Texas 2019 - 86th Regular

Texas House Bill HB1756 Compare Versions

Only one version of the bill is available at this time.

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1	1	86R6259 JCG-D
2	2	By: Springer H.B. No. 1756
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the practice of dentistry and the provision of
8	8	teledentistry dental services.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. The heading to Chapter 111, Occupations Code, is
11	11	amended to read as follows:
12	12	CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
13	13	SECTION 2. Section 111.001, Occupations Code, is amended by
14	14	amending Subdivisions (1) and (3) and adding Subdivision (2-a) to
15	15	read as follows:
16	16	(1) "Dentist," "health [Health] professional," and
17	17	"physician" have the meanings assigned by Section 1455.001,
18	18	Insurance Code.
19	19	(2-a) "Teledentistry dental service" means a health
20	20	care service delivered by a dentist, or a health professional
21	21	acting under the delegation and supervision of a dentist, acting
22	22	within the scope of the dentist's or health professional's license
23	23	or certification to a patient at a different physical location than
24	24	the dentist or health professional using telecommunications or
25	25	information technology.
26	26	(3) "Telehealth service" means a health service, other
27	27	than a telemedicine medical service or a teledentistry dental
28	28	service, delivered by a health professional licensed, certified, or
29	29	otherwise entitled to practice in this state and acting within the
30	30	scope of the health professional's license, certification, or
31	31	entitlement to a patient at a different physical location than the
32	32	health professional using telecommunications or information
33	33	technology.
34	34	SECTION 3. Section 111.002, Occupations Code, is amended to
35	35	read as follows:
36	36	Sec. 111.002. INFORMED CONSENT. A treating physician,
37	37	dentist, or health professional who provides or facilitates the use
38	38	of telemedicine medical services, teledentistry dental services,
39	39	or telehealth services shall ensure that the informed consent of
40	40	the patient, or another appropriate individual authorized to make
41	41	health care treatment decisions for the patient, is obtained before
42	42	telemedicine medical services, teledentistry dental services, or
43	43	telehealth services are provided.
44	44	SECTION 4. Section 111.003, Occupations Code, is amended to
45	45	read as follows:
46	46	Sec. 111.003. CONFIDENTIALITY. A treating physician,
47	47	dentist, or health professional who provides or facilitates the use
48	48	of telemedicine medical services, teledentistry dental services,
49	49	or telehealth services shall ensure that the confidentiality of the
50	50	patient's clinical [medical] information is maintained as required
51	51	by Chapter 159, by Subchapter C, Chapter 258, or by other applicable
52	52	law.
53	53	SECTION 5. Section 111.004, Occupations Code, is amended
54	54	to read as follows:
55	55	Sec. 111.004. RULES. (a) The Texas Medical Board, in
56	56	consultation with the commissioner of insurance, as appropriate,
57	57	may adopt rules necessary to:
58	58	(1) ensure that patients using telemedicine medical
59	59	services receive appropriate, quality care;
60	60	(2) prevent abuse and fraud in the use of telemedicine
61	61	medical services, including rules relating to the filing of claims
62	62	and records required to be maintained in connection with
63	63	telemedicine medical services;
64	64	(3) ensure adequate supervision of health
65	65	professionals who are not physicians and who provide telemedicine
66	66	medical services; and
67	67	(4) establish the maximum number of health
68	68	professionals who are not physicians that a physician may supervise
69	69	through a telemedicine medical service.
70	70	(b) The State Board of Dental Examiners, in consultation
71	71	with the commissioner of insurance, as appropriate, may adopt rules
72	72	necessary to:
73	73	(1) ensure that patients using teledentistry dental
74	74	services receive appropriate, quality care;
75	75	(2) prevent abuse and fraud in the use of
76	76	teledentistry dental services, including rules relating to the
77	77	filing of claims and records required to be maintained in
78	78	connection with teledentistry dental services;
79	79	(3) ensure adequate supervision of health
80	80	professionals who are not dentists and who provide teledentistry
81	81	dental services; and
82	82	(4) establish the maximum number of health
83	83	professionals who are not dentists that a dentist may supervise
84	84	through a teledentistry dental service.
85	85	SECTION 6. The heading to Section 111.005, Occupations
86	86	Code, is amended to read as follows:
87	87	Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
88	88	TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES.
