Texas 2017 - 85th Regular

Texas Senate Bill SB1107 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	85R22531 EES-F
2		-	By: Schwertner, et al. S.B. No. 1107
3		-	(Price, Coleman, Springer, et al.)
4		-	Substitute the following for S.B. No. 1107: No.
	1	+	S.B. No. 1107
5	2
6	3
7		-	A BILL TO BE ENTITLED
8	4		AN ACT
9	5		relating to telemedicine and telehealth services.
10	6		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	7		SECTION 1. Section 111.001, Occupations Code, is amended by
12	8		amending Subdivision (2) and adding Subdivisions (3) and (4) to
13	9		read as follows:
14	10		(2) "Store and forward technology" means technology
15	11		that stores and transmits or grants access to a person's clinical
16	12		information for review by a health professional at a different
17	13		physical location than the person.
18	14		(3) "Telehealth service" means a health service, other
19	15		than a telemedicine medical service, delivered by a health
20	16		professional licensed, certified, or otherwise entitled to
21	17		practice in this state and acting within the scope of the health
22	18		professional's license, certification, or entitlement to a patient
23	19		at a different physical location than the health professional using
24	20		telecommunications or information technology.
25	21		(4) "Telemedicine [and "telemedicine] medical
26	22		service" means a health care service delivered by a physician
27	23		licensed in this state, or a health professional acting under the
28	24		delegation and supervision of a physician licensed in this state,
29	25		and acting within the scope of the physician's or health
30	26		professional's license to a patient at a different physical
31	27		location than the physician or health professional using
32	28		telecommunications or information technology [have the meanings
33	29		assigned by Section 57.042, Utilities Code].
34	30		SECTION 2. Section 111.004, Occupations Code, is amended to
35	31		read as follows:
36	32		Sec. 111.004. RULES. The Texas [State Board of] Medical
37	33		Board [Examiners], in consultation with the commissioner of
38	34		insurance, as appropriate, may adopt rules necessary to:
39	35		(1) ensure that patients using telemedicine medical
40	36		services receive appropriate, quality care;
41	37		(2) prevent abuse and fraud in the use of telemedicine
42	38		medical services, including rules relating to the filing of claims
43	39		and records required to be maintained in connection with
44	40		telemedicine medical services;
45	41		(3) ensure adequate supervision of health
46	42		professionals who are not physicians and who provide telemedicine
47	43		medical services; and
48	44		(4) establish the maximum number of health
49	45		professionals who are not physicians that a physician may supervise
50	46		through a telemedicine medical service[; and
51	47		[(5) require a face-to-face consultation between a
52	48		patient and a physician providing a telemedicine medical service
53	49		within a certain number of days following an initial telemedicine
54	50		medical service only if the physician has never seen the patient].
55	51		SECTION 3. Chapter 111, Occupations Code, is amended by
56	52		adding Sections 111.005 through 111.008 to read as follows:
57	53		Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
58	54		TELEMEDICINE MEDICAL SERVICES. (a) For purposes of Section
59	55		562.056, a valid practitioner-patient relationship is present
60	56		between a practitioner providing a telemedicine medical service and
61	57		a patient receiving the telemedicine medical service as long as the
62	58		practitioner complies with the standard of care described in
63	59		Section 111.007 and the practitioner:
64	60		(1) has a preexisting practitioner-patient
65	61		relationship with the patient established in accordance with rules
66	62		adopted under Section 111.006;
67	63		(2) communicates, regardless of the method of
68	64		communication, with the patient pursuant to a call coverage
69	65		agreement established in accordance with Texas Medical Board rules
70	66		with a physician requesting coverage of medical care for the
71	67		patient; or
72	68		(3) provides the telemedicine medical services
73	69		through the use of one of the following methods, as long as the
74	70		practitioner complies with the follow-up requirements in
75	71		Subsection (b), and the method allows the practitioner to have
76	72		access to, and the practitioner uses, the relevant clinical
77	73		information that would be required in accordance with the standard
78	74		of care described in Section 111.007:
79	75		(A) synchronous audiovisual interaction between
80	76		the practitioner and the patient in another location;
81	77		(B) asynchronous store and forward technology,
82	78		including asynchronous store and forward technology in conjunction
83	79		with synchronous audio interaction between the practitioner and the
84	80		patient in another location, as long as the practitioner uses
85	81		clinical information from:
86	82		(i) clinically relevant photographic or
87	83		video images, including diagnostic images; or
88	84		(ii) the patient's relevant medical
89	85		records, such as the relevant medical history, laboratory and
90	86		pathology results, and prescriptive histories; or
91	87		(C) another form of audiovisual
92	88		telecommunication technology that allows the practitioner to
93	89		comply with the standard of care described in Section 111.007.
