Texas 2017 - 85th Regular

Texas House Bill HB2697 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	85R22531 EES-F
2	2	By: Price, Coleman, et al. H.B. No. 2697
3	3	Substitute the following for H.B. No. 2697:
4	4	By: Price C.S.H.B. No. 2697
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to telemedicine and telehealth services.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 111.001, Occupations Code, is amended by
12	12	amending Subdivision (2) and adding Subdivisions (3) and (4) to
13	13	read as follows:
14	14	(2) "Store and forward technology" means technology
15	15	that stores and transmits or grants access to a person's clinical
16	16	information for review by a health professional at a different
17	17	physical location than the person.
18	18	(3) "Telehealth service" means a health service, other
19	19	than a telemedicine medical service, delivered by a health
20	20	professional licensed, certified, or otherwise entitled to
21	21	practice in this state and acting within the scope of the health
22	22	professional's license, certification, or entitlement to a patient
23	23	at a different physical location than the health professional using
24	24	telecommunications or information technology.
25	25	(4) "Telemedicine [and "telemedicine] medical
26	26	service" means a health care service delivered by a physician
27	27	licensed in this state, or a health professional acting under the
28	28	delegation and supervision of a physician licensed in this state,
29	29	and acting within the scope of the physician's or health
30	30	professional's license to a patient at a different physical
31	31	location than the physician or health professional using
32	32	telecommunications or information technology [have the meanings
33	33	assigned by Section 57.042, Utilities Code].
34	34	SECTION 2. Section 111.004, Occupations Code, is amended to
35	35	read as follows:
36	36	Sec. 111.004. RULES. The Texas [State Board of] Medical
37	37	Board [Examiners], in consultation with the commissioner of
38	38	insurance, as appropriate, may adopt rules necessary to:
39	39	(1) ensure that patients using telemedicine medical
40	40	services receive appropriate, quality care;
41	41	(2) prevent abuse and fraud in the use of telemedicine
42	42	medical services, including rules relating to the filing of claims
43	43	and records required to be maintained in connection with
44	44	telemedicine medical services;
45	45	(3) ensure adequate supervision of health
46	46	professionals who are not physicians and who provide telemedicine
47	47	medical services; and
48	48	(4) establish the maximum number of health
49	49	professionals who are not physicians that a physician may supervise
50	50	through a telemedicine medical service[; and
51	51	[(5) require a face-to-face consultation between a
52	52	patient and a physician providing a telemedicine medical service
53	53	within a certain number of days following an initial telemedicine
54	54	medical service only if the physician has never seen the patient].
55	55	SECTION 3. Chapter 111, Occupations Code, is amended by
56	56	adding Sections 111.005 through 111.008 to read as follows:
57	57	Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
58	58	TELEMEDICINE MEDICAL SERVICES. (a) For purposes of Section
59	59	562.056, a valid practitioner-patient relationship is present
60	60	between a practitioner providing a telemedicine medical service and
61	61	a patient receiving the telemedicine medical service as long as the
62	62	practitioner complies with the standard of care described in
63	63	Section 111.007 and the practitioner:
64	64	(1) has a preexisting practitioner-patient
65	65	relationship with the patient established in accordance with rules
66	66	adopted under Section 111.006;
67	67	(2) communicates, regardless of the method of
68	68	communication, with the patient pursuant to a call coverage
69	69	agreement established in accordance with Texas Medical Board rules
70	70	with a physician requesting coverage of medical care for the
71	71	patient; or
72	72	(3) provides the telemedicine medical services
73	73	through the use of one of the following methods, as long as the
74	74	practitioner complies with the follow-up requirements in
75	75	Subsection (b), and the method allows the practitioner to have
76	76	access to, and the practitioner uses, the relevant clinical
77	77	information that would be required in accordance with the standard
78	78	of care described in Section 111.007:
79	79	(A) synchronous audiovisual interaction between
80	80	the practitioner and the patient in another location;
81	81	(B) asynchronous store and forward technology,
82	82	including asynchronous store and forward technology in conjunction
83	83	with synchronous audio interaction between the practitioner and the
84	84	patient in another location, as long as the practitioner uses
85	85	clinical information from:
86	86	(i) clinically relevant photographic or
87	87	video images, including diagnostic images; or
88	88	(ii) the patient's relevant medical
89	89	records, such as the relevant medical history, laboratory and
90	90	pathology results, and prescriptive histories; or
91	91	(C) another form of audiovisual
92	92	telecommunication technology that allows the practitioner to
93	93	comply with the standard of care described in Section 111.007.