89	89	SECTION 7. Sections 111.005(a) and (b), Occupations Code,
90	90	are amended to read as follows:
91	91	(a) For purposes of Section 562.056, a valid
92	92	practitioner-patient relationship is present between a
93	93	practitioner providing a telemedicine medical service or a
94	94	teledentistry dental service and a patient receiving the
95	95	[telemedicine medical] service as long as the practitioner complies
96	96	with the standard of care described in Section 111.007 and the
97	97	practitioner:
98	98	(1) has a preexisting practitioner-patient
99	99	relationship with the patient established in accordance with rules
100	100	adopted under Section 111.006;
101	101	(2) communicates, regardless of the method of
102	102	communication, with the patient pursuant to a call coverage
103	103	agreement established in accordance with:
104	104	(A) Texas Medical Board rules with a physician
105	105	requesting coverage of medical care for the patient; or
106	106	(B) State Board of Dental Examiners rules with a
107	107	dentist requesting coverage of dental care for the patient; or
108	108	(3) provides the telemedicine medical services or
109	109	teledentistry dental services through the use of one of the
110	110	following methods, as long as the practitioner complies with the
111	111	follow-up requirements in Subsection (b), and the method allows the
112	112	practitioner to have access to, and the practitioner uses, the
113	113	relevant clinical information that would be required in accordance
114	114	with the standard of care described in Section 111.007:
115	115	(A) synchronous audiovisual interaction between
116	116	the practitioner and the patient in another location;
117	117	(B) asynchronous store and forward technology,
118	118	including asynchronous store and forward technology in conjunction
119	119	with synchronous audio interaction between the practitioner and the
120	120	patient in another location, as long as the practitioner uses
121	121	clinical information from:
122	122	(i) clinically relevant photographic or
123	123	video images, including diagnostic images; or
124	124	(ii) the patient's relevant clinical
125	125	[medical] records, such as the relevant medical or dental history,
126	126	laboratory and pathology results, and prescriptive histories; or
127	127	(C) another form of audiovisual
128	128	telecommunication technology that allows the practitioner to
129	129	comply with the standard of care described in Section 111.007.
130	130	(b) A practitioner who provides telemedicine medical
131	131	services or teledentistry dental services to a patient as described
132	132	in Subsection (a)(3) shall:
133	133	(1) provide the patient with guidance on appropriate
134	134	follow-up care; and
135	135	(2) if the patient consents and the patient has a
136	136	primary care physician or a regular dentist, provide to the
137	137	patient's primary care physician or regular dentist, as
138	138	appropriate, within 72 hours after the practitioner provides the
139	139	services to the patient, a clinical [medical] record or other
140	140	report containing an explanation of the treatment provided by the
141	141	practitioner to the patient and the practitioner's evaluation,
142	142	analysis, or diagnosis, as appropriate, of the patient's condition.
143	143	SECTION 8. Section 111.006, Occupations Code, is amended by
144	144	adding Subsection (c) to read as follows:
145	145	(c) The State Board of Dental Examiners and the Texas State
146	146	Board of Pharmacy shall jointly adopt rules that establish the
147	147	determination of a valid prescription in accordance with Section
148	148	111.005, as that section applies to teledentistry dental services.
149	149	Rules adopted under this subsection must allow for the
150	150	establishment of a practitioner-patient relationship by a
151	151	teledentistry dental service provided by a practitioner to a
152	152	patient in a manner that complies with Section 111.005(a)(3). The
153	153	State Board of Dental Examiners and the Texas State Board of
154	154	Pharmacy shall jointly develop and publish on each respective
155	155	board's Internet website responses to frequently asked questions
156	156	relating to the determination of a valid prescription issued in the
157	157	course of the provision of teledentistry dental services.
158	158	SECTION 9. Section 111.007, Occupations Code, is amended to
159	159	read as follows:
160	160	Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
161	161	SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.
162	162	(a) A health professional providing a health care service or
163	163	procedure as a telemedicine medical service, a teledentistry dental
164	164	service, or a telehealth service is subject to the standard of care
165	165	that would apply to the provision of the same health care service or
166	166	procedure in an in-person setting.
167	167	(b) An agency with regulatory authority over a health
168	168	professional may not adopt rules pertaining to telemedicine medical
169	169	services, teledentistry dental services, or telehealth services
170	170	that would impose a higher standard of care than the standard
171	171	described in Subsection (a).
172	172	SECTION 10. Chapter 111, Occupations Code, is amended by
173	173	adding Section 111.009 to read as follows:
174	174	Sec. 111.009. CERTAIN PRESCRIPTIONS PROHIBITED. (a) In
175	175	this section, "controlled substance" and "prescribe" have the
176	176	meanings assigned by Section 481.002, Health and Safety Code.
177	177	(b) A dentist may not prescribe a controlled substance to a
178	178	patient as a teledentistry dental service.
179	179	SECTION 11. Section 251.003, Occupations Code, is amended
180	180	by adding Subsection (d) to read as follows:
181	181	(d) For purposes of this subtitle, a person located in
182	182	another state practices dentistry in this state if the person
183	183	through the use of any medium, including an electronic medium,
184	184	performs an act that constitutes the practice of dentistry on a
185	185	patient in this state.
186	186	SECTION 12. Chapter 254, Occupations Code, is amended by
187	187	adding Section 254.0035 to read as follows:
188	188	Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS.
189	189	The board shall adopt rules governing a call coverage agreement
190	190	between dentists.