94	90		(b) A practitioner who provides telemedicine medical
95	91		services to a patient as described in Subsection (a)(3) shall:
96	92		(1) provide the patient with guidance on appropriate
97	93		follow-up care; and
98	94		(2) if the patient consents and the patient has a
99	95		primary care physician, provide to the patient's primary care
100	96		physician within 72 hours after the practitioner provides the
101	97		services to the patient a medical record or other report containing
102	98		an explanation of the treatment provided by the practitioner to the
103	99		patient and the practitioner's evaluation, analysis, or diagnosis,
104	100		as appropriate, of the patient's condition.
105	101		(c) Notwithstanding any other provision of this section, a
106	102		practitioner-patient relationship is not present if a practitioner
107	103		prescribes an abortifacient or any other drug or device that
108	104		terminates a pregnancy.
109	105		Sec. 111.006. COORDINATION TO ADOPT RULES THAT DETERMINE
110	106		VALID PRESCRIPTION. (a) The Texas Medical Board, the Texas Board
111	107		of Nursing, the Texas Physician Assistant Board, and the Texas
112	108		State Board of Pharmacy shall jointly adopt rules that establish
113	109		the determination of a valid prescription in accordance with
114	110		Section 111.005. Rules adopted under this section must allow for
115	111		the establishment of a practitioner-patient relationship by a
116	112		telemedicine medical service provided by a practitioner to a
117	113		patient in a manner that complies with Section 111.005(a)(3).
118	114		(b) The Texas Medical Board, the Texas Board of Nursing, the
119	115		Texas Physician Assistant Board, and the Texas State Board of
120	116		Pharmacy shall jointly develop and publish on each respective
121	117		board's Internet website responses to frequently asked questions
122	118		relating to the determination of a valid prescription issued in the
123	119		course of the provision of telemedicine medical services.
124	120		Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
125	121		SERVICES AND TELEHEALTH SERVICES. (a) A health professional
126	122		providing a health care service or procedure as a telemedicine
127	123		medical service or a telehealth service is subject to the standard
128	124		of care that would apply to the provision of the same health care
129	125		service or procedure in an in-person setting.
130	126		(b) An agency with regulatory authority over a health
131	127		professional may not adopt rules pertaining to telemedicine medical
132	128		services or telehealth services that would impose a higher standard
133	129		of care than the standard described in Subsection (a).
134	130		Sec. 111.008. MENTAL HEALTH SERVICES EXCLUDED. This
135	131		chapter does not apply to mental health services.
136	132		SECTION 4. Section 562.056, Occupations Code, is amended by
137	133		adding Subsection (c) to read as follows:
138	134		(c) For purposes of this section, a valid
139	135		practitioner-patient relationship is present between a
140	136		practitioner providing telemedicine medical services and the
141	137		patient receiving the telemedicine medical services if the
142	138		practitioner has complied with the requirements for establishing
143	139		such a relationship in accordance with Section 111.005.
144	140		SECTION 5. Section 1455.001(3), Insurance Code, is amended
145	141		to read as follows:
146	142		(3) "Telehealth service" and "telemedicine medical
147	143		service" have the meanings assigned by Section 111.001 [57.042],
148	144		Occupations [Utilities] Code.
149	145		SECTION 6. Section 1455.004, Insurance Code, is amended to
150	146		read as follows:
151	147		Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES
152		-	AND TELEHEALTH SERVICES. (a) A health benefit plan may not ~~exclude~~
153		-	from coverage a covered health care service or procedure ~~delivered~~
154		-	by a preferred or contracted health professional to a ~~covered~~
155		-	patient as a telemedicine medical service or a telehealth ~~service~~
156		-	[from coverage under the plan] solely because the covered ~~health~~
157		-	care service or procedure is not provided through an ~~in-person [a~~
158		-	face-to-face] consultation.
