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