84R10560 EES-F
 
  By: Laubenberg H.B. No. 3444
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the provision of telemedicine medical services by a
  physician.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The legislature finds that there are
  circumstances in which telemedicine medical services may be
  provided to patients in this state in a manner that is highly
  convenient and cost-effective for the patient and that safeguards
  the patient's need for competent and effective medical care. A
  governmental entity in this state may not construe or implement the
  changes in law made by this Act to discourage or inhibit broad
  access by patients in this state to highly convenient and
  cost-effective telemedicine medical services.
         SECTION 2.  Section 111.001, Occupations Code, is amended to
  read as follows:
         Sec. 111.001.  DEFINITIONS. In this chapter:
               (1)  'Health professional' and 'physician' have the
  meanings assigned by Section 1455.001, Insurance Code.
               (2)  "Telecommunications technology" means technology
  used for communication or for the transfer of information or data.
  The term includes:
                     (A)  wired or wireless telephone services;
                     (B)  interactive video, audio, or data
  transmission; and
                     (C)  data transmission using computer imaging. 
               (3)  "Telehealth service" means a health service, other
  than a telemedicine medical service, that is delivered by a health
  professional and that requires the use of telecommunications
  technology. 
               (4)  "Telemedicine medical service" means a health care
  service provided to a patient in this state through the use of
  telecommunications technology in real time by a physician, or by a
  health professional acting under physician delegation and
  supervision, to:
                     (A)  evaluate, diagnose, consult with, or treat a
  patient; or
                     (B)  transfer medical data ['Telehealth service'
  and 'telemedicine medical service' have the meanings assigned by
  Section 57.042, Utilities Code].
         SECTION 3.  Section 111.004, Occupations Code, is amended to
  read as follows:
         Sec. 111.004.  RULES. The Texas Medical [State] Board [of
  Medical Examiners], in consultation with the commissioner of
  insurance, as appropriate, may adopt rules necessary to:
               (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; and
               (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].
         SECTION 4.  Chapter 111, Occupations Code, is amended by
  adding Section 111.006 to read as follows:
         Sec. 111.006.  PROVISION OF TELEMEDICINE MEDICAL SERVICES
  UNDER CERTAIN CIRCUMSTANCES. (a) This section does not apply to
  the provision of telemedicine medical services under circumstances
  in which:
               (1)  the physician providing the services conducts a
  face-to-face visit with the patient before providing the services; 
               (2)  the patient receiving the services undergoes an
  in-person evaluation by another physician who refers the patient to
  the physician providing the services for additional care and
  documents the referral in the patient's medical record; or
               (3)  the services are provided at an established
  medical site, as defined by Texas Medical Board rules, where a
  patient seeks medical care and where there is a patient site
  presenter and sufficient technology and medical equipment to allow
  for an adequate physical evaluation. 
         (b)  Before a physician may provide telemedicine medical
  services to a patient, the physician must establish a
  physician-patient relationship with the patient. A physician may
  establish a physician-patient relationship with a patient by an
  initial encounter through the use of telecommunications
  technology. 
         (c)  A physician shall provide telemedicine medical services
  according to a written protocol adopted by the physician or the
  organization in which the physician is practicing. A protocol must
  include: 
               (1)  a description of the circumstances under which the
  provision of telemedicine medical services is medically
  appropriate, including a description of the circumstances under
  which the physician-patient relationship may be established and
  services may be provided through the use of a telephone; 
               (2)  an indication of the types of medically indicated
  services that may be provided under the circumstances described in
  Subdivision (1);
               (3)  procedures to prevent fraud and abuse in the
  provision of telemedicine medical services;
               (4)  policies for the maintenance of adequate medical
  records of the telemedicine medical services provided; and 
               (5)  guidelines for advising a patient to see a
  physician or other appropriate health professional in person and
  within a reasonable time if the patient's symptoms do not improve. 
         (d)  A physician may not prescribe a Schedule II, III, IV, or
  V controlled substance, as specified under Chapter 481, Health and
  Safety Code, in the course of providing telemedicine medical
  services. 
         (e)  A physician providing telemedicine medical services
  shall exercise the physician's discretion to:
               (1)  ensure that the physician is providing the
  services using the same standard of care applicable to the
  provision of medical services in a traditional clinical setting;
  and 
               (2)  determine when a face-to-face examination of a
  patient is necessary to comply with the applicable standard of care
  for the services. 
         (f)  The Texas Medical Board may not require that
  telemedicine medical services be provided only in conjunction with:
               (1)  a face-to-face visit with or in-person evaluation
  of the patient before, while, or after the patient receives
  telemedicine medical services; or
               (2)  an examination of the patient at an established
  medical site as described in Subsection (a)(3) before, while, or
  after the patient receives telemedicine medical services.
         SECTION 5.  This Act takes effect September 1, 2015.