Texas 2019 - 86th Regular

Texas Senate Bill SB792 Latest Draft

Bill / Comm Sub Version Filed 04/26/2019

                            By: Perry, Flores S.B. No. 792
 (In the Senate - Filed February 12, 2019; March 1, 2019,
 read first time and referred to Committee on Health & Human
 Services; April 26, 2019, reported adversely, with favorable
 Committee Substitute by the following vote:  Yeas 9, Nays 0;
 April 26, 2019, sent to printer.)
Click here to see the committee vote
 COMMITTEE SUBSTITUTE FOR S.B. No. 792 By:  Perry


 A BILL TO BE ENTITLED
 AN ACT
 relating to the practice of dentistry and the provision of
 teledentistry dental services.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 SECTION 1.  The heading to Chapter 111, Occupations Code, is
 amended to read as follows:
 CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
 SECTION 2.  Section 111.001, Occupations Code, is amended by
 amending Subdivisions (1) and (3) and adding Subdivision (2-a) to
 read as follows:
 (1)  "Dentist," "health [Health] professional," and
 "physician" have the meanings assigned by Section 1455.001,
 Insurance Code.
 (2-a)  "Teledentistry dental service" means a health
 care service delivered by a dentist, or a health professional
 acting under the delegation and supervision of a dentist, acting
 within the scope of the dentist's or health professional's license
 or certification to a patient at a different physical location than
 the dentist or health professional using telecommunications or
 information technology.
 (3)  "Telehealth service" means a health service, other
 than a telemedicine medical service or a teledentistry dental
 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.
 SECTION 3.  Section 111.002, Occupations Code, is amended to
 read as follows:
 Sec. 111.002.  INFORMED CONSENT. (a)  A treating physician,
 dentist, or health professional who provides or facilitates the use
 of telemedicine medical services, teledentistry dental services,
 or telehealth services shall ensure that the informed consent of
 the patient, or another appropriate individual authorized to make
 health care treatment decisions for the patient, is obtained before
 telemedicine medical services, teledentistry dental services, or
 telehealth services are provided.
 (b)  A dentist who delegates a teledentistry dental service
 shall ensure that the informed consent of the patient includes
 disclosure to the patient that the dentist has delegated the
 service.
 SECTION 4.  Section 111.003, Occupations Code, is amended to
 read as follows:
 Sec. 111.003.  CONFIDENTIALITY. A treating physician,
 dentist, or health professional who provides or facilitates the use
 of telemedicine medical services, teledentistry dental services,
 or telehealth services shall ensure that the confidentiality of the
 patient's clinical [medical] information is maintained as required
 by Chapter 159, by Subchapter C, Chapter 258, or by other applicable
 law.
 SECTION 5.  Section 111.004, Occupations Code, is amended
 to read as follows:
 Sec. 111.004.  RULES. (a)  The Texas Medical Board, 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.
 (b)  The State Board of Dental Examiners, in consultation
 with the commissioner of insurance, as appropriate, may adopt rules
 necessary to:
 (1)  ensure that patients using teledentistry dental
 services receive appropriate, quality care;
 (2)  prevent abuse and fraud in the use of
 teledentistry dental services, including rules relating to the
 filing of claims and records required to be maintained in
 connection with teledentistry dental services;
 (3)  ensure adequate supervision of health
 professionals who are not dentists and who provide teledentistry
 dental services under the delegation and supervision of a dentist;
 and
 (4)  establish that a dentist may delegate to and
 supervise through a teledentistry dental service not more than two
 health professionals who are not dentists.
 SECTION 6.  The heading to Section 111.005, Occupations
 Code, is amended to read as follows:
 Sec. 111.005.  PRACTITIONER-PATIENT RELATIONSHIP FOR
 TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES.
