
(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.
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SECTION 1. Section 1455.001,
Insurance Code, is amended by amending Subdivision (3) and adding
Subdivisions (4), (5), and (6) to read as follows:
(3)
"Telehealth provider" means a licensed or certified health
professional who provides telehealth services.
(4) "Telehealth
service" has the meaning assigned by Section 531.001, Government
Code.
(5) "Telemedicine
[and "telemedicine] medical service" means a medical 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 [have the meanings assigned by Section 57.042,
Utilities Code].
(6) "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.
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SECTION 3. Section 1455.004,
Insurance Code, is amended to read as follows:
Sec. 1455.004. COVERAGE FOR
TELEMEDICINE MEDICAL SERVICES [AND TELEHEALTH SERVICES].
(a)
A health benefit plan may not exclude a telemedicine medical service [or
a telehealth service] from coverage under the plan solely because the
service is not provided through a face-to-face consultation.
(b)
A health benefit plan may require a deductible, a copayment, or coinsurance
for a telemedicine medical service [or a telehealth service]. The
amount of the deductible, copayment, or coinsurance may not exceed the
amount of the deductible, copayment, or coinsurance required for a
comparable medical service provided through a face-to-face consultation.
(c) A health benefit plan
may not cover a telemedicine medical service unless the telemedicine
provider:
(1) is licensed and resides in this state;
(2) has established a
physician-patient relationship with the recipient of the service;
(3) is able to verify the
identity of the patient;
(4) has discussed the
risks and benefits of telemedicine medical
services with the patient;
(5) 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;
(6) provides only
services that are medically indicated;
(7) adopts protocols to
prevent fraud and abuse;
(8) does not violate
state or federal laws relating to patient privacy;
(9) maintains medical
records for all telemedicine medical services;
(10) 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
(11) practices according
to the appropriate standard of care for the patient's condition.
(d) For the purposes of
Subsection (c), a telemedicine provider may establish a physician-patient
relationship in an initial encounter using telemedicine medical services.
(e) For the purposes of
Subsection (c), a telemedicine provider must 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 are provided.
(f) For the purposes of
Subsection (c), a telemedicine provider shall ensure that the
confidentiality of the patient's medical information is maintained as
required by Chapter 159, Occupations Code, or other applicable law.
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SECTION 2. Section 1455.004,
Insurance Code, is amended by adding Subsections (c), (d), (e), and (f) to
read as follows:
(c) A health benefit plan
may not cover a telemedicine medical service or
telehealth service unless the telemedicine or telehealth provider:
(1) is licensed or certified, as applicable, in this state;
(2) has established a
physician-patient or provider-patient
relationship with the recipient of the service;
(3) is able to verify the
identity of the patient;
(4) has discussed the
risks and benefits of the service with
the patient;
(5) 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;
(6) provides only
services that are medically indicated;
(7) adopts protocols to
prevent fraud and abuse;
(8) does not violate
state or federal laws relating to patient privacy;
(9) maintains medical or health care records, as applicable, for
all telemedicine medical services or
telehealth services;
(10) 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
(11) practices according
to the appropriate standard of care for the patient's condition.
(d) For the purposes of
Subsection (c), a telemedicine or telehealth
provider may establish a physician-patient or
provider-patient relationship, as applicable, in an initial
encounter using telemedicine medical services or
telehealth services.
(e) For the purposes of
Subsection (c), a telemedicine or telehealth
provider must 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 provided.
(f) For the purposes of
Subsection (c), a telemedicine or telehealth
provider shall ensure that the confidentiality of the patient's medical
information is maintained as required by Chapter 159, Occupations Code, or
other applicable law.
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No
equivalent provision.
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SECTION 3. Subtitle F, Title
8, Insurance Code, is amended by adding Chapter 1459 to read as follows:
CHAPTER 1459. FAIR ACCESS
TO TELEPHONE CONSULTATIONS
Sec. 1459.001.
DEFINITION. In this chapter, "physician" means:
(1) an individual
licensed to practice medicine in this state under Subtitle B, Title 3,
Occupations Code;
(2) a professional
association composed solely of individuals licensed to practice medicine in
this state;
(3) a single legal entity
authorized to practice medicine in this state that is owned by a group of
individuals licensed to practice medicine in this state;
(4) a nonprofit health
corporation certified by the Texas Medical Board under Chapter 162,
Occupations Code; or
(5) a partnership
composed solely of individuals licensed to practice medicine in this state.
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No
equivalent provision.
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Sec. 1459.002.
APPLICABILITY OF CHAPTER. (a) This chapter applies only to an employee
benefit plan or a health benefit plan that provides benefits for medical or
surgical expenses incurred as a result of a health condition, accident, or
sickness, including:
(1) an individual, group,
blanket, or franchise insurance policy or insurance agreement, a group
hospital service contract, or a small or large employer group contract or
similar coverage document that is offered by:
(A) an insurance company;
(B) a group hospital
service corporation operating under Chapter 842;
(C) a fraternal benefit
society operating under Chapter 885;
(D) a stipulated premium
company operating under Chapter 884;
(E) a reciprocal exchange
operating under Chapter 942;
(F) a health maintenance
organization operating under Chapter 843; or
(G) an approved nonprofit
health corporation that holds a certificate of authority under Chapter 844;
or
(2) a multiple employer
welfare arrangement that holds a certificate of authority under Chapter
846, or any other employee benefit plan.
(b) This chapter applies
to group health coverage made available by a school district in accordance
with Section 22.004, Education Code.
(c) Notwithstanding
Section 172.014, Local Government Code, or any other law, this chapter
applies to health and accident coverage provided by a risk pool created
under Chapter 172, Local Government Code.
(d) Notwithstanding any
provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this
chapter applies to:
(1) a basic coverage plan
under Chapter 1551;
(2) a basic plan under
Chapter 1575;
(3) a primary care
coverage plan under Chapter 1579; and
(4) basic coverage under
Chapter 1601.
(e) Notwithstanding
Section 1501.251 or any other law, this chapter applies to a small employer
health benefit plan subject to Chapter 1501.
(f) Notwithstanding
Sections 1507.004 and 1507.053, or any other law, this chapter applies to a
consumer choice of benefits plan issued under Chapter 1507.
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SECTION 4.
The change in law made by
this Act applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2014. A health benefit plan
delivered, issued for delivery, or renewed before January 1, 2014, is
governed by the law in effect immediately before the effective date of this
Act, and that law is continued in effect for that purpose.
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SECTION 4. (a) Sections
1455.001 and 1455.004, Insurance Code, as amended by this Act, apply only
to a health benefit plan delivered, issued for delivery, or renewed on or
after January 1, 2014. A health benefit plan delivered, issued for
delivery, or renewed before January 1, 2014, is governed by the law in
effect immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
(b)
Chapter 1459, Insurance Code, as added by this Act, applies only to an
employee benefit plan or a health benefit plan that is delivered, issued
for delivery, or renewed on or after September 1, 2013. An employee
benefit plan or a health benefit plan delivered, issued for delivery, or
renewed before September 1, 2013, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
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