191	191	SECTION 13. Section 258.001, Occupations Code, is amended
192	192	to read as follows:
193	193	Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not
194	194	delegate:
195	195	(1) an act to an individual who, by board order, is
196	196	prohibited from performing the act;
197	197	(2) any of the following acts to a person not licensed
198	198	as a dentist or dental hygienist:
199	199	(A) the removal of calculus, deposits, or
200	200	accretions from the natural and restored surfaces of exposed human
201	201	teeth and restorations in the human mouth;
202	202	(B) root planing or the smoothing and polishing
203	203	of roughened root surfaces or exposed human teeth; or
204	204	(C) any other act the delegation of which is
205	205	prohibited by board rule;
206	206	(3) any of the following acts to a person not licensed
207	207	as a dentist:
208	208	(A) comprehensive examination or diagnosis and
209	209	treatment planning;
210	210	(B) a surgical or cutting procedure on hard or
211	211	soft tissue;
212	212	(C) the prescription of a drug, medication, or
213	213	work authorization;
214	214	(D) the taking of an impression for a final
215	215	restoration, appliance, or prosthesis;
216	216	(E) the making of an intraoral occlusal
217	217	adjustment;
218	218	(F) direct pulp capping, pulpotomy, or any other
219	219	endodontic procedure;
220	220	(G) the final placement and intraoral adjustment
221	221	of a fixed or removable appliance; or
222	222	(H) the placement of any final restoration; or
223	223	(4) the authority to an individual to administer a
224	224	local anesthetic agent, inhalation sedative agent, parenteral
225	225	sedative agent, or general anesthetic agent, including the
226	226	authority to administer an anesthetic or sedative agent as a
227	227	teledentistry dental service as that term is defined by Section
228	228	111.001, if the individual is not licensed as:
229	229	(A) a dentist with a permit issued by the board
230	230	for the procedure being performed, if a permit is required;
231	231	(B) a certified registered nurse anesthetist
232	232	licensed by the Texas Board of Nursing, only if the delegating
233	233	dentist holds a permit issued by the board for the procedure being
234	234	performed, if a permit is required; or
235	235	(C) a physician anesthesiologist licensed by the
236	236	Texas Medical Board.
237	237	SECTION 14. Subchapter A, Chapter 258, Occupations Code, is
238	238	amended by adding Section 258.004 to read as follows:
239	239	Sec. 258.004. COLLABORATIVE PRACTICE WITH DENTAL
240	240	HYGIENIST. (a) In this section, "collaborative practice
241	241	agreement" means a written practice agreement and protocols for the
242	242	practice of dental hygiene.
243	243	(b) A dental hygienist may practice dental hygiene under a
244	244	collaborative practice agreement with a dentist if the dental
245	245	hygienist has been engaged in the practice of dental hygiene for at
246	246	least one year with a minimum of 2,000 practice hours.
247	247	(c) A dental hygienist may enter into a collaborative
248	248	practice agreement to practice dental hygiene in any setting
249	249	authorized by law for the practice of dental hygiene.
250	250	(d) A collaborative practice agreement must include
251	251	protocols:
252	252	(1) describing the practice of dental hygiene for:
253	253	(A) medically compromised patients;
254	254	(B) specific medical conditions;
255	255	(C) patients with needs related to age; and
256	256	(D) patients with complex medical histories;
257	257	(2) prescribing standards for specific dental hygiene
258	258	procedures, including intervals for the performance of those
259	259	procedures;
260	260	(3) prescribing intervals at which a supervising
261	261	dentist must examine a patient;
262	262	(4) describing the services that the dental hygienist
263	263	may provide, the procedures that the dental hygienist may perform,
264	264	the practice settings in which the services may be provided and the
265	265	procedures may be performed, and any limitations on the services
266	266	and procedures;
267	267	(5) describing case selection criteria, assessment
268	268	guidelines, and imaging frequency guidelines for patients by age
269	269	and in relation to specific procedures;
270	270	(6) prescribing procedures for obtaining informed
271	271	consent from patients and for creating and maintaining patient
272	272	records;
273	273	(7) establishing a plan for the dentist to review
274	274	patient records created and maintained by the dental hygienist;
275	275	(8) establishing a plan for the management of medical
276	276	emergencies in each setting in which the dental hygienist
277	277	practices;
278	278	(9) establishing a quality assurance plan for the
279	279	dentist to monitor care provided by the dental hygienist, including
280	280	review of patient care, referrals, and charts;
281	281	(10) describing the medications that may be
282	282	administered and dispensed by the dental hygienist and the specific
283	283	circumstances under which the medications may be administered and
284	284	dispensed;
285	285	(11) describing any requirements for consultation
286	286	with the dentist before providing care to patients with specific
287	287	medical conditions or complex medical histories; and
288	288	(12) establishing a plan, which includes clinical
289	289	resources and referrals, for situations in which a patient requires
290	290	treatment that exceeds the capabilities or scope of practice of the
291	291	dental hygienist.