 SECTION 7.  Section 111.005, Occupations Code, is amended by
 amending Subsections (a) and (b) and adding Subsection (d) to read
 as follows:
 (a)  For purposes of Section 562.056, a valid
 practitioner-patient relationship is present between a
 practitioner providing a telemedicine medical service or a
 teledentistry dental 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:
 (A)  Texas Medical Board rules with a physician
 requesting coverage of medical care for the patient; or
 (B)  State Board of Dental Examiners rules with a
 dentist requesting coverage of dental care for the patient; or
 (3)  provides the telemedicine medical services or
 teledentistry dental 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 clinical
 [medical] records, such as the relevant medical or dental 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 or teledentistry dental services to a patient as described
 in Subsection (a)(3) shall:
 (1)  provide the patient with guidance on appropriate
 follow-up care; and
 (2)  subject to Subsection (d), if the patient consents
 and the patient has a primary care physician or a regular dentist,
 provide to the patient's primary care physician or regular dentist,
 as appropriate, within 72 hours after the practitioner provides the
 services to the patient, a clinical [medical] record or other
 report containing an explanation of:
 (A)  the treatment provided by the practitioner to
 the patient; and
 (B)  as authorized by the law under which the
 practitioner is licensed, certified, or otherwise permitted to
 provide the service, the practitioner's evaluation, analysis, or
 diagnosis[, as appropriate,] of the patient's condition.
 (d)  A practitioner who provides teledentistry dental
 services to a patient as described in Subsection (a)(3):
 (1)  on the date the practitioner first provides the
 teledentistry dental services, shall inform the patient of the
 limitation provided by Subdivision (2); and
 (2)  may only provide teledentistry dental services
 with respect to the patient for 12 months unless:
 (A)  a dentist performs an in-person tactile and
 visual examination of the hard and soft tissues of the patient's
 oral cavity; and
 (B)  the practitioner receives notice of the
 examination described by Paragraph (A).
 SECTION 8.  Section 111.006, Occupations Code, is amended by
 adding Subsection (c) to read as follows:
 (c)  The State Board of Dental Examiners 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 subsection must allow for the
 establishment of a practitioner-patient relationship by a
 teledentistry dental service provided by a dentist to a patient in a
 manner that complies with Section 111.005(a)(3). The State Board
 of Dental Examiners 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 teledentistry dental services.
 SECTION 9.  Section 111.007, Occupations Code, is amended to
 read as follows:
 Sec. 111.007.  STANDARD OF CARE FOR TELEMEDICINE MEDICAL
 SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.
 (a)  A health professional providing a health care service or
 procedure as a telemedicine medical service, a teledentistry dental
 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, teledentistry dental services, or telehealth services
 that would impose a higher standard of care than the standard
 described in Subsection (a).
 SECTION 10.  Chapter 111, Occupations Code, is amended by
 adding Section 111.0075 to read as follows:
 Sec. 111.0075.  LICENSING FOR TELEDENTISTRY DENTAL
 SERVICES. A health professional providing a health care service or
 procedure as a teledentistry dental service is subject to the
 licensing requirements that would apply to the provision of the
 same health care service or procedure in an in-person setting.
 SECTION 11.  Chapter 111, Occupations Code, is amended by
 adding Section 111.009 to read as follows:
 Sec. 111.009.  CERTAIN PRESCRIPTIONS PROHIBITED. (a)  In
 this section, "controlled substance" and "prescribe" have the
 meanings assigned by Section 481.002, Health and Safety Code.
 (b)  A dentist may not prescribe a controlled substance to a
 patient as a teledentistry dental service.
 SECTION 12.  Section 251.003, Occupations Code, is amended
 by adding Subsection (d) to read as follows:
 (d)  For purposes of this subtitle, a person located in
 another state practices dentistry in this state and is required to
 hold a license to practice dentistry in this state if the person
 through the use of any medium, including an electronic medium,
 performs an act that constitutes the practice of dentistry on a
 patient in this state.
 SECTION 13.  Chapter 254, Occupations Code, is amended by
 adding Section 254.0035 to read as follows:
 Sec. 254.0035.  RULES REGARDING CALL COVERAGE AGREEMENTS.
 The board shall adopt rules governing a call coverage agreement
 between dentists.
