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|
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A BILL TO BE ENTITLED
|
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AN ACT
|
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relating to the practice of dentistry and the provision of |
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teledentistry dental services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 111, Occupations Code, is |
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amended to read as follows: |
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CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH |
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SECTION 2. Section 111.001, Occupations Code, is amended by |
|
amending Subdivisions (1) and (3) and adding Subdivision (2-a) to |
|
read as follows: |
|
(1) "Dentist," "health [Health] professional," and |
|
"physician" have the meanings assigned by Section 1455.001, |
|
Insurance Code. |
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(2-a) "Teledentistry dental service" means a health |
|
care service delivered by a dentist, or a health professional |
|
acting under the delegation and supervision of a dentist, acting |
|
within the scope of the dentist's or health professional's license |
|
or certification to a patient at a different physical location than |
|
the dentist or health professional using telecommunications or |
|
information technology. |
|
(3) "Telehealth service" means a health service, other |
|
than a telemedicine medical service or a teledentistry dental |
|
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. |
|
SECTION 3. Section 111.002, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 111.002. INFORMED CONSENT. A treating physician, |
|
dentist, or health professional who provides or facilitates the use |
|
of telemedicine medical services, teledentistry dental services, |
|
or telehealth services shall 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, teledentistry dental services, or |
|
telehealth services are provided. |
|
SECTION 4. Section 111.003, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 111.003. CONFIDENTIALITY. A treating physician, |
|
dentist, or health professional who provides or facilitates the use |
|
of telemedicine medical services, teledentistry dental services, |
|
or telehealth services shall ensure that the confidentiality of the |
|
patient's clinical [medical] information is maintained as required |
|
by Chapter 159, by Subchapter C, Chapter 258, or by other applicable |
|
law. |
|
SECTION 5. Section 111.004, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 111.004. RULES. (a) The Texas Medical Board, 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. |
|
(b) The State Board of Dental Examiners, in consultation |
|
with the commissioner of insurance, as appropriate, may adopt rules |
|
necessary to: |
|
(1) ensure that patients using teledentistry dental |
|
services receive appropriate, quality care; |
|
(2) prevent abuse and fraud in the use of |
|
teledentistry dental services, including rules relating to the |
|
filing of claims and records required to be maintained in |
|
connection with teledentistry dental services; |
|
(3) ensure adequate supervision of health |
|
professionals who are not dentists and who provide teledentistry |
|
dental services; and |
|
(4) establish the maximum number of health |
|
professionals who are not dentists that a dentist may supervise |
|
through a teledentistry dental service. |
|
SECTION 6. The heading to Section 111.005, Occupations |
|
Code, is amended to read as follows: |
|
Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR |
|
TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES. |
|
SECTION 7. Sections 111.005(a) and (b), Occupations Code, |
|
are amended to read as follows: |
|
(a) For purposes of Section 562.056, a valid |
|
practitioner-patient relationship is present between a |
|
practitioner providing a telemedicine medical service or a |
|
teledentistry dental 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: |
|
(A) Texas Medical Board rules with a physician |
|
requesting coverage of medical care for the patient; or |
|
(B) State Board of Dental Examiners rules with a |
|
dentist requesting coverage of dental care for the patient; or |
|
(3) provides the telemedicine medical services or |
|
teledentistry dental 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 clinical |
|
[medical] records, such as the relevant medical or dental 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 or teledentistry dental 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 or a regular dentist, provide to the |
