87R4665 JCG-D
 
  By: Guerra H.B. No. 1742
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the practice of dentistry and the provision of
  teledentistry dental services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Chapter 111, Occupations Code, is
  amended to read as follows:
  CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
         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.
               (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) 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.
         (b)  A dentist who delegates a teledentistry dental service
  shall ensure that the informed consent of the patient includes
  disclosure to the patient that the dentist has delegated the
  service.
         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 under the delegation and supervision of a dentist;
  and
               (4)  establish that a dentist may delegate to and
  supervise through a teledentistry dental service not more than two
  health professionals who are not dentists.
         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.  Section 111.005, Occupations Code, is amended by
  amending Subsections (a) and (b) and adding Subsection (d) 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)  subject to Subsection (d), 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:
                     (A)  the treatment provided by the practitioner to
  the patient; and
                     (B)  as authorized by the law under which the
  practitioner is licensed, certified, or otherwise permitted to
  provide the service, the practitioner's evaluation, analysis, or
  diagnosis[, as appropriate,] of the patient's condition.
         (d)  A practitioner who provides teledentistry dental
  services to a patient as described in Subsection (a)(3):
               (1)  on the date the practitioner first provides the
  teledentistry dental services, shall inform the patient of the
  limitation provided by Subdivision (2); and
               (2)  may only provide teledentistry dental services
  with respect to the patient for 12 months unless:
                     (A)  a dentist performs an in-person tactile and
  visual examination of the hard and soft tissues of the patient's
  oral cavity; and
                     (B)  the practitioner receives notice of the
  examination described by Paragraph (A).
         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. Rules adopted under this subsection must allow for the
  establishment of a practitioner-patient relationship by a
  teledentistry dental service provided by a dentist 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 111.0075 to read as follows:
         Sec. 111.0075.  LICENSING FOR TELEDENTISTRY DENTAL
  SERVICES. A health professional providing a health care service or
  procedure as a teledentistry dental service is subject to the
  licensing requirements that would apply to the provision of the
  same health care service or procedure in an in-person setting.
         SECTION 11.  Chapter 111, Occupations Code, is amended by
  adding Sections 111.009, 111.010, and 111.011 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.
         Sec. 111.010.  DENTIST'S DUTY REGARDING FOLLOW-UP CARE FOR
  ACUTE DENTAL CONDITION. (a) A dentist who treats a patient for an
  acute dental condition as a teledentistry dental service shall, not
  later than six weeks after the date of the service:
               (1)  contact or attempt to contact the patient to
  schedule an in-person dental service for the patient in connection
  with the acute dental condition; or
               (2)  refer the patient to another dentist for the
  service described by Subdivision (1). 
         (b)  A violation of Subsection (a) constitutes a ground for
  disciplinary action under Section 263.002.
         Sec. 111.011.  STUDY AND REPORT. (a) The State Board of
  Dental Examiners shall study the extent to which teledentistry
  dental services may be used to substantially increase access to
  dental care for the children of low-income families, including the
  use of teledentistry dental services to perform a consultation
  before referring the child's parents or legal guardians to
  charitable organizations providing access to affordable dental
  care.
         (b)  Not later than December 1, 2022, the board shall report
  the results of the study conducted under Subsection (a) to the
  standing committee of each house of the legislature with primary
  jurisdiction over the board.
         (c)  This section expires January 1, 2023.
         SECTION 12.  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 and is required to
  hold a license to practice 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 13.  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 14.  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 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 15.  Section 262.152, Occupations Code, is amended
  to read as follows:
         Sec. 262.152.  PERFORMANCE OF DELEGATED DUTIES. (a) Except
  as provided by Section 262.1515, a dental hygienist shall practice
  dental hygiene:
               (1)  in the dental office of a supervising dentist
  licensed by the board; or
               (2)  in an alternate setting, including a nursing home,
  the patient's home, a school, a hospital, a state institution, a
  public health clinic, or another institution, under the supervision
  of a supervising dentist.