292	292	(e) A collaborative practice agreement may include
293	293	provisions to allow the practice of dental hygiene without:
294	294	(1) prior examination of the patient by a dentist; and
295	295	(2) the presence of a supervising dentist.
296	296	(f) A collaborative practice agreement must be:
297	297	(1) signed by the dentist, the dental hygienist, and,
298	298	if applicable, a representative of the facility, program, or
299	299	organization in which the practice of dental hygiene takes place;
300	300	(2) reviewed annually by the dentist and the dental
301	301	hygienist who are parties to the collaborative practice agreement;
302	302	and
303	303	(3) made available to the board and other interested
304	304	parties on request.
305	305	(g) Not more than two collaborative practice agreements
306	306	between a dentist and a dental hygienist may be in effect at a time.
307	307	(h) Notwithstanding any rule adopted under Section
308	308	111.004(b)(4), a dentist may have a collaborative practice
309	309	agreement with not more than six dental hygienists at the same time.
310	310	The board may grant an exception to the requirements of this
311	311	subsection for the practice of dental hygiene in a public health
312	312	setting.
313	313	(i) Before providing any service authorized by a
314	314	collaborative practice agreement, the dental hygienist must
315	315	provide the patient with a written statement advising the patient
316	316	that the dental hygiene services performed are not a substitute for
317	317	examination by a dentist.
318	318	(j) If a dental hygienist operating under a collaborative
319	319	practice agreement makes a referral for further dental procedures,
320	320	the dental hygienist must complete a referral form approved by the
321	321	board and provide a copy of the form to the dentist who is a party to
322	322	the collaborative practice agreement.
323	323	SECTION 15. Section 262.001, Occupations Code, is amended
324	324	by adding Subdivision (3) to read as follows:
325	325	(3) "Teledentistry dental service" has the meaning
326	326	assigned by Section 111.001.
327	327	SECTION 16. Section 262.151(a), Occupations Code, is
328	328	amended to read as follows:
329	329	(a) A licensed dentist may delegate orally or in writing a
330	330	service, task, or procedure to a dental hygienist who is under the
331	331	supervision and responsibility of the dentist, if:
332	332	(1) the dental hygienist is licensed to perform the
333	333	service, task, or procedure;
334	334	(2) the supervising dentist:
335	335	(A) examines the patient, including an
336	336	examination performed as a teledentistry dental service:
337	337	(i) [(A)] at the time the service, task, or
338	338	procedure is performed by the dental hygienist; or
339	339	(ii) [(B)] during the 12 calendar months
340	340	preceding the date of performance of the service, task, or
341	341	procedure by the dental hygienist; or
342	342	(B) enters into a collaborative practice
343	343	agreement with the dental hygienist, as described by Section
344	344	258.004, that includes a provision allowing the dental hygienist to
345	345	practice dental hygiene without prior examination of the patient by
346	346	the dentist; and
347	347	(3) the dental hygienist does not:
348	348	(A) diagnose a dental disease or ailment;
349	349	(B) prescribe a treatment or a regimen;
350	350	(C) prescribe or[,] order[, or dispense]
351	351	medication; [or]
352	352	(D) except as authorized by the supervising
353	353	dentist in a collaborative practice agreement described by Section
354	354	258.004, administer or dispense medication; or
355	355	(E) perform any procedure that is irreversible or
356	356	involves the intentional cutting of soft or hard tissue by any
357	357	means.
358	358	SECTION 17. Sections 262.1515(a), (b), and (c), Occupations
359	359	Code, are amended to read as follows:
360	360	(a) A licensed dentist may delegate a service, task, or
361	361	procedure, pursuant to this section, to a dental hygienist, without
362	362	complying with Section 262.151(a)(2) if:
363	363	(1) the dental hygienist has at least two years'
364	364	experience in the practice of dental hygiene; and
365	365	(2) the service, task, or procedure is performed in
366	366	one of the following locations:
367	367	(A) a medical facility, including:
368	368	(i) a public health clinic conducted by a
369	369	local health unit, health department, or public health district
370	370	organized and recognized under Chapter 121, Health and Safety Code;
371	371	(ii) a general hospital or special
372	372	hospital, as those terms are defined by Section 241.003, Health and
373	373	Safety Code, including a hospital maintained or operated by this
374	374	state;
375	375	(iii) a nursing facility as defined in
376	376	Section 242.301, Health and Safety Code;
377	377	(iv) an ambulatory surgical center licensed
378	378	under Chapter 243, Health and Safety Code;
379	379	(v) a birthing center licensed under
380	380	Chapter 244, Health and Safety Code;
381	381	(vi) a mental hospital licensed under
382	382	Chapter 577, Health and Safety Code;
383	383	(vii) a community health center as defined
384	384	by Section 136.002, Human Resources Code;
385	385	(viii) a mobile dental facility operating
386	386	under a permit issued by the board; and
387	387	(ix) an outpatient clinic;
388	388	(B) a primary or secondary school [school-based
389	389	health center established under Subchapter B, Chapter 38, Education
390	390	Code]; [or]
391	391	(C) a Head Start program facility;
392	392	(D) a secure correctional facility as defined by
393	393	Section 1.07, Penal Code;
394	394	(E) the residence of a patient who is homebound
395	395	or who is receiving or is eligible to receive:
396	396	(i) home and community-based waiver
397	397	services under the Medicaid program;
398	398	(ii) hospice services; or
399	399	(iii) other home care services; or
400	400	(F) any other facility approved by board rule [a
401	401	community health center as defined by Section 136.002, Human
402	402	Resources Code].