|
patient's primary care physician or regular dentist, as |
|
appropriate, within 72 hours after the practitioner provides the |
|
services to the patient, a clinical [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. |
|
SECTION 8. Section 111.006, Occupations Code, is amended by |
|
adding Subsection (c) to read as follows: |
|
(c) The State Board of Dental Examiners 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, as that section applies to teledentistry dental services. |
|
Rules adopted under this subsection must allow for the |
|
establishment of a practitioner-patient relationship by a |
|
teledentistry dental service provided by a practitioner to a |
|
patient in a manner that complies with Section 111.005(a)(3). The |
|
State Board of Dental Examiners 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 teledentistry dental services. |
|
SECTION 9. Section 111.007, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL |
|
SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. |
|
(a) A health professional providing a health care service or |
|
procedure as a telemedicine medical service, a teledentistry dental |
|
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, teledentistry dental services, or telehealth services |
|
that would impose a higher standard of care than the standard |
|
described in Subsection (a). |
|
SECTION 10. Chapter 111, Occupations Code, is amended by |
|
adding Section 111.009 to read as follows: |
|
Sec. 111.009. CERTAIN PRESCRIPTIONS PROHIBITED. (a) In |
|
this section, "controlled substance" and "prescribe" have the |
|
meanings assigned by Section 481.002, Health and Safety Code. |
|
(b) A dentist may not prescribe a controlled substance to a |
|
patient as a teledentistry dental service. |
|
SECTION 11. Section 251.003, Occupations Code, is amended |
|
by adding Subsection (d) to read as follows: |
|
(d) For purposes of this subtitle, a person located in |
|
another state practices dentistry in this state if the person |
|
through the use of any medium, including an electronic medium, |
|
performs an act that constitutes the practice of dentistry on a |
|
patient in this state. |
|
SECTION 12. Chapter 254, Occupations Code, is amended by |
|
adding Section 254.0035 to read as follows: |
|
Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS. |
|
The board shall adopt rules governing a call coverage agreement |
|
between dentists. |
|
SECTION 13. Section 258.001, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not |
|
delegate: |
|
(1) an act to an individual who, by board order, is |
|
prohibited from performing the act; |
|
(2) any of the following acts to a person not licensed |
|
as a dentist or dental hygienist: |
|
(A) the removal of calculus, deposits, or |
|
accretions from the natural and restored surfaces of exposed human |
|
teeth and restorations in the human mouth; |
|
(B) root planing or the smoothing and polishing |
|
of roughened root surfaces or exposed human teeth; or |
|
(C) any other act the delegation of which is |
|
prohibited by board rule; |
|
(3) any of the following acts to a person not licensed |
|
as a dentist: |
|
(A) comprehensive examination or diagnosis and |
|
treatment planning; |
|
(B) a surgical or cutting procedure on hard or |
|
soft tissue; |
|
(C) the prescription of a drug, medication, or |
|
work authorization; |
|
(D) the taking of an impression for a final |
|
restoration, appliance, or prosthesis; |
|
(E) the making of an intraoral occlusal |
|
adjustment; |
|
(F) direct pulp capping, pulpotomy, or any other |
|
endodontic procedure; |
|
(G) the final placement and intraoral adjustment |
|
of a fixed or removable appliance; or |
|
(H) the placement of any final restoration; or |
|
(4) the authority to an individual to administer a |
|
local anesthetic agent, inhalation sedative agent, parenteral |
|
sedative agent, or general anesthetic agent, including the |
|
authority to administer an anesthetic or sedative agent as a |
|
teledentistry dental service as that term is defined by Section |
|
111.001, if the individual is not licensed as: |
|
(A) a dentist with a permit issued by the board |
|
for the procedure being performed, if a permit is required; |
|
(B) a certified registered nurse anesthetist |
|
licensed by the Texas Board of Nursing, only if the delegating |
|
dentist holds a permit issued by the board for the procedure being |
|
performed, if a permit is required; or |
|
(C) a physician anesthesiologist licensed by the |
|
Texas Medical Board. |
|
SECTION 14. Subchapter A, Chapter 258, Occupations Code, is |
|
amended by adding Section 258.004 to read as follows: |
|