94	94	(b) A practitioner who provides telemedicine medical
95	95	services to a patient as described in Subsection (a)(3) shall:
96	96	(1) provide the patient with guidance on appropriate
97	97	follow-up care; and
98	98	(2) if the patient consents and the patient has a
99	99	primary care physician, provide to the patient's primary care
100	100	physician within 72 hours after the practitioner provides the
101	101	services to the patient a medical record or other report containing
102	102	an explanation of the treatment provided by the practitioner to the
103	103	patient and the practitioner's evaluation, analysis, or diagnosis,
104	104	as appropriate, of the patient's condition.
105	105	(c) Notwithstanding any other provision of this section, a
106	106	practitioner-patient relationship is not present if a practitioner
107	107	prescribes an abortifacient or any other drug or device that
108	108	terminates a pregnancy.
109	109	Sec. 111.006. COORDINATION TO ADOPT RULES THAT DETERMINE
110	110	VALID PRESCRIPTION. (a) The Texas Medical Board, the Texas Board
111	111	of Nursing, the Texas Physician Assistant Board, and the Texas
112	112	State Board of Pharmacy shall jointly adopt rules that establish
113	113	the determination of a valid prescription in accordance with
114	114	Section 111.005. Rules adopted under this section must allow for
115	115	the establishment of a practitioner-patient relationship by a
116	116	telemedicine medical service provided by a practitioner to a
117	117	patient in a manner that complies with Section 111.005(a)(3).
118	118	(b) The Texas Medical Board, the Texas Board of Nursing, the
119	119	Texas Physician Assistant Board, and the Texas State Board of
120	120	Pharmacy shall jointly develop and publish on each respective
121	121	board's Internet website responses to frequently asked questions
122	122	relating to the determination of a valid prescription issued in the
123	123	course of the provision of telemedicine medical services.
124	124	Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
125	125	SERVICES AND TELEHEALTH SERVICES. (a) A health professional
126	126	providing a health care service or procedure as a telemedicine
127	127	medical service or a telehealth service is subject to the standard
128	128	of care that would apply to the provision of the same health care
129	129	service or procedure in an in-person setting.
130	130	(b) An agency with regulatory authority over a health
131	131	professional may not adopt rules pertaining to telemedicine medical
132	132	services or telehealth services that would impose a higher standard
133	133	of care than the standard described in Subsection (a).
134	134	Sec. 111.008. MENTAL HEALTH SERVICES EXCLUDED. This
135	135	chapter does not apply to mental health services.
136	136	SECTION 4. Section 562.056, Occupations Code, is amended by
137	137	adding Subsection (c) to read as follows:
138	138	(c) For purposes of this section, a valid
139	139	practitioner-patient relationship is present between a
140	140	practitioner providing telemedicine medical services and the
141	141	patient receiving the telemedicine medical services if the
142	142	practitioner has complied with the requirements for establishing
143	143	such a relationship in accordance with Section 111.005.
144	144	SECTION 5. Section 1455.001(3), Insurance Code, is amended
145	145	to read as follows:
146	146	(3) "Telehealth service" and "telemedicine medical
147	147	service" have the meanings assigned by Section 111.001 [57.042],
148	148	Occupations [Utilities] Code.