         (b)  For purposes of this section, a dental hygienist who
  practices dental hygiene as a teledentistry dental service, as
  defined by Section 111.001, is practicing in an alternate setting
  in compliance with Subsection (a)(2).
         SECTION 16.  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 17.  Section 531.001, Government Code, is amended by
  amending Subdivision (4-d) and adding Subdivision (6-a) to read as
  follows:
               (4-d)  "Platform" means the technology, system,
  software, application, modality, or other method through which a
  health professional remotely interfaces with a patient when
  providing a health care service or procedure as a telemedicine
  medical service, teledentistry dental service, or telehealth
  service.
               (6-a)  "Teledentistry dental service" has the meaning
  assigned by Section 111.001, Occupations Code.
         SECTION 18.  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.  (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.
         (c)  The commission shall encourage health care providers
  and health care facilities to provide telemedicine medical
  services, teledentistry dental services, and telehealth services
  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.
         (c-1)  Subsection (c) does not prohibit the authorization of
  the provision of any service to a patient through teledentistry
  dental services if:
               (1)  the patient requests the service; and
               (2)  the provision of the service through teledentistry
  does not violate the standard of care applicable to the service.
         (c-2)  The commission shall  explore opportunities to
  increase STAR Health program providers' use of telemedicine medical
  services in medically underserved areas of this state.
         (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.
         (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, the cost of utilization, and
  the cost savings of telemedicine medical services, teledentistry
  dental services, telehealth services, and home telemonitoring
  services to Medicaid.
         (g)  The commission shall ensure that a Medicaid managed care
  organization:
               (1)  does not deny reimbursement for a covered health
  care service or procedure delivered by a health care provider with
  whom the managed care organization contracts to a Medicaid
  recipient as a telemedicine medical service, a teledentistry dental
  service, or a telehealth service solely because the covered service
  or procedure is not provided through an in-person consultation;
               (2)  does not limit, deny, or reduce reimbursement for
  a covered health care service or procedure delivered by a health
  care provider with whom the managed care organization contracts to
  a Medicaid recipient as a telemedicine medical service, a
  teledentistry dental service, or a telehealth service based on the
  health care provider's choice of platform for providing the health
  care service or procedure; and
               (3)  ensures that the use of telemedicine medical
  services, teledentistry dental services, or telehealth services
  promotes and supports patient-centered medical homes by allowing a
  Medicaid recipient to receive a telemedicine medical service,
  teledentistry dental service, or telehealth service from a provider
  other than the recipient's primary care physician or provider,
  except as provided by Section 531.0217(c-4), only if:
                     (A)  the telemedicine medical service,
  teledentistry dental service, or telehealth service is provided in
  accordance with the law and contract requirements applicable to the
  provision of the same health care service in an in-person setting,
  including requirements regarding care coordination; and
                     (B)  the provider of the telemedicine medical
  service, teledentistry dental service, or telehealth service gives
  notice to the Medicaid recipient's primary care physician or
  provider regarding the [telemedicine medical service or
  telehealth] service, including a summary of the service, exam
  findings, a list of prescribed or administered medications, and
  patient instructions, for the purpose of sharing medical
  information, provided that the recipient has a primary care
  physician or provider and the recipient or, if appropriate, the
  recipient's parent or legal guardian, consents to the notice.
         (h)  The commission shall develop, document, and implement a
  monitoring process to ensure that a Medicaid managed care
  organization ensures that the use of telemedicine medical services,
  teledentistry dental services, or telehealth services promotes and
  supports patient-centered medical homes and care coordination in
  accordance with Subsection (g)(3). The process must include
  monitoring of the rate at which a telemedicine medical service,
  teledentistry dental service, or telehealth service provider gives
  notice in accordance with Subsection (g)(3)(B).