Sec. 258.004. COLLABORATIVE PRACTICE WITH DENTAL |
|
HYGIENIST. (a) In this section, "collaborative practice |
|
agreement" means a written practice agreement and protocols for the |
|
practice of dental hygiene. |
|
(b) A dental hygienist may practice dental hygiene under a |
|
collaborative practice agreement with a dentist if the dental |
|
hygienist has been engaged in the practice of dental hygiene for at |
|
least one year with a minimum of 2,000 practice hours. |
|
(c) A dental hygienist may enter into a collaborative |
|
practice agreement to practice dental hygiene in any setting |
|
authorized by law for the practice of dental hygiene. |
|
(d) A collaborative practice agreement must include |
|
protocols: |
|
(1) describing the practice of dental hygiene for: |
|
(A) medically compromised patients; |
|
(B) specific medical conditions; |
|
(C) patients with needs related to age; and |
|
(D) patients with complex medical histories; |
|
(2) prescribing standards for specific dental hygiene |
|
procedures, including intervals for the performance of those |
|
procedures; |
|
(3) prescribing intervals at which a supervising |
|
dentist must examine a patient; |
|
(4) describing the services that the dental hygienist |
|
may provide, the procedures that the dental hygienist may perform, |
|
the practice settings in which the services may be provided and the |
|
procedures may be performed, and any limitations on the services |
|
and procedures; |
|
(5) describing case selection criteria, assessment |
|
guidelines, and imaging frequency guidelines for patients by age |
|
and in relation to specific procedures; |
|
(6) prescribing procedures for obtaining informed |
|
consent from patients and for creating and maintaining patient |
|
records; |
|
(7) establishing a plan for the dentist to review |
|
patient records created and maintained by the dental hygienist; |
|
(8) establishing a plan for the management of medical |
|
emergencies in each setting in which the dental hygienist |
|
practices; |
|
(9) establishing a quality assurance plan for the |
|
dentist to monitor care provided by the dental hygienist, including |
|
review of patient care, referrals, and charts; |
|
(10) describing the medications that may be |
|
administered and dispensed by the dental hygienist and the specific |
|
circumstances under which the medications may be administered and |
|
dispensed; |
|
(11) describing any requirements for consultation |
|
with the dentist before providing care to patients with specific |
|
medical conditions or complex medical histories; and |
|
(12) establishing a plan, which includes clinical |
|
resources and referrals, for situations in which a patient requires |
|
treatment that exceeds the capabilities or scope of practice of the |
|
dental hygienist. |
|
(e) A collaborative practice agreement may include |
|
provisions to allow the practice of dental hygiene without: |
|
(1) prior examination of the patient by a dentist; and |
|
(2) the presence of a supervising dentist. |
|
(f) A collaborative practice agreement must be: |
|
(1) signed by the dentist, the dental hygienist, and, |
|
if applicable, a representative of the facility, program, or |
|
organization in which the practice of dental hygiene takes place; |
|
(2) reviewed annually by the dentist and the dental |
|
hygienist who are parties to the collaborative practice agreement; |
|
and |
|
(3) made available to the board and other interested |
|
parties on request. |
|
(g) Not more than two collaborative practice agreements |
|
between a dentist and a dental hygienist may be in effect at a time. |
|
(h) Notwithstanding any rule adopted under Section |
|
111.004(b)(4), a dentist may have a collaborative practice |
|
agreement with not more than six dental hygienists at the same time. |
|
The board may grant an exception to the requirements of this |
|
subsection for the practice of dental hygiene in a public health |
|
setting. |
|
(i) Before providing any service authorized by a |
|
collaborative practice agreement, the dental hygienist must |
|
provide the patient with a written statement advising the patient |
|
that the dental hygiene services performed are not a substitute for |
|
examination by a dentist. |
|
(j) If a dental hygienist operating under a collaborative |
|
practice agreement makes a referral for further dental procedures, |
|
the dental hygienist must complete a referral form approved by the |
|
board and provide a copy of the form to the dentist who is a party to |
|
the collaborative practice agreement. |
|
SECTION 15. Section 262.001, Occupations Code, is amended |
|
by adding Subdivision (3) to read as follows: |
|
(3) "Teledentistry dental service" has the meaning |
