88R7280 MEW-D
 
  By: Blanco, LaMantia S.B. No. 1043
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the reimbursement and payment of claims by certain
  health benefit plan issuers for telemedicine medical services,
  teledentistry dental services, and telehealth services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1455.001(1-a), Insurance Code, is
  amended to read as follows:
               (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,
  including a mental 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; or
                     (E)  an individual who is credentialed to provide
  qualified mental health professional community services, has
  demonstrated and documented competency in the work to be performed,
  is acting within the scope of the individual's license or other
  authorization issued by this state and does not perform a
  telemedicine medical service, and:
                           (i)  holds a bachelor's or more advanced
  degree from an accredited institution of higher education with a
  minimum number of hours that is equivalent to a major in psychology,
  social work, medicine, nursing, rehabilitation, counseling,
  sociology, human growth and development, physician assistant
  studies, gerontology, special education, educational psychology,
  early childhood education, or early childhood intervention;
                           (ii)  is a registered nurse; or
                           (iii)  completes an alternative
  credentialing process identified by the Health and Human Services
  Commission.
         SECTION 2.  Chapter 1455, Insurance Code, is amended by
  adding Sections 1455.007 and 1455.008 to read as follows:
         Sec. 1455.007.  REIMBURSEMENT AND PAYMENT. (a) A health
  benefit plan issuer must reimburse a preferred or contracted health
  professional for providing a covered health care service or
  procedure to a covered patient as a telemedicine medical service,
  teledentistry dental service, or telehealth service on the same
  basis and at least at the same rate that the issuer provides
  reimbursement to that health professional for the service or
  procedure in an in-person setting.
         (b)  Notwithstanding Subsection (a), a health benefit plan
  issuer is not required to:
               (1)  pay more than the billed charge on a claim for
  payment by a preferred or contracted health professional; or
               (2)  reimburse a preferred or contracted health
  professional as specified in Subsection (a) if the telemedicine
  medical service, teledentistry dental service, or telehealth
  service is provided to a covered patient by that health
  professional as part of a mutually agreed upon risk-based payment
  arrangement.
         (c)  For purposes of processing payment of a claim, a health
  benefit plan issuer may not require a preferred or contracted
  health professional to provide documentation of a covered health
  care service or procedure delivered by the health professional to a
  covered patient as a telemedicine medical service, teledentistry
  dental service, or telehealth service beyond that which is required
  for the service or procedure in an in-person setting.
         Sec. 1455.008.  WAIVER PROHIBITED. The provisions of this
  chapter may not be waived, voided, or nullified by contract.
         SECTION 3.  Chapter 1455, Insurance Code, as amended by this
  Act, applies only to a health benefit plan delivered, issued for
  delivery, or renewed on or after January 1, 2024. A health benefit
  plan delivered, issued for delivery, or renewed before January 1,
  2024, is governed by the law as it existed immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         SECTION 4.  This Act takes effect September 1, 2023.