Texas 2013 - 83rd Regular

Texas House Bill HB1806 Compare Versions

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1	1	83R20978 SCL-F
2	2	By: Smithee, Bonnen of Galveston H.B. No. 1806
3	3	Substitute the following for H.B. No. 1806:
4	4	By: Smithee C.S.H.B. No. 1806
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to coverage of telephone consultations and telehealth
10	10	services or telemedicine medical services under health benefit
11	11	plans.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Section 1455.001, Insurance Code, is amended by
14	14	amending Subdivision (3) and adding Subdivisions (4), (5), and (6)
15	15	to read as follows:
16	16	(3) "Telehealth provider" means a licensed or
17	17	certified health professional who provides telehealth services.
18	18	(4) "Telehealth service" has the meaning assigned by
19	19	Section 531.001, Government Code.
20	20	(5) "Telemedicine [and "telemedicine] medical
21	21	service" means a medical service that is provided through the use of
22	22	advanced telecommunications technology for the purpose of:
23	23	(A) patient assessment, diagnosis, consultation,
24	24	or treatment; or
25	25	(B) the transfer of medical data [have the
26	26	meanings assigned by Section 57.042, Utilities Code].
27	27	(6) "Telemedicine provider" means:
28	28	(A) a physician who provides telemedicine
29	29	medical services; or
30	30	(B) a physician assistant or advanced practice
31	31	nurse who:
32	32	(i) provides telemedicine medical
33	33	services; and
34	34	(ii) is supervised by and has delegated
35	35	authority from a physician licensed in this state.
36	36	SECTION 2. Section 1455.004, Insurance Code, is amended by
37	37	adding Subsections (c), (d), (e), and (f) to read as follows:
38	38	(c) A health benefit plan may not cover a telemedicine
39	39	medical service or telehealth service unless the telemedicine or
40	40	telehealth provider:
41	41	(1) is licensed or certified, as applicable, in this
42	42	state;
43	43	(2) has established a physician-patient or
44	44	provider-patient relationship with the recipient of the service;
45	45	(3) is able to verify the identity of the patient;
46	46	(4) has discussed the risks and benefits of the
47	47	service with the patient;
48	48	(5) advises the patient to see a physician or other
49	49	health care professional in person within a reasonable time if the
50	50	patient's symptoms do not improve;
51	51	(6) provides only services that are medically
52	52	indicated;
53	53	(7) adopts protocols to prevent fraud and abuse;
54	54	(8) does not violate state or federal laws relating to
55	55	patient privacy;
56	56	(9) maintains medical or health care records, as
57	57	applicable, for all telemedicine medical services or telehealth
58	58	services;
59	59	(10) does not treat chronic pain with a controlled
60	60	substance listed on Schedule II, III, IV, or V under Chapter 481,
61	61	Health and Safety Code, at a site other than a site normally used
62	62	for the provision of medical care; and
63	63	(11) practices according to the appropriate standard
64	64	of care for the patient's condition.
65	65	(d) For the purposes of Subsection (c), a telemedicine or
66	66	telehealth provider may establish a physician-patient or
67	67	provider-patient relationship, as applicable, in an initial
68	68	encounter using telemedicine medical services or telehealth
69	69	services.
70	70	(e) For the purposes of Subsection (c), a telemedicine or
71	71	telehealth provider must ensure that the informed consent of the
72	72	patient, or another appropriate individual authorized to make
73	73	health care treatment decisions for the patient, is obtained before
74	74	telemedicine medical services or telehealth services are provided.
75	75	(f) For the purposes of Subsection (c), a telemedicine or
76	76	telehealth provider shall ensure that the confidentiality of the
77	77	patient's medical information is maintained as required by Chapter
78	78	159, Occupations Code, or other applicable law.
79	79	SECTION 3. Subtitle F, Title 8, Insurance Code, is amended
80	80	by adding Chapter 1459 to read as follows:
81	81	CHAPTER 1459. FAIR ACCESS TO TELEPHONE CONSULTATIONS
82	82	Sec. 1459.001. DEFINITION. In this chapter, "physician"
83	83	means:
84	84	(1) an individual licensed to practice medicine in
85	85	this state under Subtitle B, Title 3, Occupations Code;
86	86	(2) a professional association composed solely of
87	87	individuals licensed to practice medicine in this state;
88	88	(3) a single legal entity authorized to practice
89	89	medicine in this state that is owned by a group of individuals
90	90	licensed to practice medicine in this state;
91	91	(4) a nonprofit health corporation certified by the
92	92	Texas Medical Board under Chapter 162, Occupations Code; or
93	93	(5) a partnership composed solely of individuals
94	94	licensed to practice medicine in this state.