|
assigned by Section 111.001. |
|
SECTION 16. Section 262.151(a), Occupations Code, is |
|
amended to read as follows: |
|
(a) A licensed dentist may delegate orally or in writing a |
|
service, task, or procedure to a dental hygienist who is under the |
|
supervision and responsibility of the dentist, if: |
|
(1) the dental hygienist is licensed to perform the |
|
service, task, or procedure; |
|
(2) the supervising dentist: |
|
(A) examines the patient, including an |
|
examination performed as a teledentistry dental service: |
|
(i) [(A)] at the time the service, task, or |
|
procedure is performed by the dental hygienist; or |
|
(ii) [(B)] during the 12 calendar months |
|
preceding the date of performance of the service, task, or |
|
procedure by the dental hygienist; or |
|
(B) enters into a collaborative practice |
|
agreement with the dental hygienist, as described by Section |
|
258.004, that includes a provision allowing the dental hygienist to |
|
practice dental hygiene without prior examination of the patient by |
|
the dentist; and |
|
(3) the dental hygienist does not: |
|
(A) diagnose a dental disease or ailment; |
|
(B) prescribe a treatment or a regimen; |
|
(C) prescribe or[,] order[, or dispense] |
|
medication; [or] |
|
(D) except as authorized by the supervising |
|
dentist in a collaborative practice agreement described by Section |
|
258.004, administer or dispense medication; or |
|
(E) perform any procedure that is irreversible or |
|
involves the intentional cutting of soft or hard tissue by any |
|
means. |
|
SECTION 17. Sections 262.1515(a), (b), and (c), Occupations |
|
Code, are amended to read as follows: |
|
(a) A licensed dentist may delegate a service, task, or |
|
procedure, pursuant to this section, to a dental hygienist, without |
|
complying with Section 262.151(a)(2) if: |
|
(1) the dental hygienist has at least two years' |
|
experience in the practice of dental hygiene; and |
|
(2) the service, task, or procedure is performed in |
|
one of the following locations: |
|
(A) a medical facility, including: |
|
(i) a public health clinic conducted by a |
|
local health unit, health department, or public health district |
|
organized and recognized under Chapter 121, Health and Safety Code; |
|
(ii) a general hospital or special |
|
hospital, as those terms are defined by Section 241.003, Health and |
|
Safety Code, including a hospital maintained or operated by this |
|
state; |
|
(iii) a nursing facility as defined in |
|
Section 242.301, Health and Safety Code; |
|
(iv) an ambulatory surgical center licensed |
|
under Chapter 243, Health and Safety Code; |
|
(v) a birthing center licensed under |
|
Chapter 244, Health and Safety Code; |
|
(vi) a mental hospital licensed under |
|
Chapter 577, Health and Safety Code; |
|
(vii) a community health center as defined |
|
by Section 136.002, Human Resources Code; |
|
(viii) a mobile dental facility operating |
|
under a permit issued by the board; and |
|
(ix) an outpatient clinic; |
|
(B) a primary or secondary school [school-based
|
|
health center established under Subchapter B, Chapter 38, Education
|
|
Code]; [or] |
|
(C) a Head Start program facility; |
|
(D) a secure correctional facility as defined by |
|
Section 1.07, Penal Code; |
|
(E) the residence of a patient who is homebound |
|
or who is receiving or is eligible to receive: |
|
(i) home and community-based waiver |
|
services under the Medicaid program; |
|
(ii) hospice services; or |
|
(iii) other home care services; or |
|
(F) any other facility approved by board rule [a
|
|
community health center as defined by Section 136.002, Human
|
|
Resources Code]. |
|
(b) The patient may [must] be referred as needed to a |
|
licensed dentist after the completion of a service, task, or |
|
procedure performed under Subsection (a). |
|
(c) A dental hygienist may [only] perform delegated tasks or |
|
procedures with respect to a patient for not more than 12 [six] |
|
months unless: |
|
(1) the patient has been examined by a dentist in |
|
compliance with Section 262.151(a)(2)(A); |
|
(2) a dentist reviews the patient's dental records, |
|
including a review performed as a teledentistry dental service, and |
|
determines that the dental hygienist may continue to provide |
|
services to the patient; or |
|
(3) a dentist otherwise provides teledentistry dental |
|
services to the patient and determines that the dental hygienist |
|
may continue to provide services to the patient [262.151(a)(2)]. |
|
SECTION 18. Section 562.056(c), Occupations Code, is |
|
amended to read as follows: |
|
(c) For purposes of this section and Section 562.112, a |
|