403	403	(b) The patient may [must] be referred as needed to a
404	404	licensed dentist after the completion of a service, task, or
405	405	procedure performed under Subsection (a).
406	406	(c) A dental hygienist may [only] perform delegated tasks or
407	407	procedures with respect to a patient for not more than 12 [six]
408	408	months unless:
409	409	(1) the patient has been examined by a dentist in
410	410	compliance with Section 262.151(a)(2)(A);
411	411	(2) a dentist reviews the patient's dental records,
412	412	including a review performed as a teledentistry dental service, and
413	413	determines that the dental hygienist may continue to provide
414	414	services to the patient; or
415	415	(3) a dentist otherwise provides teledentistry dental
416	416	services to the patient and determines that the dental hygienist
417	417	may continue to provide services to the patient [262.151(a)(2)].
418	418	SECTION 18. Section 562.056(c), Occupations Code, is
419	419	amended to read as follows:
420	420	(c) For purposes of this section and Section 562.112, a
421	421	valid practitioner-patient relationship is present between a
422	422	practitioner providing telemedicine medical services or
423	423	teledentistry dental services and the patient receiving the
424	424	[telemedicine medical] services if the practitioner has complied
425	425	with the requirements for establishing such a relationship in
426	426	accordance with Section 111.005.
427	427	SECTION 19. Section 531.001, Government Code, is amended by
428	428	adding Subdivision (6-a) to read as follows:
429	429	(6-a) "Teledentistry dental service" has the meaning
430	430	assigned by Section 111.001, Occupations Code.
431	431	SECTION 20. The heading to Section 531.0216, Government
432	432	Code, is amended to read as follows:
433	433	Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
434	434	TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL
435	435	SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER
436	436	MEDICAID.
437	437	SECTION 21. Sections 531.0216(a), (b), (c), (d), (e), and
438	438	(f), Government Code, are amended to read as follows:
439	439	(a) The executive commissioner by rule shall develop and
440	440	implement a system to reimburse providers of services under
441	441	Medicaid for services performed using telemedicine medical
442	442	services, teledentistry dental services, or telehealth services.
443	443	(b) In developing the system, the executive commissioner by
444	444	rule shall:
445	445	(1) review programs and pilot projects in other states
446	446	to determine the most effective method for reimbursement;
447	447	(2) establish billing codes and a fee schedule for
448	448	services;
449	449	(3) consult with the Department of State Health
450	450	Services to establish procedures to:
451	451	(A) identify clinical evidence supporting
452	452	delivery of health care services using a telecommunications system;
453	453	and
454	454	(B) annually review health care services,
455	455	considering new clinical findings, to determine whether
456	456	reimbursement for particular services should be denied or
457	457	authorized;
458	458	(4) establish a separate provider identifier for
459	459	telemedicine medical services providers, teledentistry dental
460	460	services providers, telehealth services providers, and home
461	461	telemonitoring services providers; and
462	462	(5) establish a separate modifier for telemedicine
463	463	medical services, teledentistry dental services, telehealth
464	464	services, and home telemonitoring services eligible for
465	465	reimbursement.
466	466	(c) The commission shall encourage health care providers
467	467	and health care facilities to participate as telemedicine medical
468	468	service providers, teledentistry dental service providers, or
469	469	telehealth service providers in the health care delivery system.
470	470	The commission may not require that a service be provided to a
471	471	patient through telemedicine medical services, teledentistry
472	472	dental services, or telehealth services when the service can
473	473	reasonably be provided by a physician or a dentist, if appropriate,
474	474	through a face-to-face consultation with the patient in the
475	475	community in which the patient resides or works. This subsection
476	476	does not prohibit the authorization of the provision of any service
477	477	to a patient through telemedicine medical services, teledentistry
478	478	dental services, or telehealth services at the patient's request.
479	479	(d) Subject to Sections 111.004 and [Section] 153.004,
480	480	Occupations Code, the executive commissioner may adopt rules as
481	481	necessary to implement this section. In the rules adopted under
482	482	this section, the executive commissioner shall:
483	483	(1) refer to the site where the patient is physically
484	484	located as the patient site; and
485	485	(2) refer to the site where the physician, dentist, or
486	486	health professional providing the telemedicine medical service,
487	487	teledentistry dental service, or telehealth service is physically
488	488	located as the distant site.