95	95	Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter
96	96	applies only to an employee benefit plan or a health benefit plan
97	97	that provides benefits for medical or surgical expenses incurred as
98	98	a result of a health condition, accident, or sickness, including:
99	99	(1) an individual, group, blanket, or franchise
100	100	insurance policy or insurance agreement, a group hospital service
101	101	contract, or a small or large employer group contract or similar
102	102	coverage document that is offered by:
103	103	(A) an insurance company;
104	104	(B) a group hospital service corporation
105	105	operating under Chapter 842;
106	106	(C) a fraternal benefit society operating under
107	107	Chapter 885;
108	108	(D) a stipulated premium company operating under
109	109	Chapter 884;
110	110	(E) a reciprocal exchange operating under
111	111	Chapter 942;
112	112	(F) a health maintenance organization operating
113	113	under Chapter 843; or
114	114	(G) an approved nonprofit health corporation
115	115	that holds a certificate of authority under Chapter 844; or
116	116	(2) a multiple employer welfare arrangement that holds
117	117	a certificate of authority under Chapter 846, or any other employee
118	118	benefit plan.
119	119	(b) This chapter applies to group health coverage made
120	120	available by a school district in accordance with Section 22.004,
121	121	Education Code.
122	122	(c) Notwithstanding Section 172.014, Local Government Code,
123	123	or any other law, this chapter applies to health and accident
124	124	coverage provided by a risk pool created under Chapter 172, Local
125	125	Government Code.
126	126	(d) Notwithstanding any provision in Chapter 1551, 1575,
127	127	1579, or 1601 or any other law, this chapter applies to:
128	128	(1) a basic coverage plan under Chapter 1551;
129	129	(2) a basic plan under Chapter 1575;
130	130	(3) a primary care coverage plan under Chapter 1579;
131	131	and
132	132	(4) basic coverage under Chapter 1601.
133	133	(e) Notwithstanding Section 1501.251 or any other law, this
134	134	chapter applies to a small employer health benefit plan subject to
135	135	Chapter 1501.
136	136	(f) Notwithstanding Sections 1507.004 and 1507.053, or any
137	137	other law, this chapter applies to a consumer choice of benefits
138	138	plan issued under Chapter 1507.
139	139	Sec. 1459.003. NONDISCRIMINATION IN TELEPHONE CONSULTATION
140	140	SERVICES. (a) An employee benefit plan or a health benefit plan
141	141	may not:
142	142	(1) prohibit a physician from charging for a telephone
143	143	consultation with a covered patient if that plan allows another
144	144	person to charge for a telephone consultation with a covered
145	145	patient;
146	146	(2) deny payment to a physician for a medically
147	147	necessary telephone consultation with a covered patient if that
148	148	plan pays another person for a telephone consultation with a
149	149	covered patient; or
150	150	(3) discriminate against a physician in determining a
151	151	payment amount for a medically necessary telephone consultation
152	152	provided to a covered patient if that plan pays another person for a
153	153	telephone consultation with a covered patient.
154	154	(b) Nothing in this section shall be construed as
155	155	prohibiting an employee benefit plan or a health benefit plan from
156	156	paying a physician for medically necessary telephone
157	157	consultations.
158	158	SECTION 4. (a) Sections 1455.001 and 1455.004, Insurance
159	159	Code, as amended by this Act, apply only to a health benefit plan
160	160	delivered, issued for delivery, or renewed on or after January 1,
161	161	2014. A health benefit plan delivered, issued for delivery, or
162	162	renewed before January 1, 2014, is governed by the law in effect
163	163	immediately before the effective date of this Act, and that law is
164	164	continued in effect for that purpose.
165	165	(b) Chapter 1459, Insurance Code, as added by this Act,
166	166	applies only to an employee benefit plan or a health benefit plan
167	167	that is delivered, issued for delivery, or renewed on or after
168	168	September 1, 2013. An employee benefit plan or a health benefit
169	169	plan delivered, issued for delivery, or renewed before September 1,
170	170	2013, is governed by the law as it existed immediately before the
171	171	effective date of this Act, and that law is continued in effect for
172	172	that purpose.
173	173	SECTION 5. This Act takes effect September 1, 2013.