valid practitioner-patient relationship is present between a |
|
practitioner providing telemedicine medical services or |
|
teledentistry dental 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 19. Section 531.001, Government Code, is amended by |
|
adding Subdivision (6-a) to read as follows: |
|
(6-a) "Teledentistry dental service" has the meaning |
|
assigned by Section 111.001, Occupations Code. |
|
SECTION 20. The heading to Section 531.0216, Government |
|
Code, is amended to read as follows: |
|
Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF |
|
TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL |
|
SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER |
|
MEDICAID. |
|
SECTION 21. Sections 531.0216(a), (b), (c), (d), (e), and |
|
(f), Government Code, are amended to read as follows: |
|
(a) The executive commissioner by rule shall develop and |
|
implement a system to reimburse providers of services under |
|
Medicaid for services performed using telemedicine medical |
|
services, teledentistry dental services, or telehealth services. |
|
(b) In developing the system, the executive commissioner by |
|
rule shall: |
|
(1) review programs and pilot projects in other states |
|
to determine the most effective method for reimbursement; |
|
(2) establish billing codes and a fee schedule for |
|
services; |
|
(3) consult with the Department of State Health |
|
Services to establish procedures to: |
|
(A) identify clinical evidence supporting |
|
delivery of health care services using a telecommunications system; |
|
and |
|
(B) annually review health care services, |
|
considering new clinical findings, to determine whether |
|
reimbursement for particular services should be denied or |
|
authorized; |
|
(4) establish a separate provider identifier for |
|
telemedicine medical services providers, teledentistry dental |
|
services providers, telehealth services providers, and home |
|
telemonitoring services providers; and |
|
(5) establish a separate modifier for telemedicine |
|
medical services, teledentistry dental services, telehealth |
|
services, and home telemonitoring services eligible for |
|
reimbursement. |
|
(c) The commission shall encourage health care providers |
|
and health care facilities to participate as telemedicine medical |
|
service providers, teledentistry dental service providers, or |
|
telehealth service providers in the health care delivery system. |
|
The commission may not require that a service be provided to a |
|
patient through telemedicine medical services, teledentistry |
|
dental services, or telehealth services when the service can |
|
reasonably be provided by a physician or a dentist, if appropriate, |
|
through a face-to-face consultation with the patient in the |
|
community in which the patient resides or works. This subsection |
|
does not prohibit the authorization of the provision of any service |
|
to a patient through telemedicine medical services, teledentistry |
|
dental services, or telehealth services at the patient's request. |
|
(d) Subject to Sections 111.004 and [Section] 153.004, |
|
Occupations Code, the executive commissioner may adopt rules as |
|
necessary to implement this section. In the rules adopted under |
|
this section, the executive commissioner shall: |
|
(1) refer to the site where the patient is physically |
|
located as the patient site; and |
|
(2) refer to the site where the physician, dentist, or |
|
health professional providing the telemedicine medical service, |
|
teledentistry dental service, or telehealth service is physically |
|
located as the distant site. |
|
(e) The commission may not reimburse a health care facility |
|
for telemedicine medical services, teledentistry dental services, |
|
or telehealth services provided to a Medicaid recipient unless the |
|
facility complies with the minimum standards adopted under Section |
|
531.02161. |
|
(f) Not later than December 1 of each even-numbered year, |
|
the commission shall report to the speaker of the house of |
|
representatives and the lieutenant governor on the effects of |
|
telemedicine medical services, teledentistry dental services, |
|
telehealth services, and home telemonitoring services on Medicaid |
|
in the state, including the number of physicians, dentists, health |
|
professionals, and licensed health care facilities using |
|
telemedicine medical services, teledentistry dental services, |
|
telehealth services, or home telemonitoring services, the |
|
geographic and demographic disposition of the physicians, |
|
dentists, and health professionals, the number of patients |
|
receiving telemedicine medical services, teledentistry dental |
|
services, telehealth services, and home telemonitoring services, |