489	489	(e) The commission may not reimburse a health care facility
490	490	for telemedicine medical services, teledentistry dental services,
491	491	or telehealth services provided to a Medicaid recipient unless the
492	492	facility complies with the minimum standards adopted under Section
493	493	531.02161.
494	494	(f) Not later than December 1 of each even-numbered year,
495	495	the commission shall report to the speaker of the house of
496	496	representatives and the lieutenant governor on the effects of
497	497	telemedicine medical services, teledentistry dental services,
498	498	telehealth services, and home telemonitoring services on Medicaid
499	499	in the state, including the number of physicians, dentists, health
500	500	professionals, and licensed health care facilities using
501	501	telemedicine medical services, teledentistry dental services,
502	502	telehealth services, or home telemonitoring services, the
503	503	geographic and demographic disposition of the physicians,
504	504	dentists, and health professionals, the number of patients
505	505	receiving telemedicine medical services, teledentistry dental
506	506	services, telehealth services, and home telemonitoring services,
507	507	the types of services being provided, and the cost of utilization of
508	508	telemedicine medical services, teledentistry dental services,
509	509	telehealth services, and home telemonitoring services to Medicaid.
510	510	SECTION 22. The heading to Section 531.02161, Government
511	511	Code, is amended to read as follows:
512	512	Sec. 531.02161. TELEMEDICINE, TELEDENTISTRY, TELEHEALTH,
513	513	AND HOME TELEMONITORING TECHNOLOGY STANDARDS.
514	514	SECTION 23. Section 531.02161(b), Government Code, is
515	515	amended to read as follows:
516	516	(b) The executive commissioner by rule shall establish and
517	517	adopt minimum standards for an operating system used in the
518	518	provision of telemedicine medical services, teledentistry dental
519	519	services, telehealth services, or home telemonitoring services by a
520	520	health care facility participating in Medicaid, including
521	521	standards for electronic transmission, software, and hardware.
522	522	SECTION 24. The heading to Section 531.02162, Government
523	523	Code, is amended to read as follows:
524	524	Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH
525	525	TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND
526	526	TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.
527	527	SECTION 25. Sections 531.02162(b) and (c), Government Code,
528	528	are amended to read as follows:
529	529	(b) The executive commissioner by rule shall establish
530	530	policies that permit reimbursement under Medicaid and the child
531	531	health plan program for services provided through telemedicine
532	532	medical services, teledentistry dental services, and telehealth
533	533	services to children with special health care needs.
534	534	(c) The policies required under this section must:
535	535	(1) be designed to:
536	536	(A) prevent unnecessary travel and encourage
537	537	efficient use of telemedicine medical services, teledentistry
538	538	dental services, and telehealth services for children with special
539	539	health care needs in all suitable circumstances; and
540	540	(B) ensure in a cost-effective manner the
541	541	availability to a child with special health care needs of services
542	542	appropriately performed using telemedicine medical services,
543	543	teledentistry dental services, and telehealth services that are
544	544	comparable to the same types of services available to that child
545	545	without the use of telemedicine medical services, teledentistry
546	546	dental services, and telehealth services; and
547	547	(2) provide for reimbursement of multiple providers of
548	548	different services who participate in a single session of
549	549	telemedicine medical services, teledentistry dental services,
550	550	[and] telehealth services, or any combination of those services,
551	551	[session] for a child with special health care needs, if the
552	552	commission determines that reimbursing each provider for the
553	553	session is cost-effective in comparison to the costs that would be
554	554	involved in obtaining the services from providers without the use
555	555	of telemedicine medical services, teledentistry dental services,
556	556	and telehealth services, including the costs of transportation and
557	557	lodging and other direct costs.
558	558	SECTION 26. Subchapter B, Chapter 531, Government Code, is
559	559	amended by adding Section 531.02172 to read as follows:
560	560	Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL
561	561	SERVICES. The commission by rule shall require each health and
562	562	human services agency that administers a part of the Medicaid
563	563	program to provide Medicaid reimbursement for teledentistry dental
564	564	services provided by a dentist licensed to practice dentistry in
565	565	this state or a dental hygienist licensed to practice dental
566	566	hygiene in this state. The commission shall require reimbursement
567	567	for a teledentistry dental service at the same rate as the Medicaid
568	568	program reimburses for a comparable in-person dental service. A
569	569	request for reimbursement may not be denied solely because an
570	570	in-person dental service between a dentist and a patient did not
571	571	occur.
572	572	SECTION 27. The heading to Section 62.157, Health and
573	573	Safety Code, is amended to read as follows:
574	574	Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY
575	575	DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL
576	576	HEALTH CARE NEEDS.
577	577	SECTION 28. Sections 62.157(a) and (b), Health and Safety
578	578	Code, are amended to read as follows:
579	579	(a) In providing covered benefits to a child with special
580	580	health care needs, a health plan provider must permit benefits to be
581	581	provided through telemedicine medical services, teledentistry
582	582	dental services, and telehealth services in accordance with
583	583	policies developed by the commission.
