87R4482 MEW-D
By: Goodwin H.B. No. 1722
A BILL TO BE ENTITLED
AN ACT
relating to the reimbursement and payment of claims for
telemedicine medical services and telehealth services under
certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1455.001(1), Insurance Code, is amended
to read as follows:
(1) "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 physician in
providing telemedicine medical services that are delegated and
supervised by the physician; [or]
(C) a licensed or certified health professional,
including a mental health professional, acting within the scope of
the license or certification who does not perform a telemedicine
medical service; or
(D) an individual who is credentialed to provide
qualified mental health professional community services, has
demonstrated and documented competency in the work to be performed,
and:
(i) holds a bachelor's or more advanced
degree from an accredited institution of higher education with a
minimum number of hours that is equivalent to a major in psychology,
social work, medicine, nursing, rehabilitation, counseling,
sociology, human growth and development, physician assistant
studies, gerontology, special education, educational psychology,
early childhood education, or early childhood intervention;
(ii) is a registered nurse; or
(iii) completes an alternative
credentialing process identified by the Department of State Health
Services.
SECTION 2. Section 1455.002, Insurance Code, is amended to
read as follows:
Sec. 1455.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or an individual or group evidence of coverage that is
offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a stipulated premium company operating
under Chapter 884; or
(v) a health maintenance organization
operating under Chapter 843; and
(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a health benefit plan that is offered by:
(i) a multiple employer welfare arrangement
as defined by Section 3 of that Act; or
(ii) another analogous benefit
arrangement; or
(2) is offered by an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844.
(b) Notwithstanding any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575; and
(3) a primary care coverage plan under Chapter 1579.
SECTION 3. Section 1455.004, Insurance Code, is amended by
amending Subsection (c) and adding Subsection (c-1) to read as
follows:
(c) Notwithstanding Subsection (a) and except as provided
by Subsection (c-1), a health benefit plan is not required to
provide coverage for a telemedicine medical service or a telehealth
service provided by only synchronous or asynchronous audio
interaction, including:
(1) [an audio-only telephone consultation;
[(2)] a text-only e-mail message; or
(2) [(3)] a facsimile transmission.
(c-1) A health benefit plan is required to provide coverage
for a telemedicine medical service or a telehealth service provided
by an audio-only telephone consultation.
SECTION 4. Chapter 1455, Insurance Code, is amended by
adding Sections 1455.007 and 1455.008 to read as follows:
Sec. 1455.007. REIMBURSEMENT AND PAYMENT. (a) A health
benefit plan issuer must reimburse a preferred or contracted health
professional for providing a covered health care service or
procedure to a covered patient as a telemedicine medical service or
telehealth service on the same basis and at least at the same rate
that the issuer provides reimbursement to that health professional
for the service or procedure in an in-person setting.
(b) Notwithstanding Subsection (a), a health benefit plan
issuer is not required to pay more than the billed charge on a claim
for payment by a preferred or contracted health professional.
(c) For purposes of processing payment of a claim, a health
benefit plan issuer may not require a preferred or contracted
health professional to provide documentation of a covered health
care service or procedure delivered by the health professional to a
covered patient as a telemedicine medical service or telehealth
service beyond that which is required for the service or procedure
in an in-person setting.
Sec. 1455.008. WAIVER PROHIBITED. The provisions of this
chapter may not be waived, voided, or nullified by contract.
SECTION 5. Chapter 1455, Insurance Code, as amended by this
Act, applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2022. A health benefit
plan delivered, issued for delivery, or renewed before January 1,
2022, is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 6. This Act takes effect September 1, 2021.