 SECTION 14.  Section 258.001, Occupations Code, is amended
 to read as follows:
 Sec. 258.001.  IMPERMISSIBLE DELEGATIONS. A dentist may not
 delegate:
 (1)  an act to an individual who, by board order, is
 prohibited from performing the act;
 (2)  any of the following acts to a person not licensed
 as a dentist or dental hygienist:
 (A)  the removal of calculus, deposits, or
 accretions from the natural and restored surfaces of exposed human
 teeth and restorations in the human mouth;
 (B)  root planing or the smoothing and polishing
 of roughened root surfaces or exposed human teeth; or
 (C)  any other act the delegation of which is
 prohibited by board rule;
 (3)  any of the following acts to a person not licensed
 as a dentist:
 (A)  comprehensive examination or diagnosis and
 treatment planning;
 (B)  a surgical or cutting procedure on hard or
 soft tissue;
 (C)  the prescription of a drug, medication, or
 work authorization;
 (D)  the taking of an impression for a final
 restoration, appliance, or prosthesis;
 (E)  the making of an intraoral occlusal
 adjustment;
 (F)  direct pulp capping, pulpotomy, or any other
 endodontic procedure;
 (G)  the final placement and intraoral adjustment
 of a fixed or removable appliance; or
 (H)  the placement of any final restoration; or
 (4)  the authority to an individual to administer a
 local anesthetic agent, inhalation sedative agent, parenteral
 sedative agent, or general anesthetic agent, including as a
 teledentistry dental service as that term is defined by Section
 111.001, if the individual is not licensed as:
 (A)  a dentist with a permit issued by the board
 for the procedure being performed, if a permit is required;
 (B)  a certified registered nurse anesthetist
 licensed by the Texas Board of Nursing, only if the delegating
 dentist holds a permit issued by the board for the procedure being
 performed, if a permit is required; or
 (C)  a physician anesthesiologist licensed by the
 Texas Medical Board.
 SECTION 15.  Section 262.152, Occupations Code, is amended
 to read as follows:
 Sec. 262.152.  PERFORMANCE OF DELEGATED DUTIES. (a)  Except
 as provided by Section 262.1515, a dental hygienist shall practice
 dental hygiene:
 (1)  in the dental office of a supervising dentist
 licensed by the board; or
 (2)  in an alternate setting, including a nursing home,
 the patient's home, a school, a hospital, a state institution, a
 public health clinic, or another institution, under the supervision
 of a supervising dentist.
 (b)  For purposes of this section, a dental hygienist who
 practices dental hygiene as a teledentistry dental service, as
 defined by Section 111.001, is practicing in an alternate setting
 in compliance with Subsection (a)(2).
 SECTION 16.  Section 562.056(c), Occupations Code, is
 amended to read as follows:
 (c)  For purposes of this section and Section 562.112, a
 valid practitioner-patient relationship is present between a
 practitioner providing telemedicine medical services or
 teledentistry dental 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 17.  Section 531.001, Government Code, is amended by
 adding Subdivision (6-a) to read as follows:
 (6-a)  "Teledentistry dental service" has the meaning
 assigned by Section 111.001, Occupations Code.
 SECTION 18.  Section 531.0216, Government Code, is amended
 to read as follows:
 Sec. 531.0216.  PARTICIPATION AND REIMBURSEMENT OF
 TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL
 SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER
 MEDICAID.  (a)  The executive commissioner by rule shall develop
 and implement a system to reimburse providers of services under
 Medicaid for services performed using telemedicine medical
 services, teledentistry dental services, or telehealth services.
 (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)  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)  establish a separate provider identifier for
 telemedicine medical services providers, teledentistry dental
 services providers, telehealth services providers, and home
 telemonitoring services providers; and
 (5)  establish a separate modifier for telemedicine
 medical services, teledentistry dental services, telehealth
 services, and home telemonitoring services eligible for
 reimbursement.
 (c)  The commission shall encourage health care providers
 and health care facilities to participate as telemedicine medical
 service providers, teledentistry dental service providers, or
 telehealth service providers in the health care delivery system.