584	584	(b) The policies must provide for:
585	585	(1) the availability of covered benefits
586	586	appropriately provided through telemedicine medical services,
587	587	teledentistry dental services, and telehealth services that are
588	588	comparable to the same types of covered benefits provided without
589	589	the use of telemedicine medical services, teledentistry dental
590	590	services, and telehealth services; and
591	591	(2) the availability of covered benefits for different
592	592	services performed by multiple health care providers during a
593	593	single [telemedicine medical services and telehealth services]
594	594	session of telemedicine medical services, teledentistry dental
595	595	services, telehealth services, or any combination of those
596	596	services, if the executive commissioner determines that delivery of
597	597	the covered benefits in that manner is cost-effective in comparison
598	598	to the costs that would be involved in obtaining the services from
599	599	providers without the use of telemedicine medical services,
600	600	teledentistry dental services, and telehealth services, including
601	601	the costs of transportation and lodging and other direct costs.
602	602	SECTION 29. Section 62.1571, Health and Safety Code, is
603	603	amended to read as follows:
604	604	Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND
605	605	TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits
606	606	to a child, a health plan provider must permit benefits to be
607	607	provided through telemedicine medical services and teledentistry
608	608	dental services in accordance with policies developed by the
609	609	commission.
610	610	(b) The policies must provide for:
611	611	(1) the availability of covered benefits
612	612	appropriately provided through telemedicine medical services and
613	613	teledentistry dental services that are comparable to the same types
614	614	of covered benefits provided without the use of telemedicine
615	615	medical services and teledentistry dental services; and
616	616	(2) the availability of covered benefits for different
617	617	services performed by multiple health care providers during a
618	618	single session of telemedicine medical services, teledentistry
619	619	dental services, or both services, if the executive commissioner
620	620	determines that delivery of the covered benefits in that manner is
621	621	cost-effective in comparison to the costs that would be involved in
622	622	obtaining the services from providers without the use of
623	623	telemedicine medical services or teledentistry dental services,
624	624	including the costs of transportation and lodging and other direct
625	625	costs.
626	626	(c) [(d)] In this section, "teledentistry dental service"
627	627	and "telemedicine medical service" have [has] the meanings
628	628	[meaning] assigned by Section 531.001, Government Code.
629	629	SECTION 30. Section 32.024, Human Resources Code, is
630	630	amended by adding Subsection (ll) to read as follows:
631	631	(ll) The executive commissioner shall establish a separate
632	632	provider type for dental hygienists for purposes of enrollment as a
633	633	provider of and reimbursement under the medical assistance program.
634	634	SECTION 31. Section 843.002(24), Insurance Code, is amended
635	635	to read as follows:
636	636	(24) "Provider" means:
637	637	(A) a person, other than a physician, who is
638	638	licensed or otherwise authorized to provide a health care service
639	639	in this state, including:
640	640	(i) a chiropractor, registered nurse,
641	641	pharmacist, optometrist, [or] acupuncturist, or dental hygienist;
642	642	or
643	643	(ii) a pharmacy, hospital, or other
644	644	institution or organization;
645	645	(B) a person who is wholly owned or controlled by
646	646	a provider or by a group of providers who are licensed or otherwise
647	647	authorized to provide the same health care service; or
648	648	(C) a person who is wholly owned or controlled by
649	649	one or more hospitals and physicians, including a
650	650	physician-hospital organization.
651	651	SECTION 32. Section 1301.001(1-a), Insurance Code, is
652	652	amended to read as follows:
653	653	(1-a) "Health care provider" means a practitioner,
654	654	institutional provider, or other person or organization that
655	655	furnishes health care services and that is licensed or otherwise
656	656	authorized to practice in this state. [The term includes a
657	657	pharmacist and a pharmacy.] The term does not include a physician.
658	658	The term includes:
659	659	(A) a pharmacist;
660	660	(B) a pharmacy; and
661	661	(C) a dental hygienist.
662	662	SECTION 33. Section 1451.101, Insurance Code, is amended by
663	663	amending Subdivision (1) and adding Subdivision (1-a) to read as
664	664	follows:
665	665	(1) "Dental hygienist" has the meaning assigned by
666	666	Section 256.051, Occupations Code.
667	667	(1-a) "Health insurance policy" means a policy,
668	668	contract, or agreement described by Section 1451.102.
669	669	SECTION 34. Subchapter C, Chapter 1451, Insurance Code, is
670	670	amended by adding Section 1451.128 to read as follows:
671	671	Sec. 1451.128. SELECTION OF DENTAL HYGIENIST. An insured
672	672	may select a dental hygienist to provide the services scheduled in
673	673	the health insurance policy that are within the scope of the dental
674	674	hygienist's license.
