83R2656 AJA-F

By: Smithee H.B. No. 1806

A BILL TO BE ENTITLED

AN ACT

relating to coverage of telemedicine medical services under health benefit plans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. The heading to Chapter 1455, Insurance Code, is amended to read as follows:

CHAPTER 1455. TELEMEDICINE [AND TELEHEALTH]

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.

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.

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.

SECTION 5. This Act takes effect September 1, 2013.