85R22531 EES-F
By: Price, Coleman, et al. H.B. No. 2697
Substitute the following for H.B. No. 2697:
By: Price C.S.H.B. No. 2697
A BILL TO BE ENTITLED
AN ACT
relating to telemedicine and telehealth services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 111.001, Occupations Code, is amended by
amending Subdivision (2) and adding Subdivisions (3) and (4) to
read as follows:
(2) "Store and forward technology" means technology
that stores and transmits or grants access to a person's clinical
information for review by a health professional at a different
physical location than the person.
(3) "Telehealth service" means a health service, other
than a telemedicine medical 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.
(4) "Telemedicine [and "telemedicine] medical
service" means a health care service delivered by a physician
licensed in this state, or a health professional acting under the
delegation and supervision of a physician licensed in this state,
and acting within the scope of the physician's or health
professional's license to a patient at a different physical
location than the physician or health professional using
telecommunications or information technology [have the meanings
assigned by Section 57.042, Utilities Code].
SECTION 2. Section 111.004, Occupations Code, is amended to
read as follows:
Sec. 111.004. RULES. The Texas [State Board of] Medical
Board [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 3. Chapter 111, Occupations Code, is amended by
adding Sections 111.005 through 111.008 to read as follows:
Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
TELEMEDICINE MEDICAL SERVICES. (a) For purposes of Section
562.056, a valid practitioner-patient relationship is present
between a practitioner providing a telemedicine medical 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 Texas Medical Board rules
with a physician requesting coverage of medical care for the
patient; or
(3) provides the telemedicine medical 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 medical
records, such as the relevant medical 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 to a patient as described in Subsection (a)(3) shall:
(1) provide the patient with guidance on appropriate
follow-up care; and
(2) if the patient consents and the patient has a
primary care physician, provide to the patient's primary care
physician within 72 hours after the practitioner provides the
services to the patient a medical record or other report containing
an explanation of the treatment provided by the practitioner to the
patient and the practitioner's evaluation, analysis, or diagnosis,
as appropriate, of the patient's condition.
(c) Notwithstanding any other provision of this section, a
practitioner-patient relationship is not present if a practitioner
prescribes an abortifacient or any other drug or device that
terminates a pregnancy.
Sec. 111.006. COORDINATION TO ADOPT RULES THAT DETERMINE
VALID PRESCRIPTION. (a) The Texas Medical Board, the Texas Board
of Nursing, the Texas Physician Assistant Board, 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 section must allow for
the establishment of a practitioner-patient relationship by a
telemedicine medical service provided by a practitioner to a
patient in a manner that complies with Section 111.005(a)(3).
(b) The Texas Medical Board, the Texas Board of Nursing, the
Texas Physician Assistant Board, 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 telemedicine medical services.
Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
SERVICES AND TELEHEALTH SERVICES. (a) A health professional
providing a health care service or procedure as a telemedicine
medical 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 or telehealth services that would impose a higher standard
of care than the standard described in Subsection (a).
Sec. 111.008. MENTAL HEALTH SERVICES EXCLUDED. This
chapter does not apply to mental health services.
SECTION 4. Section 562.056, Occupations Code, is amended by
adding Subsection (c) to read as follows:
(c) For purposes of this section, a valid
practitioner-patient relationship is present between a
practitioner providing telemedicine medical 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 5. Section 1455.001(3), Insurance Code, is amended
to read as follows:
(3) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001 [57.042],
Occupations [Utilities] Code.
SECTION 6. Section 1455.004, Insurance Code, is amended to
read as follows:
Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES
AND TELEHEALTH SERVICES. (a) A health benefit plan may not 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 or a telehealth service
[from coverage under the plan] solely because the covered health
care service or procedure is not provided through an in-person [a
face-to-face] consultation.
(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
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 [a
comparable medical] service or procedure provided through an
in-person [a face-to-face] consultation.
(c) Notwithstanding Subsection (a), a health benefit plan
is not required to provide coverage for a telemedicine medical
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.
SECTION 7. Chapter 1455, Insurance Code, is amended by
adding Section 1455.006 to read as follows:
Sec. 1455.006. TELEMEDICINE MEDICAL 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 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 or telehealth services.