	148	+	AND TELEHEALTH SERVICES. (a) A health benefit plan may not
	149	+	exclude from coverage a covered health care service or procedure
	150	+	delivered by a preferred or contracted health professional to a
	151	+	covered patient as a telemedicine medical service or a telehealth
	152	+	service [from coverage under the plan] solely because the covered
	153	+	health care service or procedure is not provided through an
	154	+	in-person [a face-to-face] consultation.
159	155		(b) A health benefit plan may require a deductible, a
160	156		copayment, or coinsurance for a covered health care service or
161	157		procedure delivered by a preferred or contracted health
162	158		professional to a covered patient as a telemedicine medical service
163	159		or a telehealth service. The amount of the deductible, copayment,
164	160		or coinsurance may not exceed the amount of the deductible,
165	161		copayment, or coinsurance required for the covered health care [a
166	162		comparable medical] service or procedure provided through an
167	163		in-person [a face-to-face] consultation.
168	164		(c) Notwithstanding Subsection (a), a health benefit plan
169	165		is not required to provide coverage for a telemedicine medical
170	166		service or a telehealth service provided by only synchronous or
171	167		asynchronous audio interaction, including:
172	168		(1) an audio-only telephone consultation;
173	169		(2) a text-only e-mail message; or
174	170		(3) a facsimile transmission.
175	171		SECTION 7. Chapter 1455, Insurance Code, is amended by
176	172		adding Section 1455.006 to read as follows:
177	173		Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES AND
178	174		TELEHEALTH SERVICES STATEMENT. (a) Each issuer of a health
179	175		benefit plan shall adopt and display in a conspicuous manner on the
180	176		health benefit plan issuer's Internet website the issuer's policies
181	177		and payment practices for telemedicine medical services and
182	178		telehealth services.
183	179		(b) This section does not require an issuer of a health
184	180		benefit plan to display negotiated contract payment rates for
185	181		health professionals who contract with the issuer to provide
186	182		telemedicine medical services or telehealth services.
187	183		SECTION 8. Sections 531.001(7) and (8), Government Code,
188	184		are amended to read as follows:
189	185		(7) "Telehealth service" has the meaning assigned by
190	186		Section 111.001, Occupations Code [means a health service, other
191	187		than a telemedicine medical service, that is delivered by a
192	188		licensed or certified health professional acting within the scope
193	189		of the health professional's license or certification who does not
194	190		perform a telemedicine medical service and that requires the use of
195	191		advanced telecommunications technology, other than telephone or
196	192		facsimile technology, including:
197	193		[(A) compressed digital interactive video,
198	194		audio, or data transmission;
199	195		[(B) clinical data transmission using computer
200	196		imaging by way of still-image capture and store and forward; and
201	197		[(C) other technology that facilitates access to
202	198		health care services or medical specialty expertise].
203	199		(8) "Telemedicine medical service" has the meaning
204	200		assigned by Section 111.001, Occupations Code [means a health care
205	201		service that is initiated by a physician or provided by a health
206	202		professional acting under physician delegation and supervision,
207	203		that is provided for purposes of patient assessment by a health
208	204		professional, diagnosis or consultation by a physician, or
209	205		treatment, or for the transfer of medical data, and that requires
210	206		the use of advanced telecommunications technology, other than
211	207		telephone or facsimile technology, including:
212	208		[(A) compressed digital interactive video,
213	209		audio, or data transmission;
214	210		[(B) clinical data transmission using computer
215	211		imaging by way of still-image capture and store and forward; and
216	212		[(C) other technology that facilitates access to
217	213		health care services or medical specialty expertise].
218	214		SECTION 9. Section 531.0216(b), Government Code, is amended
219	215		to read as follows:
220	216		(b) In developing the system, the executive commissioner by
221	217		rule shall:
222	218		(1) review programs and pilot projects in other states
223	219		to determine the most effective method for reimbursement;
224	220		(2) establish billing codes and a fee schedule for
225	221		services;
226	222		(3) [provide for an approval process before a provider
227	223		can receive reimbursement for services;
228	224		[(4)] consult with the Department of State Health
229	225		Services to establish procedures to:
230	226		(A) identify clinical evidence supporting
231	227		delivery of health care services using a telecommunications system;
232	228		and
233	229		(B) annually review health care services,
234	230		considering new clinical findings, to determine whether
235	231		reimbursement for particular services should be denied or
236	232		authorized;
237	233		(4) [(5)] establish a separate provider identifier
238	234		for telemedicine medical services providers, telehealth services
239	235		providers, and home telemonitoring services providers; and
240	236		(5) [(6)] establish a separate modifier for
241	237		telemedicine medical services, telehealth services, and home
242	238		telemonitoring services eligible for reimbursement.
