Texas 2021 - 87th Regular

Texas House Bill HB1742 Compare Versions

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

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1	1	87R4665 JCG-D
2	2	By: Guerra H.B. No. 1742
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) 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	(b) A dentist who delegates a teledentistry dental service
45	45	shall ensure that the informed consent of the patient includes
46	46	disclosure to the patient that the dentist has delegated the
47	47	service.
48	48	SECTION 4. Section 111.003, Occupations Code, is amended to
49	49	read as follows:
50	50	Sec. 111.003. CONFIDENTIALITY. A treating physician,
51	51	dentist, or health professional who provides or facilitates the use
52	52	of telemedicine medical services, teledentistry dental services,
53	53	or telehealth services shall ensure that the confidentiality of the
54	54	patient's clinical [medical] information is maintained as required
55	55	by Chapter 159, by Subchapter C, Chapter 258, or by other applicable
56	56	law.
57	57	SECTION 5. Section 111.004, Occupations Code, is amended
58	58	to read as follows:
59	59	Sec. 111.004. RULES. (a) The Texas Medical Board, in
60	60	consultation with the commissioner of insurance, as appropriate,
61	61	may adopt rules necessary to:
62	62	(1) ensure that patients using telemedicine medical
63	63	services receive appropriate, quality care;
64	64	(2) prevent abuse and fraud in the use of telemedicine
65	65	medical services, including rules relating to the filing of claims
66	66	and records required to be maintained in connection with
67	67	telemedicine medical services;
68	68	(3) ensure adequate supervision of health
69	69	professionals who are not physicians and who provide telemedicine
70	70	medical services; and
71	71	(4) establish the maximum number of health
72	72	professionals who are not physicians that a physician may supervise
73	73	through a telemedicine medical service.
74	74	(b) The State Board of Dental Examiners, in consultation
75	75	with the commissioner of insurance, as appropriate, may adopt rules
76	76	necessary to:
77	77	(1) ensure that patients using teledentistry dental
78	78	services receive appropriate, quality care;
79	79	(2) prevent abuse and fraud in the use of
80	80	teledentistry dental services, including rules relating to the
81	81	filing of claims and records required to be maintained in
82	82	connection with teledentistry dental services;
83	83	(3) ensure adequate supervision of health
84	84	professionals who are not dentists and who provide teledentistry
85	85	dental services under the delegation and supervision of a dentist;
86	86	and
87	87	(4) establish that a dentist may delegate to and
88	88	supervise through a teledentistry dental service not more than two
89	89	health professionals who are not dentists.
90	90	SECTION 6. The heading to Section 111.005, Occupations
91	91	Code, is amended to read as follows:
92	92	Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
93	93	TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES.
94	94	SECTION 7. Section 111.005, Occupations Code, is amended by
95	95	amending Subsections (a) and (b) and adding Subsection (d) to read
96	96	as follows:
97	97	(a) For purposes of Section 562.056, a valid
98	98	practitioner-patient relationship is present between a
99	99	practitioner providing a telemedicine medical service or a
100	100	teledentistry dental service and a patient receiving the
101	101	[telemedicine medical] service as long as the practitioner complies
102	102	with the standard of care described in Section 111.007 and the
103	103	practitioner:
104	104	(1) has a preexisting practitioner-patient
105	105	relationship with the patient established in accordance with rules
106	106	adopted under Section 111.006;
107	107	(2) communicates, regardless of the method of
108	108	communication, with the patient pursuant to a call coverage
109	109	agreement established in accordance with:
110	110	(A) Texas Medical Board rules with a physician
111	111	requesting coverage of medical care for the patient; or
112	112	(B) State Board of Dental Examiners rules with a
113	113	dentist requesting coverage of dental care for the patient; or
114	114	(3) provides the telemedicine medical services or
115	115	teledentistry dental services through the use of one of the
116	116	following methods, as long as the practitioner complies with the
117	117	follow-up requirements in Subsection (b), and the method allows the
118	118	practitioner to have access to, and the practitioner uses, the
119	119	relevant clinical information that would be required in accordance
120	120	with the standard of care described in Section 111.007:
121	121	(A) synchronous audiovisual interaction between
122	122	the practitioner and the patient in another location;
123	123	(B) asynchronous store and forward technology,
124	124	including asynchronous store and forward technology in conjunction
125	125	with synchronous audio interaction between the practitioner and the
126	126	patient in another location, as long as the practitioner uses
127	127	clinical information from:
128	128	(i) clinically relevant photographic or
129	129	video images, including diagnostic images; or
130	130	(ii) the patient's relevant clinical
131	131	[medical] records, such as the relevant medical or dental history,
132	132	laboratory and pathology results, and prescriptive histories; or
133	133	(C) another form of audiovisual
134	134	telecommunication technology that allows the practitioner to
135	135	comply with the standard of care described in Section 111.007.
