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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage of telephone consultations and telehealth |
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services or telemedicine medical services under health benefit |
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plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1455.001, Insurance Code, is amended by |
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amending Subdivision (3) and adding Subdivisions (4), (5), and (6) |
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to read as follows: |
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(3) "Telehealth provider" means a licensed or |
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certified health professional who provides telehealth services. |
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(4) "Telehealth service" has the meaning assigned by |
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Section 531.001, Government Code. |
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(5) "Telemedicine [and "telemedicine] medical |
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service" means a medical service that is provided through the use of |
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advanced telecommunications technology for the purpose of: |
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(A) patient assessment, diagnosis, consultation, |
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or treatment; or |
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(B) the transfer of medical data [have the
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meanings assigned by Section 57.042, Utilities Code]. |
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(6) "Telemedicine provider" means: |
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(A) a physician who provides telemedicine |
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medical services; or |
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(B) a physician assistant or advanced practice |
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nurse who: |
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(i) provides telemedicine medical |
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services; and |
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(ii) is supervised by and has delegated |
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authority from a physician licensed in this state. |
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SECTION 2. Section 1455.004, Insurance Code, is amended by |
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adding Subsections (c), (d), (e), and (f) to read as follows: |
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(c) A health benefit plan may not cover a telemedicine |
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medical service or telehealth service unless the telemedicine or |
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telehealth provider: |
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(1) is licensed or certified, as applicable, in this |
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state; |
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(2) has established a physician-patient or |
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provider-patient relationship with the recipient of the service; |
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(3) is able to verify the identity of the patient; |
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(4) has discussed the risks and benefits of the |
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service with the patient; |
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(5) advises the patient to see a physician or other |
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health care professional in person within a reasonable time if the |
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patient's symptoms do not improve; |
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(6) provides only services that are medically |
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indicated; |
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(7) adopts protocols to prevent fraud and abuse; |
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(8) does not violate state or federal laws relating to |
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patient privacy; |
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(9) maintains medical or health care records, as |
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applicable, for all telemedicine medical services or telehealth |
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services; |
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(10) does not treat chronic pain with a controlled |
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substance listed on Schedule II, III, IV, or V under Chapter 481, |
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Health and Safety Code, at a site other than a site normally used |
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for the provision of medical care; and |
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(11) practices according to the appropriate standard |
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of care for the patient's condition. |
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(d) For the purposes of Subsection (c), a telemedicine or |
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telehealth provider may establish a physician-patient or |
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provider-patient relationship, as applicable, in an initial |
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encounter using telemedicine medical services or telehealth |
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services. |
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(e) For the purposes of Subsection (c), a telemedicine or |
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telehealth provider must ensure that the informed consent of the |
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patient, or another appropriate individual authorized to make |
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health care treatment decisions for the patient, is obtained before |
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telemedicine medical services or telehealth services are provided. |
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(f) For the purposes of Subsection (c), a telemedicine or |
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telehealth provider shall ensure that the confidentiality of the |
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patient's medical information is maintained as required by Chapter |
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159, Occupations Code, or other applicable law. |
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SECTION 3. Subtitle F, Title 8, Insurance Code, is amended |
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by adding Chapter 1459 to read as follows: |
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CHAPTER 1459. FAIR ACCESS TO TELEPHONE CONSULTATIONS |
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Sec. 1459.001. DEFINITION. In this chapter, "physician" |
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means: |
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(1) an individual licensed to practice medicine in |
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this state under Subtitle B, Title 3, Occupations Code; |
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(2) a professional association composed solely of |
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individuals licensed to practice medicine in this state; |
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(3) a single legal entity authorized to practice |
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medicine in this state that is owned by a group of individuals |
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licensed to practice medicine in this state; |
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(4) a nonprofit health corporation certified by the |
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Texas Medical Board under Chapter 162, Occupations Code; or |
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(5) a partnership composed solely of individuals |
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licensed to practice medicine in this state. |
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Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to an employee benefit plan or a health benefit plan |
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that provides benefits for medical or surgical expenses incurred as |
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a result of a health condition, accident, or sickness, including: |
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(1) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or a small or large employer group contract or similar |
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coverage document that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; |
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(E) a reciprocal exchange operating under |
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Chapter 942; |
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(F) a health maintenance organization operating |
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under Chapter 843; or |
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(G) an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844; or |
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(2) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846, or any other employee |
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benefit plan. |
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(b) This chapter applies to group health coverage made |
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available by a school district in accordance with Section 22.004, |
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Education Code. |
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(c) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this chapter applies to health and accident |
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coverage provided by a risk pool created under Chapter 172, Local |
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Government Code. |
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(d) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(e) Notwithstanding Section 1501.251 or any other law, this |
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chapter applies to a small employer health benefit plan subject to |
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Chapter 1501. |
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(f) Notwithstanding Sections 1507.004 and 1507.053, or any |
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other law, this chapter applies to a consumer choice of benefits |
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plan issued under Chapter 1507. |
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Sec. 1459.003. NONDISCRIMINATION IN TELEPHONE CONSULTATION |
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SERVICES. (a) An employee benefit plan or a health benefit plan |
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may not: |
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(1) prohibit a physician from charging for a telephone |
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consultation with a covered patient if that plan allows another |
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person to charge for a telephone consultation with a covered |
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patient; |
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(2) deny payment to a physician for a medically |
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necessary telephone consultation with a covered patient if that |
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plan pays another person for a telephone consultation with a |
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covered patient; or |
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(3) discriminate against a physician in determining a |
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payment amount for a medically necessary telephone consultation |
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provided to a covered patient if that plan pays another person for a |
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telephone consultation with a covered patient. |
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(b) Nothing in this section shall be construed as |
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prohibiting an employee benefit plan or a health benefit plan from |
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paying a physician for medically necessary telephone |
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consultations. |
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SECTION 4. (a) Sections 1455.001 and 1455.004, Insurance |
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Code, as amended by this Act, apply only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2014. A health benefit plan delivered, issued for delivery, or |
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renewed before January 1, 2014, is governed by the law in effect |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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(b) Chapter 1459, Insurance Code, as added by this Act, |
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applies only to an employee benefit plan or a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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September 1, 2013. An employee benefit plan or a health benefit |
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plan delivered, issued for delivery, or renewed before September 1, |
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2013, is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 5. This Act takes effect September 1, 2013. |