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A BILL TO BE ENTITLED
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AN ACT
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relating to telemedicine and telehealth services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 111.001, Occupations Code, is amended by |
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amending Subdivision (2) and adding Subdivisions (3) and (4) to |
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read as follows: |
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(2) "Store and forward technology" means technology |
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that stores and transmits or grants access to a person's clinical |
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information for review by a health professional at a different |
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physical location than the person. |
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(3) "Telehealth service" means a health service, other |
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than a telemedicine medical service, delivered by a health |
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professional licensed, certified, or otherwise entitled to |
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practice in this state and acting within the scope of the health |
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professional's license, certification, or entitlement to a patient |
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at a different physical location than the health professional using |
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telecommunications or information technology. |
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(4) "Telemedicine [and "telemedicine] medical |
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service" means a health care service delivered by a physician |
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licensed in this state, or a health professional acting under the |
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delegation and supervision of a physician licensed in this state, |
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and acting within the scope of the physician's or health |
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professional's license to a patient at a different physical |
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location than the physician or health professional using |
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telecommunications or information technology [have the meanings
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assigned by Section 57.042, Utilities Code]. |
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SECTION 2. Section 111.004, Occupations Code, is amended to |
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read as follows: |
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Sec. 111.004. RULES. The Texas [State Board of] Medical |
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Board [Examiners], in consultation with the commissioner of |
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insurance, as appropriate, may adopt rules necessary to: |
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(1) ensure that patients using telemedicine medical |
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services receive appropriate, quality care; |
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(2) prevent abuse and fraud in the use of telemedicine |
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medical services, including rules relating to the filing of claims |
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and records required to be maintained in connection with |
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telemedicine medical services; |
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(3) ensure adequate supervision of health |
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professionals who are not physicians and who provide telemedicine |
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medical services; and |
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(4) establish the maximum number of health |
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professionals who are not physicians that a physician may supervise |
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through a telemedicine medical service[; and
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[(5)
require a face-to-face consultation between a
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patient and a physician providing a telemedicine medical service
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within a certain number of days following an initial telemedicine
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medical service only if the physician has never seen the patient]. |
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SECTION 3. Chapter 111, Occupations Code, is amended by |
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adding Sections 111.005 through 111.008 to read as follows: |
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Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR |
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TELEMEDICINE MEDICAL SERVICES. (a) For purposes of Section |
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562.056, a valid practitioner-patient relationship is present |
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between a practitioner providing a telemedicine medical service and |
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a patient receiving the telemedicine medical service as long as the |
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practitioner complies with the standard of care described in |
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Section 111.007 and the practitioner: |
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(1) has a preexisting practitioner-patient |
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relationship with the patient established in accordance with rules |
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adopted under Section 111.006; |
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(2) communicates, regardless of the method of |
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communication, with the patient pursuant to a call coverage |
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agreement established in accordance with Texas Medical Board rules |
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with a physician requesting coverage of medical care for the |
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patient; or |
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(3) provides the telemedicine medical services |
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through the use of one of the following methods, as long as the |
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practitioner complies with the follow-up requirements in |
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Subsection (b), and the method allows the practitioner to have |
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access to, and the practitioner uses, the relevant clinical |
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information that would be required in accordance with the standard |
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of care described in Section 111.007: |
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(A) synchronous audiovisual interaction between |
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the practitioner and the patient in another location; |
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(B) asynchronous store and forward technology, |
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including asynchronous store and forward technology in conjunction |
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with synchronous audio interaction between the practitioner and the |
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patient in another location, as long as the practitioner uses |
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clinical information from: |
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(i) clinically relevant photographic or |
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video images, including diagnostic images; or |
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(ii) the patient's relevant medical |
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records, such as the relevant medical history, laboratory and |
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pathology results, and prescriptive histories; or |
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(C) another form of audiovisual |
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telecommunication technology that allows the practitioner to |
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comply with the standard of care described in Section 111.007. |
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(b) A practitioner who provides telemedicine medical |
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services to a patient as described in Subsection (a)(3) shall: |
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(1) provide the patient with guidance on appropriate |
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follow-up care; and |
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(2) if the patient consents and the patient has a |
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primary care physician, provide to the patient's primary care |
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physician within 72 hours after the practitioner provides the |
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services to the patient a medical record or other report containing |
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an explanation of the treatment provided by the practitioner to the |
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patient and the practitioner's evaluation, analysis, or diagnosis, |
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as appropriate, of the patient's condition. |
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(c) Notwithstanding any other provision of this section, a |
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practitioner-patient relationship is not present if a practitioner |
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prescribes an abortifacient or any other drug or device that |
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terminates a pregnancy. |
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Sec. 111.006. COORDINATION TO ADOPT RULES THAT DETERMINE |
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VALID PRESCRIPTION. (a) The Texas Medical Board, the Texas Board |
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of Nursing, the Texas Physician Assistant Board, and the Texas |
