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A BILL TO BE ENTITLED
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AN ACT
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relating to the reimbursement and payment of claims for |
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telemedicine medical services and telehealth services under |
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certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1455.001(1), Insurance Code, is amended |
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to read as follows: |
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(1) "Health professional" means: |
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(A) a physician; |
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(B) an individual who is: |
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(i) licensed or certified in this state to |
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perform health care services; and |
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(ii) authorized to assist a physician in |
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providing telemedicine medical services that are delegated and |
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supervised by the physician; [or] |
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(C) a licensed or certified health professional, |
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including a mental health professional, acting within the scope of |
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the license or certification who does not perform a telemedicine |
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medical service; or |
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(D) an individual who is credentialed to provide |
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qualified mental health professional community services, has |
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demonstrated and documented competency in the work to be performed, |
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and: |
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(i) holds a bachelor's or more advanced |
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degree from an accredited institution of higher education with a |
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minimum number of hours that is equivalent to a major in psychology, |
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social work, medicine, nursing, rehabilitation, counseling, |
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sociology, human growth and development, physician assistant |
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studies, gerontology, special education, educational psychology, |
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early childhood education, or early childhood intervention; |
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(ii) is a registered nurse; or |
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(iii) completes an alternative |
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credentialing process identified by the Department of State Health |
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Services. |
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SECTION 2. Section 1455.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1455.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that: |
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(1) provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including: |
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(A) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or an individual or group evidence of coverage that is |
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offered by: |
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(i) an insurance company; |
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(ii) a group hospital service corporation |
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operating under Chapter 842; |
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(iii) a fraternal benefit society operating |
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under Chapter 885; |
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(iv) a stipulated premium company operating |
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under Chapter 884; or |
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(v) a health maintenance organization |
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operating under Chapter 843; and |
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(B) to the extent permitted by the Employee |
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
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seq.), a health benefit plan that is offered by: |
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(i) a multiple employer welfare arrangement |
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as defined by Section 3 of that Act; or |
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(ii) another analogous benefit |
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arrangement; or |
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(2) is offered by an approved nonprofit health |
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corporation that holds a certificate of authority under Chapter |
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844. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; and |
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(3) a primary care coverage plan under Chapter 1579. |
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SECTION 3. Section 1455.004, Insurance Code, is amended by |
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amending Subsection (c) and adding Subsection (c-1) to read as |
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follows: |
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(c) Notwithstanding Subsection (a) and except as provided |
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by Subsection (c-1), a health benefit plan is not required to |
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provide coverage for a telemedicine medical service or a telehealth |
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service provided by only synchronous or asynchronous audio |
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interaction, including: |
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(1) [an audio-only telephone consultation; |
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[(2)] a text-only e-mail message; or |
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(2) [(3)] a facsimile transmission. |
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(c-1) A health benefit plan is required to provide coverage |
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for a telemedicine medical service or a telehealth service provided |
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by an audio-only telephone consultation. |
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SECTION 4. Chapter 1455, Insurance Code, is amended by |
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adding Sections 1455.007 and 1455.008 to read as follows: |
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Sec. 1455.007. REIMBURSEMENT AND PAYMENT. (a) A health |
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benefit plan issuer must reimburse a preferred or contracted health |
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professional for providing a covered health care service or |
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procedure to a covered patient as a telemedicine medical service or |
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telehealth service on the same basis and at least at the same rate |
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that the issuer provides reimbursement to that health professional |
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for the service or procedure in an in-person setting. |
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(b) Notwithstanding Subsection (a), a health benefit plan |
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issuer is not required to pay more than the billed charge on a claim |
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for payment by a preferred or contracted health professional. |
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(c) For purposes of processing payment of a claim, a health |
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benefit plan issuer may not require a preferred or contracted |
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health professional to provide documentation of a covered health |
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care service or procedure delivered by the health professional to a |
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covered patient as a telemedicine medical service or telehealth |
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service beyond that which is required for the service or procedure |
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in an in-person setting. |
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Sec. 1455.008. WAIVER PROHIBITED. The provisions of this |
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chapter may not be waived, voided, or nullified by contract. |
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SECTION 5. Chapter 1455, Insurance Code, as amended by this |
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Act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2022. A health benefit |
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plan delivered, issued for delivery, or renewed before January 1, |
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2022, is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 6. This Act takes effect September 1, 2021. |