83R20978 SCL-F
By: Smithee, Bonnen of Galveston H.B. No. 1806
Substitute the following for H.B. No. 1806:
By: Smithee C.S.H.B. No. 1806
A BILL TO BE ENTITLED
AN ACT
relating to coverage of telephone consultations and telehealth
services or telemedicine medical services under health benefit
plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1455.001, Insurance Code, is amended by
amending Subdivision (3) and adding Subdivisions (4), (5), and (6)
to read as follows:
(3) "Telehealth provider" means a licensed or
certified health professional who provides telehealth services.
(4) "Telehealth service" has the meaning assigned by
Section 531.001, Government Code.
(5) "Telemedicine [and "telemedicine] medical
service" means a medical service that is provided through the use of
advanced telecommunications technology for the purpose of:
(A) patient assessment, diagnosis, consultation,
or treatment; or
(B) the transfer of medical data [have the
meanings assigned by Section 57.042, Utilities Code].
(6) "Telemedicine provider" means:
(A) a physician who provides telemedicine
medical services; or
(B) a physician assistant or advanced practice
nurse who:
(i) provides telemedicine medical
services; and
(ii) is supervised by and has delegated
authority from a physician licensed in this state.
SECTION 2. Section 1455.004, Insurance Code, is amended by
adding Subsections (c), (d), (e), and (f) to read as follows:
(c) A health benefit plan may not cover a telemedicine
medical service or telehealth service unless the telemedicine or
telehealth provider:
(1) is licensed or certified, as applicable, in this
state;
(2) has established a physician-patient or
provider-patient relationship with the recipient of the service;
(3) is able to verify the identity of the patient;
(4) has discussed the risks and benefits of the
service with the patient;
(5) advises the patient to see a physician or other
health care professional in person within a reasonable time if the
patient's symptoms do not improve;
(6) provides only services that are medically
indicated;
(7) adopts protocols to prevent fraud and abuse;
(8) does not violate state or federal laws relating to
patient privacy;
(9) maintains medical or health care records, as
applicable, for all telemedicine medical services or telehealth
services;
(10) does not treat chronic pain with a controlled
substance listed on Schedule II, III, IV, or V under Chapter 481,
Health and Safety Code, at a site other than a site normally used
for the provision of medical care; and
(11) practices according to the appropriate standard
of care for the patient's condition.
(d) For the purposes of Subsection (c), a telemedicine or
telehealth provider may establish a physician-patient or
provider-patient relationship, as applicable, in an initial
encounter using telemedicine medical services or telehealth
services.
(e) For the purposes of Subsection (c), a telemedicine or
telehealth provider must 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 or telehealth services are provided.
(f) For the purposes of Subsection (c), a telemedicine or
telehealth provider shall ensure that the confidentiality of the
patient's medical information is maintained as required by Chapter
159, Occupations Code, or other applicable law.
SECTION 3. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1459 to read as follows:
CHAPTER 1459. FAIR ACCESS TO TELEPHONE CONSULTATIONS
Sec. 1459.001. DEFINITION. In this chapter, "physician"
means:
(1) an individual licensed to practice medicine in
this state under Subtitle B, Title 3, Occupations Code;
(2) a professional association composed solely of
individuals licensed to practice medicine in this state;
(3) a single legal entity authorized to practice
medicine in this state that is owned by a group of individuals
licensed to practice medicine in this state;
(4) a nonprofit health corporation certified by the
Texas Medical Board under Chapter 162, Occupations Code; or
(5) a partnership composed solely of individuals
licensed to practice medicine in this state.
Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to an employee benefit plan or a health benefit plan
that provides benefits for medical or surgical expenses incurred as
a result of a health condition, accident, or sickness, including:
(1) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or a small or large employer group contract or similar
coverage document that is offered by:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a fraternal benefit society operating under
Chapter 885;
(D) a stipulated premium company operating under
Chapter 884;
(E) a reciprocal exchange operating under
Chapter 942;
(F) a health maintenance organization operating
under Chapter 843; or
(G) an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844; or
(2) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846, or any other employee
benefit plan.
(b) This chapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(c) Notwithstanding Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(d) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(e) Notwithstanding Section 1501.251 or any other law, this
chapter applies to a small employer health benefit plan subject to
Chapter 1501.
(f) Notwithstanding Sections 1507.004 and 1507.053, or any
other law, this chapter applies to a consumer choice of benefits
plan issued under Chapter 1507.
Sec. 1459.003. NONDISCRIMINATION IN TELEPHONE CONSULTATION
SERVICES. (a) An employee benefit plan or a health benefit plan
may not:
(1) prohibit a physician from charging for a telephone
consultation with a covered patient if that plan allows another
person to charge for a telephone consultation with a covered
patient;
(2) deny payment to a physician for a medically
necessary telephone consultation with a covered patient if that
plan pays another person for a telephone consultation with a
covered patient; or
(3) discriminate against a physician in determining a
payment amount for a medically necessary telephone consultation
provided to a covered patient if that plan pays another person for a
telephone consultation with a covered patient.
(b) Nothing in this section shall be construed as
prohibiting an employee benefit plan or a health benefit plan from
paying a physician for medically necessary telephone
consultations.
SECTION 4. (a) Sections 1455.001 and 1455.004, Insurance
Code, as amended by this Act, apply only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2014. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2014, is governed by the law in effect
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
(b) Chapter 1459, Insurance Code, as added by this Act,
applies only to an employee benefit plan or a health benefit plan
that is delivered, issued for delivery, or renewed on or after
September 1, 2013. An employee benefit plan or a health benefit
plan delivered, issued for delivery, or renewed before September 1,
2013, 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 5. This Act takes effect September 1, 2013.