149	149	SECTION 6. Section 1455.004, Insurance Code, is amended to
150	150	read as follows:
151	151	Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES
152	152	AND TELEHEALTH SERVICES. (a) A health benefit plan may not exclude
153	153	from coverage a covered health care service or procedure delivered
154	154	by a preferred or contracted health professional to a covered
155	155	patient as a telemedicine medical service or a telehealth service
156	156	[from coverage under the plan] solely because the covered health
157	157	care service or procedure is not provided through an in-person [a
158	158	face-to-face] consultation.
159	159	(b) A health benefit plan may require a deductible, a
160	160	copayment, or coinsurance for a covered health care service or
161	161	procedure delivered by a preferred or contracted health
162	162	professional to a covered patient as a telemedicine medical service
163	163	or a telehealth service. The amount of the deductible, copayment,
164	164	or coinsurance may not exceed the amount of the deductible,
165	165	copayment, or coinsurance required for the covered health care [a
166	166	comparable medical] service or procedure provided through an
167	167	in-person [a face-to-face] consultation.
168	168	(c) Notwithstanding Subsection (a), a health benefit plan
169	169	is not required to provide coverage for a telemedicine medical
170	170	service or a telehealth service provided by only synchronous or
171	171	asynchronous audio interaction, including:
172	172	(1) an audio-only telephone consultation;
173	173	(2) a text-only e-mail message; or
174	174	(3) a facsimile transmission.
175	175	SECTION 7. Chapter 1455, Insurance Code, is amended by
176	176	adding Section 1455.006 to read as follows:
177	177	Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES AND
178	178	TELEHEALTH SERVICES STATEMENT. (a) Each issuer of a health
179	179	benefit plan shall adopt and display in a conspicuous manner on the
180	180	health benefit plan issuer's Internet website the issuer's policies
181	181	and payment practices for telemedicine medical services and
182	182	telehealth services.
183	183	(b) This section does not require an issuer of a health
184	184	benefit plan to display negotiated contract payment rates for
185	185	health professionals who contract with the issuer to provide
186	186	telemedicine medical services or telehealth services.
187	187	SECTION 8. Sections 531.001(7) and (8), Government Code,
188	188	are amended to read as follows:
189	189	(7) "Telehealth service" has the meaning assigned by
190	190	Section 111.001, Occupations Code [means a health service, other
191	191	than a telemedicine medical service, that is delivered by a
192	192	licensed or certified health professional acting within the scope
193	193	of the health professional's license or certification who does not
194	194	perform a telemedicine medical service and that requires the use of
195	195	advanced telecommunications technology, other than telephone or
196	196	facsimile technology, including:
197	197	[(A) compressed digital interactive video,
198	198	audio, or data transmission;
199	199	[(B) clinical data transmission using computer
200	200	imaging by way of still-image capture and store and forward; and
201	201	[(C) other technology that facilitates access to
202	202	health care services or medical specialty expertise].
203	203	(8) "Telemedicine medical service" has the meaning
204	204	assigned by Section 111.001, Occupations Code [means a health care
205	205	service that is initiated by a physician or provided by a health
206	206	professional acting under physician delegation and supervision,
207	207	that is provided for purposes of patient assessment by a health
208	208	professional, diagnosis or consultation by a physician, or
209	209	treatment, or for the transfer of medical data, and that requires
210	210	the use of advanced telecommunications technology, other than
211	211	telephone or facsimile technology, including:
212	212	[(A) compressed digital interactive video,
213	213	audio, or data transmission;
214	214	[(B) clinical data transmission using computer
215	215	imaging by way of still-image capture and store and forward; and
216	216	[(C) other technology that facilitates access to
217	217	health care services or medical specialty expertise].