136	136	(b) A practitioner who provides telemedicine medical
137	137	services or teledentistry dental services to a patient as described
138	138	in Subsection (a)(3) shall:
139	139	(1) provide the patient with guidance on appropriate
140	140	follow-up care; and
141	141	(2) subject to Subsection (d), if the patient consents
142	142	and the patient has a primary care physician or a regular dentist,
143	143	provide to the patient's primary care physician or regular dentist,
144	144	as appropriate, within 72 hours after the practitioner provides the
145	145	services to the patient, a clinical [medical] record or other
146	146	report containing an explanation of:
147	147	(A) the treatment provided by the practitioner to
148	148	the patient; and
149	149	(B) as authorized by the law under which the
150	150	practitioner is licensed, certified, or otherwise permitted to
151	151	provide the service, the practitioner's evaluation, analysis, or
152	152	diagnosis[, as appropriate,] of the patient's condition.
153	153	(d) A practitioner who provides teledentistry dental
154	154	services to a patient as described in Subsection (a)(3):
155	155	(1) on the date the practitioner first provides the
156	156	teledentistry dental services, shall inform the patient of the
157	157	limitation provided by Subdivision (2); and
158	158	(2) may only provide teledentistry dental services
159	159	with respect to the patient for 12 months unless:
160	160	(A) a dentist performs an in-person tactile and
161	161	visual examination of the hard and soft tissues of the patient's
162	162	oral cavity; and
163	163	(B) the practitioner receives notice of the
164	164	examination described by Paragraph (A).
165	165	SECTION 8. Section 111.006, Occupations Code, is amended by
166	166	adding Subsection (c) to read as follows:
167	167	(c) The State Board of Dental Examiners and the Texas State
168	168	Board of Pharmacy shall jointly adopt rules that establish the
169	169	determination of a valid prescription in accordance with Section
170	170	111.005. Rules adopted under this subsection must allow for the
171	171	establishment of a practitioner-patient relationship by a
172	172	teledentistry dental service provided by a dentist to a patient in a
173	173	manner that complies with Section 111.005(a)(3). The State Board
174	174	of Dental Examiners and the Texas State Board of Pharmacy shall
175	175	jointly develop and publish on each respective board's Internet
176	176	website responses to frequently asked questions relating to the
177	177	determination of a valid prescription issued in the course of the
178	178	provision of teledentistry dental services.
179	179	SECTION 9. Section 111.007, Occupations Code, is amended to
180	180	read as follows:
181	181	Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
182	182	SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.
183	183	(a) A health professional providing a health care service or
184	184	procedure as a telemedicine medical service, a teledentistry dental
185	185	service, or a telehealth service is subject to the standard of care
186	186	that would apply to the provision of the same health care service or
187	187	procedure in an in-person setting.
188	188	(b) An agency with regulatory authority over a health
189	189	professional may not adopt rules pertaining to telemedicine medical
190	190	services, teledentistry dental services, or telehealth services
191	191	that would impose a higher standard of care than the standard
192	192	described in Subsection (a).
193	193	SECTION 10. Chapter 111, Occupations Code, is amended by
194	194	adding Section 111.0075 to read as follows:
195	195	Sec. 111.0075. LICENSING FOR TELEDENTISTRY DENTAL
196	196	SERVICES. A health professional providing a health care service or
197	197	procedure as a teledentistry dental service is subject to the
198	198	licensing requirements that would apply to the provision of the
199	199	same health care service or procedure in an in-person setting.