|
the types of services being provided, and the cost of utilization of |
|
telemedicine medical services, teledentistry dental services, |
|
telehealth services, and home telemonitoring services to Medicaid. |
|
SECTION 22. The heading to Section 531.02161, Government |
|
Code, is amended to read as follows: |
|
Sec. 531.02161. TELEMEDICINE, TELEDENTISTRY, TELEHEALTH, |
|
AND HOME TELEMONITORING TECHNOLOGY STANDARDS. |
|
SECTION 23. Section 531.02161(b), Government Code, is |
|
amended to read as follows: |
|
(b) The executive commissioner by rule shall establish and |
|
adopt minimum standards for an operating system used in the |
|
provision of telemedicine medical services, teledentistry dental |
|
services, telehealth services, or home telemonitoring services by a |
|
health care facility participating in Medicaid, including |
|
standards for electronic transmission, software, and hardware. |
|
SECTION 24. The heading to Section 531.02162, Government |
|
Code, is amended to read as follows: |
|
Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH |
|
TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND |
|
TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS. |
|
SECTION 25. Sections 531.02162(b) and (c), Government Code, |
|
are amended to read as follows: |
|
(b) The executive commissioner by rule shall establish |
|
policies that permit reimbursement under Medicaid and the child |
|
health plan program for services provided through telemedicine |
|
medical services, teledentistry dental services, and telehealth |
|
services to children with special health care needs. |
|
(c) The policies required under this section must: |
|
(1) be designed to: |
|
(A) prevent unnecessary travel and encourage |
|
efficient use of telemedicine medical services, teledentistry |
|
dental services, and telehealth services for children with special |
|
health care needs in all suitable circumstances; and |
|
(B) ensure in a cost-effective manner the |
|
availability to a child with special health care needs of services |
|
appropriately performed using telemedicine medical services, |
|
teledentistry dental services, and telehealth services that are |
|
comparable to the same types of services available to that child |
|
without the use of telemedicine medical services, teledentistry |
|
dental services, and telehealth services; and |
|
(2) provide for reimbursement of multiple providers of |
|
different services who participate in a single session of |
|
telemedicine medical services, teledentistry dental services, |
|
[and] telehealth services, or any combination of those services, |
|
[session] for a child with special health care needs, if the |
|
commission determines that reimbursing each provider for the |
|
session is cost-effective in comparison to the costs that would be |
|
involved in obtaining the services from providers without the use |
|
of telemedicine medical services, teledentistry dental services, |
|
and telehealth services, including the costs of transportation and |
|
lodging and other direct costs. |
|
SECTION 26. Subchapter B, Chapter 531, Government Code, is |
|
amended by adding Section 531.02172 to read as follows: |
|
Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL |
|
SERVICES. The commission by rule shall require each health and |
|
human services agency that administers a part of the Medicaid |
|
program to provide Medicaid reimbursement for teledentistry dental |
|
services provided by a dentist licensed to practice dentistry in |
|
this state or a dental hygienist licensed to practice dental |
|
hygiene in this state. The commission shall require reimbursement |
|
for a teledentistry dental service at the same rate as the Medicaid |
|
program reimburses for a comparable in-person dental service. A |
|
request for reimbursement may not be denied solely because an |
|
in-person dental service between a dentist and a patient did not |
|
occur. |
|
SECTION 27. The heading to Section 62.157, Health and |
|
Safety Code, is amended to read as follows: |
|
Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY |
|
DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL |
|
HEALTH CARE NEEDS. |
|
SECTION 28. Sections 62.157(a) and (b), Health and Safety |
|
Code, are amended to read as follows: |
|
(a) In providing covered benefits to a child with special |
|
health care needs, a health plan provider must permit benefits to be |
|
provided through telemedicine medical services, teledentistry |
|
dental services, and telehealth services in accordance with |
|
policies developed by the commission. |
|
(b) The policies must provide for: |
|
(1) the availability of covered benefits |