675	675	SECTION 35. The heading to Chapter 1455, Insurance Code, is
676	676	amended to read as follows:
677	677	CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
678	678	SECTION 36. Section 1455.001, Insurance Code, is amended by
679	679	amending Subdivisions (1) and (3) and adding Subdivision (1-a) to
680	680	read as follows:
681	681	(1) "Dentist" means a person licensed to practice
682	682	dentistry in this state under Subtitle D, Title 3, Occupations
683	683	Code.
684	684	(1-a) "Health professional" means:
685	685	(A) a physician;
686	686	(B) an individual who is:
687	687	(i) licensed or certified in this state to
688	688	perform health care services; and
689	689	(ii) authorized to assist:
690	690	(a) a physician in providing
691	691	telemedicine medical services that are delegated and supervised by
692	692	the physician; or
693	693	(b) a dentist in providing
694	694	teledentistry dental services that are delegated and supervised by
695	695	the dentist;
696	696	(C) a licensed or certified health professional
697	697	acting within the scope of the license or certification who does not
698	698	perform a telemedicine medical service; or
699	699	(D) a dentist.
700	700	(3) "Teledentistry dental service," "telehealth
701	701	["Telehealth] service," and "telemedicine medical service" have
702	702	the meanings assigned by Section 111.001, Occupations Code.
703	703	SECTION 37. Section 1455.004, Insurance Code, is amended to
704	704	read as follows:
705	705	Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES,
706	706	TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A
707	707	health benefit plan may not exclude from coverage a covered health
708	708	care service or procedure delivered by a preferred or contracted
709	709	health professional to a covered patient as a telemedicine medical
710	710	service, a teledentistry dental service, or a telehealth service
711	711	solely because the covered health care service or procedure is not
712	712	provided through an in-person consultation.
713	713	(b) A health benefit plan may require a deductible, a
714	714	copayment, or coinsurance for a covered health care service or
715	715	procedure delivered by a preferred or contracted health
716	716	professional to a covered patient as a telemedicine medical
717	717	service, a teledentistry dental service, or a telehealth service.
718	718	The amount of the deductible, copayment, or coinsurance may not
719	719	exceed the amount of the deductible, copayment, or coinsurance
720	720	required for the covered health care service or procedure provided
721	721	through an in-person consultation.
722	722	(c) Notwithstanding Subsection (a), a health benefit plan
723	723	is not required to provide coverage for a telemedicine medical
724	724	service, a teledentistry dental service, or a telehealth service
725	725	provided by only synchronous or asynchronous audio interaction,
726	726	including:
727	727	(1) an audio-only telephone consultation;
728	728	(2) a text-only e-mail message; or
729	729	(3) a facsimile transmission.
730	730	SECTION 38. Section 1455.006, Insurance Code, is amended to
731	731	read as follows:
732	732	Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES,
733	733	TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES STATEMENT.
734	734	(a) Each issuer of a health benefit plan shall adopt and display in
735	735	a conspicuous manner on the health benefit plan issuer's Internet
736	736	website the issuer's policies and payment practices for
737	737	telemedicine medical services, teledentistry dental services, and
738	738	telehealth services.
739	739	(b) This section does not require an issuer of a health
740	740	benefit plan to display negotiated contract payment rates for
741	741	health professionals who contract with the issuer to provide
742	742	telemedicine medical services, teledentistry dental services, or
743	743	telehealth services.
744	744	SECTION 39. (a) Not later than March 1, 2020, the State
745	745	Board of Dental Examiners and the Texas State Board of Pharmacy
746	746	shall jointly adopt rules as required by Section 111.006(c),
747	747	Occupations Code, as added by this Act.
748	748	(b) Not later than March 1, 2020, the State Board of Dental
749	749	Examiners shall adopt:
750	750	(1) rules necessary to implement Chapter 111,
751	751	Occupations Code, as amended by this Act;
752	752	(2) rules as required by Section 254.0035, Occupations
753	753	Code, as added by this Act; and
754	754	(3) rules necessary to implement Section 258.004,
755	755	Occupations Code, as added by this Act.
756	756	SECTION 40. As soon as practicable after the effective date
757	757	of this Act, the Health and Human Services Commission shall
758	758	establish and implement a separate provider type for dental
759	759	hygienists as required by Section 32.024(ll), Human Resources Code,
760	760	as added by this Act.
761	761	SECTION 41. If before implementing any provision of this
762	762	Act a state agency determines that a waiver or authorization from a
763	763	federal agency is necessary for implementation of that provision,
764	764	the agency affected by the provision shall request the waiver or
765	765	authorization and may delay implementing that provision until the
766	766	waiver or authorization is granted.
767	767	SECTION 42. (a) Except as provided by Subsection (b) of
768	768	this section, this Act takes effect September 1, 2019.
769	769	(b) Sections 1455.004 and 1455.006, Insurance Code, as
770	770	amended by this Act, take effect January 1, 2020.