200	200	SECTION 11. Chapter 111, Occupations Code, is amended by
201	201	adding Sections 111.009, 111.010, and 111.011 to read as follows:
202	202	Sec. 111.009. CERTAIN PRESCRIPTIONS PROHIBITED. (a) In
203	203	this section, "controlled substance" and "prescribe" have the
204	204	meanings assigned by Section 481.002, Health and Safety Code.
205	205	(b) A dentist may not prescribe a controlled substance to a
206	206	patient as a teledentistry dental service.
207	207	Sec. 111.010. DENTIST'S DUTY REGARDING FOLLOW-UP CARE FOR
208	208	ACUTE DENTAL CONDITION. (a) A dentist who treats a patient for an
209	209	acute dental condition as a teledentistry dental service shall, not
210	210	later than six weeks after the date of the service:
211	211	(1) contact or attempt to contact the patient to
212	212	schedule an in-person dental service for the patient in connection
213	213	with the acute dental condition; or
214	214	(2) refer the patient to another dentist for the
215	215	service described by Subdivision (1).
216	216	(b) A violation of Subsection (a) constitutes a ground for
217	217	disciplinary action under Section 263.002.
218	218	Sec. 111.011. STUDY AND REPORT. (a) The State Board of
219	219	Dental Examiners shall study the extent to which teledentistry
220	220	dental services may be used to substantially increase access to
221	221	dental care for the children of low-income families, including the
222	222	use of teledentistry dental services to perform a consultation
223	223	before referring the child's parents or legal guardians to
224	224	charitable organizations providing access to affordable dental
225	225	care.
226	226	(b) Not later than December 1, 2022, the board shall report
227	227	the results of the study conducted under Subsection (a) to the
228	228	standing committee of each house of the legislature with primary
229	229	jurisdiction over the board.
230	230	(c) This section expires January 1, 2023.
231	231	SECTION 12. Section 251.003, Occupations Code, is amended
232	232	by adding Subsection (d) to read as follows:
233	233	(d) For purposes of this subtitle, a person located in
234	234	another state practices dentistry in this state and is required to
235	235	hold a license to practice dentistry in this state if the person
236	236	through the use of any medium, including an electronic medium,
237	237	performs an act that constitutes the practice of dentistry on a
238	238	patient in this state.
239	239	SECTION 13. Chapter 254, Occupations Code, is amended by
240	240	adding Section 254.0035 to read as follows:
241	241	Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS.
242	242	The board shall adopt rules governing a call coverage agreement
243	243	between dentists.
244	244	SECTION 14. Section 258.001, Occupations Code, is amended
245	245	to read as follows:
246	246	Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not
247	247	delegate:
248	248	(1) an act to an individual who, by board order, is
249	249	prohibited from performing the act;
250	250	(2) any of the following acts to a person not licensed
251	251	as a dentist or dental hygienist:
252	252	(A) the removal of calculus, deposits, or
253	253	accretions from the natural and restored surfaces of exposed human
254	254	teeth and restorations in the human mouth;
255	255	(B) root planing or the smoothing and polishing
256	256	of roughened root surfaces or exposed human teeth; or
257	257	(C) any other act the delegation of which is
258	258	prohibited by board rule;
259	259	(3) any of the following acts to a person not licensed
260	260	as a dentist:
261	261	(A) comprehensive examination or diagnosis and
262	262	treatment planning;
263	263	(B) a surgical or cutting procedure on hard or
264	264	soft tissue;
265	265	(C) the prescription of a drug, medication, or
266	266	work authorization;
267	267	(D) the taking of an impression for a final
268	268	restoration, appliance, or prosthesis;
269	269	(E) the making of an intraoral occlusal
270	270	adjustment;
271	271	(F) direct pulp capping, pulpotomy, or any other
272	272	endodontic procedure;
273	273	(G) the final placement and intraoral adjustment
274	274	of a fixed or removable appliance; or
275	275	(H) the placement of any final restoration; or
276	276	(4) the authority to an individual to administer a
277	277	local anesthetic agent, inhalation sedative agent, parenteral
278	278	sedative agent, or general anesthetic agent, including as a
279	279	teledentistry dental service as that term is defined by Section
280	280	111.001, if the individual is not licensed as:
281	281	(A) a dentist with a permit issued by the board
282	282	for the procedure being performed, if a permit is required;
283	283	(B) a certified registered nurse anesthetist
284	284	licensed by the Texas Board of Nursing, only if the delegating
285	285	dentist holds a permit issued by the board for the procedure being
286	286	performed, if a permit is required; or
287	287	(C) a physician anesthesiologist licensed by the
288	288	Texas Medical Board.