243	239		SECTION 10. Sections 531.0217(c-1) and (i), Government
244	240		Code, are amended to read as follows:
245	241		(c-1) Notwithstanding Subsection (b) or (c), the commission
246	242		shall provide for reimbursement under Medicaid for an office visit
247	243		provided through telemedicine by a physician who is assessing and
248	244		evaluating the patient from a distant site if[:
249	245		[(1) a health professional acting under the delegation
250	246		and supervision of that physician is present with the patient at the
251	247		time of the visit; and
252	248		[(2)] the medical condition, illness, or injury for
253	249		which the patient is receiving the service is not likely, within a
254	250		reasonable degree of medical certainty, to undergo material
255	251		deterioration within the 30-day period following the date of the
256	252		visit.
257	253		(i) The Texas Medical Board, in consultation with the
258	254		commission, as appropriate, may adopt rules as necessary to:
259	255		(1) ensure that appropriate care, including quality of
260	256		care, is provided to patients who receive telemedicine medical
261	257		services; and
262	258		(2) prevent abuse and fraud through the use of
263	259		telemedicine medical services, including rules relating to filing
264	260		of claims and records required to be maintained in connection with
265	261		telemedicine[; and
266	262		[(3) define those situations when a face-to-face
267	263		consultation with a physician is required after a telemedicine
268	264		medical service].
269	265		SECTION 11. Section 771.151(7), Health and Safety Code, is
270	266		amended to read as follows:
271	267		(7) "Telemedicine medical service" has the meaning
272	268		assigned by Section 111.001, Occupations Code [means a health care
273	269		service that is initiated by a physician or provided by a health
274	270		professional acting under physician delegation and supervision,
275	271		that is provided for purposes of patient assessment by a health
276	272		professional, diagnosis or consultation by a physician, or
277	273		treatment, or for the transfer of medical data, and that requires
278	274		the use of advanced telecommunications technology, other than
279	275		telephone or facsimile technology, including:
280	276		[(A) compressed digital interactive video,
281	277		audio, or data transmission;
282	278		[(B) clinical data transmission using computer
283	279		imaging by way of still-image capture and store and forward; and
284	280		[(C) other technology that facilitates access to
285	281		health care services or medical specialty expertise].
286	282		SECTION 12. Sections 531.02163 and 531.0217(i-1),
287	283		Government Code, are repealed.
288	284		SECTION 13. (a) Except as provided by Subsection (b) of
289	285		this section, this Act takes effect immediately if it receives a
290	286		vote of two-thirds of all the members elected to each house, as
291	287		provided by Section 39, Article III, Texas Constitution. If this
292	288		Act does not receive the vote necessary for immediate effect, this
293	289		Act takes effect September 1, 2017.
294	290		(b) Sections 1455.001(3) and 1455.004, Insurance Code, as
295	291		amended by this Act, and Section 1455.006, Insurance Code, as added
296	292		by this Act, take effect January 1, 2018.
	293	+	______________________________ ______________________________
	294	+	President of the Senate Speaker of the House
	295	+	I hereby certify that S.B. No. 1107 passed the Senate on
	296	+	March 29, 2017, by the following vote: Yeas 31, Nays 0; and that
	297	+	the Senate concurred in House amendment on May 18, 2017, by the
	298	+	following vote: Yeas 30, Nays 0.
	299	+	______________________________
	300	+	Secretary of the Senate
	301	+	I hereby certify that S.B. No. 1107 passed the House, with
	302	+	amendment, on May 11, 2017, by the following vote: Yeas 135,
	303	+	Nays 0, one present not voting.
	304	+	______________________________
	305	+	Chief Clerk of the House
	306	+	Approved:
	307	+	______________________________
	308	+	Date
	309	+	______________________________
	310	+	Governor