SECTION 8. Sections 531.001(7) and (8), Government Code,
are amended to read as follows:
(7) "Telehealth service" has the meaning assigned by
Section 111.001, Occupations Code [means a health service, other
than a telemedicine medical service, that is delivered by a
licensed or certified health professional acting within the scope
of the health professional's license or certification who does not
perform a telemedicine medical service and that requires the use of
advanced telecommunications technology, other than telephone or
facsimile technology, including:
[(A) compressed digital interactive video,
audio, or data transmission;
[(B) clinical data transmission using computer
imaging by way of still-image capture and store and forward; and
[(C) other technology that facilitates access to
health care services or medical specialty expertise].
(8) "Telemedicine medical service" has the meaning
assigned by Section 111.001, Occupations Code [means a health care
service that is initiated by a physician or provided by a health
professional acting under physician delegation and supervision,
that is provided for purposes of patient assessment by a health
professional, diagnosis or consultation by a physician, or
treatment, or for the transfer of medical data, and that requires
the use of advanced telecommunications technology, other than
telephone or facsimile technology, including:
[(A) compressed digital interactive video,
audio, or data transmission;
[(B) clinical data transmission using computer
imaging by way of still-image capture and store and forward; and
[(C) other technology that facilitates access to
health care services or medical specialty expertise].
SECTION 9. Section 531.0216(b), Government Code, is amended
to read as follows:
(b) In developing the system, the executive commissioner by
rule shall:
(1) review programs and pilot projects in other states
to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for
services;
(3) [provide for an approval process before a provider
can receive reimbursement for services;
[(4)] consult with the Department of State Health
Services to establish procedures to:
(A) identify clinical evidence supporting
delivery of health care services using a telecommunications system;
and
(B) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
(4) [(5)] establish a separate provider identifier
for telemedicine medical services providers, telehealth services
providers, and home telemonitoring services providers; and
(5) [(6)] establish a separate modifier for
telemedicine medical services, telehealth services, and home
telemonitoring services eligible for reimbursement.
SECTION 10. Sections 531.0217(c-1) and (i), Government
Code, are amended to read as follows:
(c-1) Notwithstanding Subsection (b) or (c), the commission
shall provide for reimbursement under Medicaid for an office visit
provided through telemedicine by a physician who is assessing and
evaluating the patient from a distant site if [:
[(1) a health professional acting under the delegation
and supervision of that physician is present with the patient at the
time of the visit; and
[(2)] the medical condition, illness, or injury for
which the patient is receiving the service is not likely, within a
reasonable degree of medical certainty, to undergo material
deterioration within the 30-day period following the date of the
visit.
(i) The Texas Medical Board, in consultation with the
commission, as appropriate, may adopt rules as necessary to:
(1) ensure that appropriate care, including quality of
care, is provided to patients who receive telemedicine medical
services; and
(2) prevent abuse and fraud through the use of
telemedicine medical services, including rules relating to filing
of claims and records required to be maintained in connection with
telemedicine[; and
[(3) define those situations when a face-to-face
consultation with a physician is required after a telemedicine
medical service].
SECTION 11. Section 771.151(7), Health and Safety Code, is
amended to read as follows:
(7) "Telemedicine medical service" has the meaning
assigned by Section 111.001, Occupations Code [means a health care
service that is initiated by a physician or provided by a health
professional acting under physician delegation and supervision,
that is provided for purposes of patient assessment by a health
professional, diagnosis or consultation by a physician, or
treatment, or for the transfer of medical data, and that requires
the use of advanced telecommunications technology, other than
telephone or facsimile technology, including:
[(A) compressed digital interactive video,
audio, or data transmission;
[(B) clinical data transmission using computer
imaging by way of still-image capture and store and forward; and
[(C) other technology that facilitates access to
health care services or medical specialty expertise].
SECTION 12. Sections 531.02163 and 531.0217(i-1),
Government Code, are repealed.
SECTION 13. (a) Except as provided by Subsection (b) of
this section, this Act takes effect immediately if it receives a
vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2017.
(b) Sections 1455.001(3) and 1455.004, Insurance Code, as
amended by this Act, and Section 1455.006, Insurance Code, as added
by this Act, take effect January 1, 2018.