289	289	SECTION 15. Section 262.152, Occupations Code, is amended
290	290	to read as follows:
291	291	Sec. 262.152. PERFORMANCE OF DELEGATED DUTIES. (a) Except
292	292	as provided by Section 262.1515, a dental hygienist shall practice
293	293	dental hygiene:
294	294	(1) in the dental office of a supervising dentist
295	295	licensed by the board; or
296	296	(2) in an alternate setting, including a nursing home,
297	297	the patient's home, a school, a hospital, a state institution, a
298	298	public health clinic, or another institution, under the supervision
299	299	of a supervising dentist.
300	300	(b) For purposes of this section, a dental hygienist who
301	301	practices dental hygiene as a teledentistry dental service, as
302	302	defined by Section 111.001, is practicing in an alternate setting
303	303	in compliance with Subsection (a)(2).
304	304	SECTION 16. Section 562.056(c), Occupations Code, is
305	305	amended to read as follows:
306	306	(c) For purposes of this section and Section 562.112, a
307	307	valid practitioner-patient relationship is present between a
308	308	practitioner providing telemedicine medical services or
309	309	teledentistry dental services and the patient receiving the
310	310	[telemedicine medical] services if the practitioner has complied
311	311	with the requirements for establishing such a relationship in
312	312	accordance with Section 111.005.
313	313	SECTION 17. Section 531.001, Government Code, is amended by
314	314	amending Subdivision (4-d) and adding Subdivision (6-a) to read as
315	315	follows:
316	316	(4-d) "Platform" means the technology, system,
317	317	software, application, modality, or other method through which a
318	318	health professional remotely interfaces with a patient when
319	319	providing a health care service or procedure as a telemedicine
320	320	medical service, teledentistry dental service, or telehealth
321	321	service.
322	322	(6-a) "Teledentistry dental service" has the meaning
323	323	assigned by Section 111.001, Occupations Code.
324	324	SECTION 18. Section 531.0216, Government Code, is amended
325	325	to read as follows:
326	326	Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
327	327	TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL
328	328	SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER
329	329	MEDICAID. (a) The executive commissioner by rule shall develop and
330	330	implement a system to reimburse providers of services under
331	331	Medicaid for services performed using telemedicine medical
332	332	services, teledentistry dental services, or telehealth services.
333	333	(c) The commission shall encourage health care providers
334	334	and health care facilities to provide telemedicine medical
335	335	services, teledentistry dental services, and telehealth services
336	336	in the health care delivery system. The commission may not require
337	337	that a service be provided to a patient through telemedicine
338	338	medical services, teledentistry dental services, or telehealth
339	339	services.
340	340	(c-1) Subsection (c) does not prohibit the authorization of
341	341	the provision of any service to a patient through teledentistry
342	342	dental services if:
343	343	(1) the patient requests the service; and
344	344	(2) the provision of the service through teledentistry
345	345	does not violate the standard of care applicable to the service.
346	346	(c-2) The commission shall explore opportunities to
347	347	increase STAR Health program providers' use of telemedicine medical
348	348	services in medically underserved areas of this state.
349	349	(d) Subject to Sections 111.004 and [Section] 153.004,
350	350	Occupations Code, the executive commissioner may adopt rules as
351	351	necessary to implement this section. In the rules adopted under
352	352	this section, the executive commissioner shall:
353	353	(1) refer to the site where the patient is physically
354	354	located as the patient site; and
355	355	(2) refer to the site where the physician, dentist, or
356	356	health professional providing the telemedicine medical service,
357	357	teledentistry dental service, or telehealth service is physically
358	358	located as the distant site.