 The commission may not require that a service be provided to a
 patient through telemedicine medical services, teledentistry
 dental services, or telehealth services when the service can
 reasonably be provided by a physician or a dentist through a
 face-to-face consultation with the patient in the community in
 which the patient resides or works. This subsection does not
 prohibit the authorization of the provision of any service to a
 patient through telemedicine medical services, teledentistry
 dental services, or telehealth services at the patient's request.
 (c-1)  Subsection (c) does not prohibit the authorization of
 the provision of any service to a patient through teledentistry
 dental services if:
 (1)  the patient requests the service; and
 (2)  the provision of the service through teledentistry
 does not violate the standard of care applicable to the service.
 (c-2)  The commission shall:
 (1)  explore opportunities to increase STAR Health
 program providers' use of telemedicine medical services in
 medically underserved areas of this state; and
 (2)  encourage STAR Health program providers to use
 telemedicine medical services as appropriate.
 (d)  Subject to Sections 111.004 and [Section] 153.004,
 Occupations Code, the executive commissioner may adopt rules as
 necessary to implement this section. In the rules adopted under
 this section, the executive commissioner shall:
 (1)  refer to the site where the patient is physically
 located as the patient site; and
 (2)  refer to the site where the physician, dentist, or
 health professional providing the telemedicine medical service,
 teledentistry dental service, or telehealth service is physically
 located as the distant site.
 (e)  The commission may not reimburse a health care facility
 for telemedicine medical services, teledentistry dental services,
 or telehealth services provided to a Medicaid recipient unless the
 facility complies with the minimum standards adopted under Section
 531.02161.
 (f)  Not later than December 1 of each even-numbered year,
 the commission shall report to the speaker of the house of
 representatives and the lieutenant governor on the effects of
 telemedicine medical services, teledentistry dental services,
 telehealth services, and home telemonitoring services on Medicaid
 in the state, including the number of physicians, dentists, health
 professionals, and licensed health care facilities using
 telemedicine medical services, teledentistry dental services,
 telehealth services, or home telemonitoring services, the
 geographic and demographic disposition of the physicians,
 dentists, and health professionals, the number of patients
 receiving telemedicine medical services, teledentistry dental
 services, telehealth services, and home telemonitoring services,
 the types of services being provided, and the cost of utilization of
 telemedicine medical services, teledentistry dental services,
 telehealth services, and home telemonitoring services to Medicaid.
 SECTION 19.  The heading to Section 531.02161, Government
 Code, is amended to read as follows:
 Sec. 531.02161.  TELEMEDICINE, TELEDENTISTRY, TELEHEALTH,
 AND HOME TELEMONITORING TECHNOLOGY STANDARDS.
 SECTION 20.  Section 531.02161(b), Government Code, is
 amended to read as follows:
 (b)  The executive commissioner by rule shall establish and
 adopt minimum standards for an operating system used in the
 provision of telemedicine medical services, teledentistry dental
 services, telehealth services, or home telemonitoring services by a
 health care facility participating in Medicaid, including
 standards for electronic transmission, software, and hardware.
 SECTION 21.  The heading to Section 531.02162, Government
 Code, is amended to read as follows:
 Sec. 531.02162.  MEDICAID SERVICES PROVIDED THROUGH
 TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND
 TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.
 SECTION 22.  Section 531.02162, Government Code, is amended
 by amending Subsections (b) and (c) and adding Subsection (d) to
 read as follows:
 (b)  The executive commissioner by rule shall establish
 policies that permit reimbursement under Medicaid and the child
 health plan program for services provided through telemedicine
 medical services, teledentistry dental services, and telehealth
 services to children with special health care needs.