         (i)  The executive commissioner by rule shall ensure that a
  federally-qualified [federally qualified] health center as defined
  by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the
  originating site facility fee or the distant site practitioner fee
  or both, as appropriate, for a covered telemedicine medical
  service, teledentistry dental service, or telehealth service
  delivered by a health care provider to a Medicaid recipient. The
  commission is required to implement this subsection only if the
  legislature appropriates money specifically for that purpose. If
  the legislature does not appropriate money specifically for that
  purpose, the commission may, but is not required to, implement this
  subsection using other money available to the commission for that
  purpose.
         (j)  In complying with state and federal requirements to
  provide access to medically necessary services under the Medicaid
  managed care program, a Medicaid managed care organization
  determining whether reimbursement for a telemedicine medical
  service, teledentistry dental service, or telehealth service is
  appropriate shall continue to consider other factors, including
  whether reimbursement is cost-effective and whether the provision
  of the service is clinically effective.
         SECTION 19.  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 20.  Section 531.02162, Government Code, is amended
  by amending Subsections (b) and (c) and adding Subsection (d) 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.
         (d)  The policies established under this section may
  authorize the provision of a service as a teledentistry dental
  service only if the provision of the service through teledentistry
  does not violate the standard of care applicable to the service.
         SECTION 21.  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.  (a)  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.
         (b)  The commission shall require reimbursement for a
  teledentistry dental service at the same rate as the Medicaid
  program reimburses for the same 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. The commission may not limit a dentist's choice of platform
  for providing a teledentistry dental service by requiring that the
  dentist use a particular platform to receive reimbursement for the
  service.
         (c)  The State Board of Dental Examiners, in consultation
  with the commission and the commission's office of inspector
  general, as appropriate, may adopt rules as necessary to:
               (1)  ensure that appropriate care, including quality of
  care, is provided to patients who receive teledentistry dental
  services; and
               (2)  prevent abuse and fraud through the use of
  teledentistry dental services, including rules relating to filing
  claims and the records required to be maintained in connection with
  teledentistry dental services.
         SECTION 22.  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 23.  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 24.  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 25.  The heading to Chapter 1455, Insurance Code, is
  amended to read as follows:
  CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
         SECTION 26.  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 a teledentistry dental
  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 27.  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:
               (1)  must provide coverage 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, teledentistry dental service, or telehealth service on the
  same basis and to the same extent that the plan provides coverage
  for the service or procedure in an in-person setting; and
               (2)  may not:
                     (A)  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; and
                     (B)  subject to Subsection (c), limit, deny, or
  reduce coverage for a covered health care service or procedure
  delivered as a telemedicine medical service, teledentistry dental
  service, or telehealth service based on the health professional's
  choice of platform for delivering the service or procedure.
         (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.
         (b-1)  Subsection (b) does not authorize a health benefit
  plan to charge a separate deductible that applies only to a covered
  health care service or procedure delivered as a telemedicine
  medical service, teledentistry dental service, or telehealth
  service.
         (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.
         (d)  A health benefit plan may not impose an annual or
  lifetime maximum on coverage for covered health care services or
  procedures delivered as telemedicine medical services,
  teledentistry dental services, or telehealth services other than
  the annual or lifetime maximum, if any, that applies in the
  aggregate to all items and services and procedures covered under
  the plan.
         SECTION 28.  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 29.  Not later than March 1, 2022:
               (1)  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;
               (2)  the State Board of Dental Examiners shall adopt:
                     (A)  rules necessary to implement Chapter 111,
  Occupations Code, as amended by this Act; and
                     (B)  rules as required by Section 254.0035,
  Occupations Code, as added by this Act; and
               (3)  the Health and Human Services Commission shall
  adopt rules as required by Section 531.02172, Government Code, as
  added by this Act.
         SECTION 30.  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 31.  (a) Except as provided by Subsection (b) of
  this section, this Act takes effect September 1, 2021.
         (b)  Sections 1455.004 and 1455.006, Insurance Code, as
  amended by this Act, take effect January 1, 2022.