|
appropriately provided through telemedicine medical services, |
|
teledentistry dental services, and telehealth services that are |
|
comparable to the same types of covered benefits provided without |
|
the use of telemedicine medical services, teledentistry dental |
|
services, and telehealth services; and |
|
(2) the availability of covered benefits for different |
|
services performed by multiple health care providers during a |
|
single [telemedicine medical services and telehealth services] |
|
session of telemedicine medical services, teledentistry dental |
|
services, telehealth services, or any combination of those |
|
services, if the executive commissioner determines that delivery of |
|
the covered benefits in that manner is cost-effective in comparison |
|
to the costs that would be involved in obtaining the services from |
|
providers without the use of telemedicine medical services, |
|
teledentistry dental services, and telehealth services, including |
|
the costs of transportation and lodging and other direct costs. |
|
SECTION 29. Section 62.1571, Health and Safety Code, is |
|
amended to read as follows: |
|
Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND |
|
TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits |
|
to a child, a health plan provider must permit benefits to be |
|
provided through telemedicine medical services and teledentistry |
|
dental services in accordance with policies developed by the |
|
commission. |
|
(b) The policies must provide for: |
|
(1) the availability of covered benefits |
|
appropriately provided through telemedicine medical services and |
|
teledentistry dental services that are comparable to the same types |
|
of covered benefits provided without the use of telemedicine |
|
medical services and teledentistry dental services; and |
|
(2) the availability of covered benefits for different |
|
services performed by multiple health care providers during a |
|
single session of telemedicine medical services, teledentistry |
|
dental services, or both services, if the executive commissioner |
|
determines that delivery of the covered benefits in that manner is |
|
cost-effective in comparison to the costs that would be involved in |
|
obtaining the services from providers without the use of |
|
telemedicine medical services or teledentistry dental services, |
|
including the costs of transportation and lodging and other direct |
|
costs. |
|
(c) [(d)] In this section, "teledentistry dental service" |
|
and "telemedicine medical service" have [has] the meanings |
|
[meaning] assigned by Section 531.001, Government Code. |
|
SECTION 30. Section 32.024, Human Resources Code, is |
|
amended by adding Subsection (ll) to read as follows: |
|
(ll) The executive commissioner shall establish a separate |
|
provider type for dental hygienists for purposes of enrollment as a |
|
provider of and reimbursement under the medical assistance program. |
|
SECTION 31. Section 843.002(24), Insurance Code, is amended |
|
to read as follows: |
|
(24) "Provider" means: |
|
(A) a person, other than a physician, who is |
|
licensed or otherwise authorized to provide a health care service |
|
in this state, including: |
|
(i) a chiropractor, registered nurse, |
|
pharmacist, optometrist, [or] acupuncturist, or dental hygienist; |
|
or |
|
(ii) a pharmacy, hospital, or other |
|
institution or organization; |
|
(B) a person who is wholly owned or controlled by |
|
a provider or by a group of providers who are licensed or otherwise |
|
authorized to provide the same health care service; or |
|
(C) a person who is wholly owned or controlled by |
|
one or more hospitals and physicians, including a |
|
physician-hospital organization. |
|
SECTION 32. Section 1301.001(1-a), Insurance Code, is |
|
amended to read as follows: |
|
(1-a) "Health care provider" means a practitioner, |
|
institutional provider, or other person or organization that |
|
furnishes health care services and that is licensed or otherwise |
|
authorized to practice in this state. [The term includes a
|
|
pharmacist and a pharmacy.] The term does not include a physician. |
|
The term includes: |
|
(A) a pharmacist; |
|
(B) a pharmacy; and |
|
(C) a dental hygienist. |
|
SECTION 33. Section 1451.101, Insurance Code, is amended by |
|
amending Subdivision (1) and adding Subdivision (1-a) to read as |
|
follows: |
|
(1) "Dental hygienist" has the meaning assigned by |
|
Section 256.051, Occupations Code. |
|
(1-a) "Health insurance policy" means a policy, |
|
contract, or agreement described by Section 1451.102. |
|
SECTION 34. Subchapter C, Chapter 1451, Insurance Code, is |
|
amended by adding Section 1451.128 to read as follows: |