 (c)  The policies required under this section must:
 (1)  be designed to:
 (A)  prevent unnecessary travel and encourage
 efficient use of telemedicine medical services, teledentistry
 dental services, and telehealth services for children with special
 health care needs in all suitable circumstances; and
 (B)  ensure in a cost-effective manner the
 availability to a child with special health care needs of services
 appropriately performed using telemedicine medical services,
 teledentistry dental services, and telehealth services that are
 comparable to the same types of services available to that child
 without the use of telemedicine medical services, teledentistry
 dental services, and telehealth services; and
 (2)  provide for reimbursement of multiple providers of
 different services who participate in a single session of
 telemedicine medical services, teledentistry dental services,
 [and] telehealth services, or any combination of those services,
 [session] for a child with special health care needs, if the
 commission determines that reimbursing each provider for the
 session is cost-effective in comparison to the costs that would be
 involved in obtaining the services from providers without the use
 of telemedicine medical services, teledentistry dental services,
 and telehealth services, including the costs of transportation and
 lodging and other direct costs.
 (d)  The policies established under Subsection (c)(1) may
 authorize the provision of a service as a teledentistry dental
 service only if the provision of the service through teledentistry
 does not violate the standard of care applicable to the service.
 SECTION 23.  Subchapter B, Chapter 531, Government Code, is
 amended by adding Section 531.02172 to read as follows:
 Sec. 531.02172.  REIMBURSEMENT FOR TELEDENTISTRY DENTAL
 SERVICES.  (a)  The commission by rule shall require each health
 and human services agency that administers a part of the Medicaid
 program to provide Medicaid reimbursement for teledentistry dental
 services provided by a dentist licensed to practice dentistry in
 this state.
 (b)  The commission shall require reimbursement for a
 teledentistry dental service at the same rate as the Medicaid
 program reimburses for a comparable in-person dental service. A
 request for reimbursement may not be denied solely because an
 in-person dental service between a dentist and a patient did not
 occur.  A service provided as a teledentistry dental service may
 only be reimbursed if provision of the service through
 teledentistry does not violate the standard of care applicable to
 the service.
 (c)  The State Board of Dental Examiners, in consultation
 with the commission and the commission's office of inspector
 general, as appropriate, may adopt rules as necessary to:
 (1)  ensure that appropriate care, including quality of
 care, is provided to patients who receive teledentistry dental
 services; and
 (2)  prevent abuse and fraud through the use of
 teledentistry dental services, including rules relating to filing
 claims and the records required to be maintained in connection with
 teledentistry dental services.
 SECTION 24.  The heading to Section 62.157, Health and
 Safety Code, is amended to read as follows:
 Sec. 62.157.  TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY
 DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL
 HEALTH CARE NEEDS.
 SECTION 25.  Sections 62.157(a) and (b), Health and Safety
 Code, are amended to read as follows:
 (a)  In providing covered benefits to a child with special
 health care needs, a health plan provider must permit benefits to be
 provided through telemedicine medical services, teledentistry
 dental services, and telehealth services in accordance with
 policies developed by the commission.
 (b)  The policies must provide for:
 (1)  the availability of covered benefits
 appropriately provided through telemedicine medical services,
 teledentistry dental services, and telehealth services that are
 comparable to the same types of covered benefits provided without
 the use of telemedicine medical services, teledentistry dental
 services, and telehealth services; and
 (2)  the availability of covered benefits for different
 services performed by multiple health care providers during a
 single [telemedicine medical services and telehealth services]
 session of telemedicine medical services, teledentistry dental
 services, telehealth services, or any combination of those
 services, if the executive commissioner determines that delivery of
 the covered benefits in that manner is cost-effective in comparison
 to the costs that would be involved in obtaining the services from
 providers without the use of telemedicine medical services,
 teledentistry dental services, and telehealth services, including
 the costs of transportation and lodging and other direct costs.
 SECTION 26.  Section 62.1571, Health and Safety Code, is
 amended to read as follows:
 Sec. 62.1571.  TELEMEDICINE MEDICAL SERVICES AND
 TELEDENTISTRY DENTAL SERVICES.  (a)  In providing covered benefits
 to a child, a health plan provider must permit benefits to be
 provided through telemedicine medical services and teledentistry
 dental services in accordance with policies developed by the
 commission.