359	359	(f) Not later than December 1 of each even-numbered year,
360	360	the commission shall report to the speaker of the house of
361	361	representatives and the lieutenant governor on the effects of
362	362	telemedicine medical services, teledentistry dental services,
363	363	telehealth services, and home telemonitoring services on Medicaid
364	364	in the state, including the number of physicians, dentists, health
365	365	professionals, and licensed health care facilities using
366	366	telemedicine medical services, teledentistry dental services,
367	367	telehealth services, or home telemonitoring services, the
368	368	geographic and demographic disposition of the physicians,
369	369	dentists, and health professionals, the number of patients
370	370	receiving telemedicine medical services, teledentistry dental
371	371	services, telehealth services, and home telemonitoring services,
372	372	the types of services being provided, the cost of utilization, and
373	373	the cost savings of telemedicine medical services, teledentistry
374	374	dental services, telehealth services, and home telemonitoring
375	375	services to Medicaid.
376	376	(g) The commission shall ensure that a Medicaid managed care
377	377	organization:
378	378	(1) does not deny reimbursement for a covered health
379	379	care service or procedure delivered by a health care provider with
380	380	whom the managed care organization contracts to a Medicaid
381	381	recipient as a telemedicine medical service, a teledentistry dental
382	382	service, or a telehealth service solely because the covered service
383	383	or procedure is not provided through an in-person consultation;
384	384	(2) does not limit, deny, or reduce reimbursement for
385	385	a covered health care service or procedure delivered by a health
386	386	care provider with whom the managed care organization contracts to
387	387	a Medicaid recipient as a telemedicine medical service, a
388	388	teledentistry dental service, or a telehealth service based on the
389	389	health care provider's choice of platform for providing the health
390	390	care service or procedure; and
391	391	(3) ensures that the use of telemedicine medical
392	392	services, teledentistry dental services, or telehealth services
393	393	promotes and supports patient-centered medical homes by allowing a
394	394	Medicaid recipient to receive a telemedicine medical service,
395	395	teledentistry dental service, or telehealth service from a provider
396	396	other than the recipient's primary care physician or provider,
397	397	except as provided by Section 531.0217(c-4), only if:
398	398	(A) the telemedicine medical service,
399	399	teledentistry dental service, or telehealth service is provided in
400	400	accordance with the law and contract requirements applicable to the
401	401	provision of the same health care service in an in-person setting,
402	402	including requirements regarding care coordination; and
403	403	(B) the provider of the telemedicine medical
404	404	service, teledentistry dental service, or telehealth service gives
405	405	notice to the Medicaid recipient's primary care physician or
406	406	provider regarding the [telemedicine medical service or
407	407	telehealth] service, including a summary of the service, exam
408	408	findings, a list of prescribed or administered medications, and
409	409	patient instructions, for the purpose of sharing medical
410	410	information, provided that the recipient has a primary care
411	411	physician or provider and the recipient or, if appropriate, the
412	412	recipient's parent or legal guardian, consents to the notice.
413	413	(h) The commission shall develop, document, and implement a
414	414	monitoring process to ensure that a Medicaid managed care
415	415	organization ensures that the use of telemedicine medical services,
416	416	teledentistry dental services, or telehealth services promotes and
417	417	supports patient-centered medical homes and care coordination in
418	418	accordance with Subsection (g)(3). The process must include
419	419	monitoring of the rate at which a telemedicine medical service,
420	420	teledentistry dental service, or telehealth service provider gives
421	421	notice in accordance with Subsection (g)(3)(B).
422	422	(i) The executive commissioner by rule shall ensure that a
423	423	federally-qualified [federally qualified] health center as defined
424	424	by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the
425	425	originating site facility fee or the distant site practitioner fee
426	426	or both, as appropriate, for a covered telemedicine medical
427	427	service, teledentistry dental service, or telehealth service
428	428	delivered by a health care provider to a Medicaid recipient. The
429	429	commission is required to implement this subsection only if the
430	430	legislature appropriates money specifically for that purpose. If
431	431	the legislature does not appropriate money specifically for that
432	432	purpose, the commission may, but is not required to, implement this
433	433	subsection using other money available to the commission for that
434	434	purpose.
