84R10560 EES-F
By: Laubenberg H.B. No. 3444
A BILL TO BE ENTITLED
AN ACT
relating to the provision of telemedicine medical services by a
physician.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The legislature finds that there are
circumstances in which telemedicine medical services may be
provided to patients in this state in a manner that is highly
convenient and cost-effective for the patient and that safeguards
the patient's need for competent and effective medical care. A
governmental entity in this state may not construe or implement the
changes in law made by this Act to discourage or inhibit broad
access by patients in this state to highly convenient and
cost-effective telemedicine medical services.
SECTION 2. Section 111.001, Occupations Code, is amended to
read as follows:
Sec. 111.001. DEFINITIONS. In this chapter:
(1) 'Health professional' and 'physician' have the
meanings assigned by Section 1455.001, Insurance Code.
(2) "Telecommunications technology" means technology
used for communication or for the transfer of information or data.
The term includes:
(A) wired or wireless telephone services;
(B) interactive video, audio, or data
transmission; and
(C) data transmission using computer imaging.
(3) "Telehealth service" means a health service, other
than a telemedicine medical service, that is delivered by a health
professional and that requires the use of telecommunications
technology.
(4) "Telemedicine medical service" means a health care
service provided to a patient in this state through the use of
telecommunications technology in real time by a physician, or by a
health professional acting under physician delegation and
supervision, to:
(A) evaluate, diagnose, consult with, or treat a
patient; or
(B) transfer medical data ['Telehealth service'
and 'telemedicine medical service' have the meanings assigned by
Section 57.042, Utilities Code].
SECTION 3. Section 111.004, Occupations Code, is amended to
read as follows:
Sec. 111.004. RULES. The Texas Medical [State] Board [of
Medical Examiners], 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[; and
[(5) require a face-to-face consultation between a
patient and a physician providing a telemedicine medical service
within a certain number of days following an initial telemedicine
medical service only if the physician has never seen the patient].
SECTION 4. Chapter 111, Occupations Code, is amended by
adding Section 111.006 to read as follows:
Sec. 111.006. PROVISION OF TELEMEDICINE MEDICAL SERVICES
UNDER CERTAIN CIRCUMSTANCES. (a) This section does not apply to
the provision of telemedicine medical services under circumstances
in which:
(1) the physician providing the services conducts a
face-to-face visit with the patient before providing the services;
(2) the patient receiving the services undergoes an
in-person evaluation by another physician who refers the patient to
the physician providing the services for additional care and
documents the referral in the patient's medical record; or
(3) the services are provided at an established
medical site, as defined by Texas Medical Board rules, where a
patient seeks medical care and where there is a patient site
presenter and sufficient technology and medical equipment to allow
for an adequate physical evaluation.
(b) Before a physician may provide telemedicine medical
services to a patient, the physician must establish a
physician-patient relationship with the patient. A physician may
establish a physician-patient relationship with a patient by an
initial encounter through the use of telecommunications
technology.
(c) A physician shall provide telemedicine medical services
according to a written protocol adopted by the physician or the
organization in which the physician is practicing. A protocol must
include:
(1) a description of the circumstances under which the
provision of telemedicine medical services is medically
appropriate, including a description of the circumstances under
which the physician-patient relationship may be established and
services may be provided through the use of a telephone;
(2) an indication of the types of medically indicated
services that may be provided under the circumstances described in
Subdivision (1);
(3) procedures to prevent fraud and abuse in the
provision of telemedicine medical services;
(4) policies for the maintenance of adequate medical
records of the telemedicine medical services provided; and
(5) guidelines for advising a patient to see a
physician or other appropriate health professional in person and
within a reasonable time if the patient's symptoms do not improve.
(d) A physician may not prescribe a Schedule II, III, IV, or
V controlled substance, as specified under Chapter 481, Health and
Safety Code, in the course of providing telemedicine medical
services.
(e) A physician providing telemedicine medical services
shall exercise the physician's discretion to:
(1) ensure that the physician is providing the
services using the same standard of care applicable to the
provision of medical services in a traditional clinical setting;
and
(2) determine when a face-to-face examination of a
patient is necessary to comply with the applicable standard of care
for the services.
(f) The Texas Medical Board may not require that
telemedicine medical services be provided only in conjunction with:
(1) a face-to-face visit with or in-person evaluation
of the patient before, while, or after the patient receives
telemedicine medical services; or
(2) an examination of the patient at an established
medical site as described in Subsection (a)(3) before, while, or
after the patient receives telemedicine medical services.
SECTION 5. This Act takes effect September 1, 2015.