|
Sec. 1451.128. SELECTION OF DENTAL HYGIENIST. An insured |
|
may select a dental hygienist to provide the services scheduled in |
|
the health insurance policy that are within the scope of the dental |
|
hygienist's license. |
|
SECTION 35. The heading to Chapter 1455, Insurance Code, is |
|
amended to read as follows: |
|
CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH |
|
SECTION 36. Section 1455.001, Insurance Code, is amended by |
|
amending Subdivisions (1) and (3) and adding Subdivision (1-a) to |
|
read as follows: |
|
(1) "Dentist" means a person licensed to practice |
|
dentistry in this state under Subtitle D, Title 3, Occupations |
|
Code. |
|
(1-a) "Health professional" means: |
|
(A) a physician; |
|
(B) an individual who is: |
|
(i) licensed or certified in this state to |
|
perform health care services; and |
|
(ii) authorized to assist: |
|
(a) a physician in providing |
|
telemedicine medical services that are delegated and supervised by |
|
the physician; or |
|
(b) a dentist in providing |
|
teledentistry dental services that are delegated and supervised by |
|
the dentist; |
|
(C) a licensed or certified health professional |
|
acting within the scope of the license or certification who does not |
|
perform a telemedicine medical service; or |
|
(D) a dentist. |
|
(3) "Teledentistry dental service," "telehealth |
|
["Telehealth] service," and "telemedicine medical service" have |
|
the meanings assigned by Section 111.001, Occupations Code. |
|
SECTION 37. Section 1455.004, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES, |
|
TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A |
|
health benefit plan may not exclude from coverage a covered health |
|
care service or procedure delivered by a preferred or contracted |
|
health professional to a covered patient as a telemedicine medical |
|
service, a teledentistry dental service, or a telehealth service |
|
solely because the covered health care service or procedure is not |
|
provided through an in-person consultation. |
|
(b) A health benefit plan may require a deductible, a |
|
copayment, or coinsurance for a covered health care service or |
|
procedure delivered by a preferred or contracted health |
|
professional to a covered patient as a telemedicine medical |
|
service, a teledentistry dental 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 the covered health care service or procedure provided |
|
through an in-person consultation. |
|
(c) Notwithstanding Subsection (a), a health benefit plan |
|
is not required to provide coverage for a telemedicine medical |
|
service, a teledentistry dental service, or a telehealth service |
|
provided by only synchronous or asynchronous audio interaction, |
|
including: |
|
(1) an audio-only telephone consultation; |
|
(2) a text-only e-mail message; or |
|
(3) a facsimile transmission. |
|
SECTION 38. Section 1455.006, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES, |
|
TELEDENTISTRY DENTAL 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, teledentistry dental 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, teledentistry dental services, or |
|
telehealth services. |
|
SECTION 39. (a) Not later than March 1, 2020, the State |
|
Board of Dental Examiners and the Texas State Board of Pharmacy |
|
shall jointly adopt rules as required by Section 111.006(c), |
|
Occupations Code, as added by this Act. |
|
(b) Not later than March 1, 2020, the State Board of Dental |
|
Examiners shall adopt: |
|
(1) rules necessary to implement Chapter 111, |
|
Occupations Code, as amended by this Act; |
|
(2) rules as required by Section 254.0035, Occupations |
|
Code, as added by this Act; and |
|
(3) rules necessary to implement Section 258.004, |
|
Occupations Code, as added by this Act. |
|
SECTION 40. As soon as practicable after the effective date |
|
of this Act, the Health and Human Services Commission shall |
|
establish and implement a separate provider type for dental |
|
hygienists as required by Section 32.024(ll), Human Resources Code, |
|
as added by this Act. |
|
SECTION 41. If before implementing any provision of this |
|
Act a state agency determines that a waiver or authorization from a |
|
federal agency is necessary for implementation of that provision, |
|
the agency affected by the provision shall request the waiver or |
|
authorization and may delay implementing that provision until the |
|
waiver or authorization is granted. |
|
SECTION 42. (a) Except as provided by Subsection (b) of |
|
this section, this Act takes effect September 1, 2019. |
|
(b) Sections 1455.004 and 1455.006, Insurance Code, as |
|
amended by this Act, take effect January 1, 2020. |