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State Board of Pharmacy shall jointly adopt rules that establish |
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the determination of a valid prescription in accordance with |
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Section 111.005. Rules adopted under this section must allow for |
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the establishment of a practitioner-patient relationship by a |
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telemedicine medical service provided by a practitioner to a |
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patient in a manner that complies with Section 111.005(a)(3). |
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(b) The Texas Medical Board, the Texas Board of Nursing, the |
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Texas Physician Assistant Board, and the Texas State Board of |
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Pharmacy shall jointly develop and publish on each respective |
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board's Internet website responses to frequently asked questions |
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relating to the determination of a valid prescription issued in the |
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course of the provision of telemedicine medical services. |
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Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL |
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SERVICES AND TELEHEALTH SERVICES. (a) A health professional |
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providing a health care service or procedure as a telemedicine |
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medical service or a telehealth service is subject to the standard |
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of care that would apply to the provision of the same health care |
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service or procedure in an in-person setting. |
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(b) An agency with regulatory authority over a health |
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professional may not adopt rules pertaining to telemedicine medical |
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services or telehealth services that would impose a higher standard |
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of care than the standard described in Subsection (a). |
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Sec. 111.008. MENTAL HEALTH SERVICES EXCLUDED. This |
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chapter does not apply to mental health services. |
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SECTION 4. Section 562.056, Occupations Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) For purposes of this section, a valid |
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practitioner-patient relationship is present between a |
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practitioner providing telemedicine medical services and the |
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patient receiving the telemedicine medical services if the |
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practitioner has complied with the requirements for establishing |
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such a relationship in accordance with Section 111.005. |
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SECTION 5. Section 1455.001(3), Insurance Code, is amended |
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to read as follows: |
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(3) "Telehealth service" and "telemedicine medical |
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service" have the meanings assigned by Section 111.001 [57.042], |
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Occupations [Utilities] Code. |
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SECTION 6. Section 1455.004, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) Notwithstanding Subsection (a), a health benefit plan |
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is not required to provide coverage for a telemedicine medical |
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service or a telehealth service provided by only synchronous or |
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asynchronous audio interaction or a facsimile. |
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SECTION 7. Chapter 1455, Insurance Code, is amended by |
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adding Section 1455.006 to read as follows: |
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Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES AND |
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TELEHEALTH SERVICES STATEMENT. Each issuer of a health benefit |
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plan shall adopt and display in a conspicuous manner on the health |
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benefit plan issuer's Internet website the issuer's policies and |
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payment practices for telemedicine medical services and telehealth |
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services. |
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SECTION 8. Sections 531.001(7) and (8), Government Code, |
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are amended to read as follows: |
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(7) "Telehealth service" has the meaning assigned by |
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Section 111.001, Occupations Code [means a health service, other
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than a telemedicine medical service, that is delivered by a
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licensed or certified health professional acting within the scope
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of the health professional's license or certification who does not
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perform a telemedicine medical service and that requires the use of
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advanced telecommunications technology, other than telephone or
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facsimile technology, including:
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[(A)
compressed digital interactive video,
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audio, or data transmission;
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[(B)
clinical data transmission using computer
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imaging by way of still-image capture and store and forward; and
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[(C)
other technology that facilitates access to
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health care services or medical specialty expertise]. |
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(8) "Telemedicine medical service" has the meaning |
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assigned by Section 111.001, Occupations Code [means a health care
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service that is initiated by a physician or provided by a health
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professional acting under physician delegation and supervision,
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that is provided for purposes of patient assessment by a health
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professional, diagnosis or consultation by a physician, or
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treatment, or for the transfer of medical data, and that requires
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the use of advanced telecommunications technology, other than
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telephone or facsimile technology, including:
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[(A)
compressed digital interactive video,
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audio, or data transmission;
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[(B)
clinical data transmission using computer
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imaging by way of still-image capture and store and forward; and
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[(C)
other technology that facilitates access to
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health care services or medical specialty expertise]. |
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SECTION 9. Section 771.151(7), Health and Safety Code, is |
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amended to read as follows: |
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(7) "Telemedicine medical service" has the meaning |
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assigned by Section 111.001, Occupations Code [means a health care
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service that is initiated by a physician or provided by a health
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professional acting under physician delegation and supervision,
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that is provided for purposes of patient assessment by a health
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professional, diagnosis or consultation by a physician, or
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treatment, or for the transfer of medical data, and that requires
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the use of advanced telecommunications technology, other than
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telephone or facsimile technology, including:
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[(A)
compressed digital interactive video,
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audio, or data transmission;
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[(B)
clinical data transmission using computer
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imaging by way of still-image capture and store and forward; and
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[(C)
other technology that facilitates access to
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health care services or medical specialty expertise]. |
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SECTION 10. (a) Except as provided by Subsection (b) of |
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this section, this Act takes effect immediately if it receives a |
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vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2017. |
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(b) Section 1455.006, Insurance Code, as added by this Act, |
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takes effect September 1, 2017. |