218	218	SECTION 9. Section 531.0216(b), Government Code, is amended
219	219	to read as follows:
220	220	(b) In developing the system, the executive commissioner by
221	221	rule shall:
222	222	(1) review programs and pilot projects in other states
223	223	to determine the most effective method for reimbursement;
224	224	(2) establish billing codes and a fee schedule for
225	225	services;
226	226	(3) [provide for an approval process before a provider
227	227	can receive reimbursement for services;
228	228	[(4)] consult with the Department of State Health
229	229	Services to establish procedures to:
230	230	(A) identify clinical evidence supporting
231	231	delivery of health care services using a telecommunications system;
232	232	and
233	233	(B) annually review health care services,
234	234	considering new clinical findings, to determine whether
235	235	reimbursement for particular services should be denied or
236	236	authorized;
237	237	(4) [(5)] establish a separate provider identifier
238	238	for telemedicine medical services providers, telehealth services
239	239	providers, and home telemonitoring services providers; and
240	240	(5) [(6)] establish a separate modifier for
241	241	telemedicine medical services, telehealth services, and home
242	242	telemonitoring services eligible for reimbursement.
243	243	SECTION 10. Sections 531.0217(c-1) and (i), Government
244	244	Code, are amended to read as follows:
245	245	(c-1) Notwithstanding Subsection (b) or (c), the commission
246	246	shall provide for reimbursement under Medicaid for an office visit
247	247	provided through telemedicine by a physician who is assessing and
248	248	evaluating the patient from a distant site if [:
249	249	[(1) a health professional acting under the delegation
250	250	and supervision of that physician is present with the patient at the
251	251	time of the visit; and
252	252	[(2)] the medical condition, illness, or injury for
253	253	which the patient is receiving the service is not likely, within a
254	254	reasonable degree of medical certainty, to undergo material
255	255	deterioration within the 30-day period following the date of the
256	256	visit.
257	257	(i) The Texas Medical Board, in consultation with the
258	258	commission, as appropriate, may adopt rules as necessary to:
259	259	(1) ensure that appropriate care, including quality of
260	260	care, is provided to patients who receive telemedicine medical
261	261	services; and
262	262	(2) prevent abuse and fraud through the use of
263	263	telemedicine medical services, including rules relating to filing
264	264	of claims and records required to be maintained in connection with
265	265	telemedicine[; and
266	266	[(3) define those situations when a face-to-face
267	267	consultation with a physician is required after a telemedicine
268	268	medical service].
269	269	SECTION 11. Section 771.151(7), Health and Safety Code, is
270	270	amended to read as follows:
271	271	(7) "Telemedicine medical service" has the meaning
272	272	assigned by Section 111.001, Occupations Code [means a health care
273	273	service that is initiated by a physician or provided by a health
274	274	professional acting under physician delegation and supervision,
275	275	that is provided for purposes of patient assessment by a health
276	276	professional, diagnosis or consultation by a physician, or
277	277	treatment, or for the transfer of medical data, and that requires
278	278	the use of advanced telecommunications technology, other than
279	279	telephone or facsimile technology, including:
280	280	[(A) compressed digital interactive video,
281	281	audio, or data transmission;
282	282	[(B) clinical data transmission using computer
283	283	imaging by way of still-image capture and store and forward; and
284	284	[(C) other technology that facilitates access to
285	285	health care services or medical specialty expertise].
286	286	SECTION 12. Sections 531.02163 and 531.0217(i-1),
287	287	Government Code, are repealed.
288	288	SECTION 13. (a) Except as provided by Subsection (b) of
289	289	this section, this Act takes effect immediately if it receives a
290	290	vote of two-thirds of all the members elected to each house, as
291	291	provided by Section 39, Article III, Texas Constitution. If this
292	292	Act does not receive the vote necessary for immediate effect, this
293	293	Act takes effect September 1, 2017.
294	294	(b) Sections 1455.001(3) and 1455.004, Insurance Code, as
295	295	amended by this Act, and Section 1455.006, Insurance Code, as added
296	296	by this Act, take effect January 1, 2018.