Texas 2021 - 87th Regular

Texas House Bill HB1722 Compare Versions

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

Old	New	Differences
1	1	87R4482 MEW-D
2	2	By: Goodwin H.B. No. 1722
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the reimbursement and payment of claims for
8	8	telemedicine medical services and telehealth services under
9	9	certain health benefit plans.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 1455.001(1), Insurance Code, is amended
12	12	to read as follows:
13	13	(1) "Health professional" means:
14	14	(A) a physician;
15	15	(B) an individual who is:
16	16	(i) licensed or certified in this state to
17	17	perform health care services; and
18	18	(ii) authorized to assist a physician in
19	19	providing telemedicine medical services that are delegated and
20	20	supervised by the physician; [or]
21	21	(C) a licensed or certified health professional,
22	22	including a mental health professional, acting within the scope of
23	23	the license or certification who does not perform a telemedicine
24	24	medical service; or
25	25	(D) an individual who is credentialed to provide
26	26	qualified mental health professional community services, has
27	27	demonstrated and documented competency in the work to be performed,
28	28	and:
29	29	(i) holds a bachelor's or more advanced
30	30	degree from an accredited institution of higher education with a
31	31	minimum number of hours that is equivalent to a major in psychology,
32	32	social work, medicine, nursing, rehabilitation, counseling,
33	33	sociology, human growth and development, physician assistant
34	34	studies, gerontology, special education, educational psychology,
35	35	early childhood education, or early childhood intervention;
36	36	(ii) is a registered nurse; or
37	37	(iii) completes an alternative
38	38	credentialing process identified by the Department of State Health
39	39	Services.
40	40	SECTION 2. Section 1455.002, Insurance Code, is amended to
41	41	read as follows:
42	42	Sec. 1455.002. APPLICABILITY OF CHAPTER. (a) This chapter
43	43	applies only to a health benefit plan that:
44	44	(1) provides benefits for medical or surgical expenses
45	45	incurred as a result of a health condition, accident, or sickness,
46	46	including:
47	47	(A) an individual, group, blanket, or franchise
48	48	insurance policy or insurance agreement, a group hospital service
49	49	contract, or an individual or group evidence of coverage that is
50	50	offered by:
51	51	(i) an insurance company;
52	52	(ii) a group hospital service corporation
53	53	operating under Chapter 842;
54	54	(iii) a fraternal benefit society operating
55	55	under Chapter 885;
56	56	(iv) a stipulated premium company operating
57	57	under Chapter 884; or
58	58	(v) a health maintenance organization
59	59	operating under Chapter 843; and
60	60	(B) to the extent permitted by the Employee
61	61	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
62	62	seq.), a health benefit plan that is offered by:
63	63	(i) a multiple employer welfare arrangement
64	64	as defined by Section 3 of that Act; or
65	65	(ii) another analogous benefit
66	66	arrangement; or
67	67	(2) is offered by an approved nonprofit health
68	68	corporation that holds a certificate of authority under Chapter
69	69	844.
70	70	(b) Notwithstanding any other law, this chapter applies to:
71	71	(1) a basic coverage plan under Chapter 1551;
72	72	(2) a basic plan under Chapter 1575; and
73	73	(3) a primary care coverage plan under Chapter 1579.
74	74	SECTION 3. Section 1455.004, Insurance Code, is amended by
75	75	amending Subsection (c) and adding Subsection (c-1) to read as
76	76	follows:
77	77	(c) Notwithstanding Subsection (a) and except as provided
78	78	by Subsection (c-1), a health benefit plan is not required to
79	79	provide coverage for a telemedicine medical service or a telehealth
80	80	service provided by only synchronous or asynchronous audio
81	81	interaction, including:
82	82	(1) [an audio-only telephone consultation;
83	83	[(2)] a text-only e-mail message; or
84	84	(2) [(3)] a facsimile transmission.
85	85	(c-1) A health benefit plan is required to provide coverage
86	86	for a telemedicine medical service or a telehealth service provided
87	87	by an audio-only telephone consultation.
88	88	SECTION 4. Chapter 1455, Insurance Code, is amended by
89	89	adding Sections 1455.007 and 1455.008 to read as follows:
90	90	Sec. 1455.007. REIMBURSEMENT AND PAYMENT. (a) A health
91	91	benefit plan issuer must reimburse a preferred or contracted health
92	92	professional for providing a covered health care service or
93	93	procedure to a covered patient as a telemedicine medical service or
94	94	telehealth service on the same basis and at least at the same rate
95	95	that the issuer provides reimbursement to that health professional
96	96	for the service or procedure in an in-person setting.
97	97	(b) Notwithstanding Subsection (a), a health benefit plan
98	98	issuer is not required to pay more than the billed charge on a claim
99	99	for payment by a preferred or contracted health professional.
100	100	(c) For purposes of processing payment of a claim, a health
101	101	benefit plan issuer may not require a preferred or contracted
102	102	health professional to provide documentation of a covered health
103	103	care service or procedure delivered by the health professional to a
104	104	covered patient as a telemedicine medical service or telehealth
105	105	service beyond that which is required for the service or procedure
106	106	in an in-person setting.
107	107	Sec. 1455.008. WAIVER PROHIBITED. The provisions of this
108	108	chapter may not be waived, voided, or nullified by contract.
109	109	SECTION 5. Chapter 1455, Insurance Code, as amended by this
110	110	Act, applies only to a health benefit plan delivered, issued for
111	111	delivery, or renewed on or after January 1, 2022. A health benefit
112	112	plan delivered, issued for delivery, or renewed before January 1,
113	113	2022, is governed by the law as it existed immediately before the
114	114	effective date of this Act, and that law is continued in effect for
115	115	that purpose.
116	116	SECTION 6. This Act takes effect September 1, 2021.