 (b)  The policies must provide for:
 (1)  the availability of covered benefits
 appropriately provided through telemedicine medical services and
 teledentistry dental services that are comparable to the same types
 of covered benefits provided without the use of telemedicine
 medical services and teledentistry dental services; and
 (2)  the availability of covered benefits for different
 services performed by multiple health care providers during a
 single session of telemedicine medical services, teledentistry
 dental services, or both services, if the executive commissioner
 determines that delivery of the covered benefits in that manner is
 cost-effective in comparison to the costs that would be involved in
 obtaining the services from providers without the use of
 telemedicine medical services or teledentistry dental services,
 including the costs of transportation and lodging and other direct
 costs.
 (c) [(d)]  In this section, "teledentistry dental service"
 and "telemedicine medical service" have [has] the meanings
 [meaning] assigned by Section 531.001, Government Code.
 SECTION 27.  The heading to Chapter 1455, Insurance Code, is
 amended to read as follows:
 CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
 SECTION 28.  Section 1455.001, Insurance Code, is amended by
 amending Subdivisions (1) and (3) and adding Subdivision (1-a) to
 read as follows:
 (1)  "Dentist" means a person licensed to practice
 dentistry in this state under Subtitle D, Title 3, Occupations
 Code.
 (1-a)  "Health professional" means:
 (A)  a physician;
 (B)  an individual who is:
 (i)  licensed or certified in this state to
 perform health care services; and
 (ii)  authorized to assist:
 (a)  a physician in providing
 telemedicine medical services that are delegated and supervised by
 the physician; or
 (b)  a dentist in providing
 teledentistry dental services that are delegated and supervised by
 the dentist;
 (C)  a licensed or certified health professional
 acting within the scope of the license or certification who does not
 perform a telemedicine medical service or a teledentistry dental
 service; or
 (D)  a dentist.
 (3)  "Teledentistry dental service," "telehealth
 ["Telehealth] service," and "telemedicine medical service" have
 the meanings assigned by Section 111.001, Occupations Code.
 SECTION 29.  Section 1455.004, Insurance Code, is amended to
 read as follows:
 Sec. 1455.004.  COVERAGE FOR TELEMEDICINE MEDICAL SERVICES,
 TELEDENTISTRY DENTAL 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, a teledentistry dental service, or a telehealth service
 solely because the covered health care service or procedure is not
 provided through an in-person 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, a teledentistry dental 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 service or procedure provided
 through an in-person consultation.
 (c)  Notwithstanding Subsection (a), a health benefit plan
 is not required to provide coverage for a telemedicine medical
 service, a teledentistry dental 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 30.  Section 1455.006, Insurance Code, is amended to
 read as follows:
 Sec. 1455.006.  TELEMEDICINE MEDICAL SERVICES,
 TELEDENTISTRY DENTAL 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, teledentistry dental 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, teledentistry dental services, or
 telehealth services.
 SECTION 31.  Not later than March 1, 2020:
 (1)  the State Board of Dental Examiners and the Texas
 State Board of Pharmacy shall jointly adopt rules as required by
 Section 111.006(c), Occupations Code, as added by this Act;
 (2)  the State Board of Dental Examiners shall adopt:
 (A)  rules necessary to implement Chapter 111,
 Occupations Code, as amended by this Act; and
 (B)  rules as required by Section 254.0035,
 Occupations Code, as added by this Act; and
 (3)  the Health and Human Services Commission shall
 adopt rules as required by Section 531.02172, Government Code, as
 added by this Act.
 SECTION 32.  If before implementing any provision of this
 Act a state agency determines that a waiver or authorization from a
 federal agency is necessary for implementation of that provision,
 the agency affected by the provision shall request the waiver or
 authorization and may delay implementing that provision until the
 waiver or authorization is granted.
 SECTION 33.  (a)  Except as provided by Subsection (b) of
 this section, this Act takes effect September 1, 2019.
 (b)  Sections 1455.004 and 1455.006, Insurance Code, as
 amended by this Act, take effect January 1, 2020.
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