435	435	(j) In complying with state and federal requirements to
436	436	provide access to medically necessary services under the Medicaid
437	437	managed care program, a Medicaid managed care organization
438	438	determining whether reimbursement for a telemedicine medical
439	439	service, teledentistry dental service, or telehealth service is
440	440	appropriate shall continue to consider other factors, including
441	441	whether reimbursement is cost-effective and whether the provision
442	442	of the service is clinically effective.
443	443	SECTION 19. The heading to Section 531.02162, Government
444	444	Code, is amended to read as follows:
445	445	Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH
446	446	TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND
447	447	TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.
448	448	SECTION 20. Section 531.02162, Government Code, is amended
449	449	by amending Subsections (b) and (c) and adding Subsection (d) to
450	450	read as follows:
451	451	(b) The executive commissioner by rule shall establish
452	452	policies that permit reimbursement under Medicaid and the child
453	453	health plan program for services provided through telemedicine
454	454	medical services, teledentistry dental services, and telehealth
455	455	services to children with special health care needs.
456	456	(c) The policies required under this section must:
457	457	(1) be designed to:
458	458	(A) prevent unnecessary travel and encourage
459	459	efficient use of telemedicine medical services, teledentistry
460	460	dental services, and telehealth services for children with special
461	461	health care needs in all suitable circumstances; and
462	462	(B) ensure in a cost-effective manner the
463	463	availability to a child with special health care needs of services
464	464	appropriately performed using telemedicine medical services,
465	465	teledentistry dental services, and telehealth services that are
466	466	comparable to the same types of services available to that child
467	467	without the use of telemedicine medical services, teledentistry
468	468	dental services, and telehealth services; and
469	469	(2) provide for reimbursement of multiple providers of
470	470	different services who participate in a single session of
471	471	telemedicine medical services, teledentistry dental services,
472	472	[and] telehealth services, or any combination of those services,
473	473	[session] for a child with special health care needs, if the
474	474	commission determines that reimbursing each provider for the
475	475	session is cost-effective in comparison to the costs that would be
476	476	involved in obtaining the services from providers without the use
477	477	of telemedicine medical services, teledentistry dental services,
478	478	and telehealth services, including the costs of transportation and
479	479	lodging and other direct costs.
480	480	(d) The policies established under this section may
481	481	authorize the provision of a service as a teledentistry dental
482	482	service only if the provision of the service through teledentistry
483	483	does not violate the standard of care applicable to the service.
484	484	SECTION 21. Subchapter B, Chapter 531, Government Code, is
485	485	amended by adding Section 531.02172 to read as follows:
486	486	Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL
487	487	SERVICES. (a) The commission by rule shall require each health and
488	488	human services agency that administers a part of the Medicaid
489	489	program to provide Medicaid reimbursement for teledentistry dental
490	490	services provided by a dentist licensed to practice dentistry in
491	491	this state.
492	492	(b) The commission shall require reimbursement for a
493	493	teledentistry dental service at the same rate as the Medicaid
494	494	program reimburses for the same in-person dental service. A
495	495	request for reimbursement may not be denied solely because an
496	496	in-person dental service between a dentist and a patient did not
497	497	occur. The commission may not limit a dentist's choice of platform
498	498	for providing a teledentistry dental service by requiring that the
499	499	dentist use a particular platform to receive reimbursement for the
500	500	service.
501	501	(c) The State Board of Dental Examiners, in consultation
502	502	with the commission and the commission's office of inspector
503	503	general, as appropriate, may adopt rules as necessary to:
504	504	(1) ensure that appropriate care, including quality of
505	505	care, is provided to patients who receive teledentistry dental
506	506	services; and
507	507	(2) prevent abuse and fraud through the use of
508	508	teledentistry dental services, including rules relating to filing
509	509	claims and the records required to be maintained in connection with
510	510	teledentistry dental services.
511	511	SECTION 22. The heading to Section 62.157, Health and
512	512	Safety Code, is amended to read as follows:
513	513	Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY
514	514	DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL
515	515	HEALTH CARE NEEDS.
516	516	SECTION 23. Sections 62.157(a) and (b), Health and Safety
517	517	Code, are amended to read as follows:
518	518	(a) In providing covered benefits to a child with special
519	519	health care needs, a health plan provider must permit benefits to be
520	520	provided through telemedicine medical services, teledentistry
521	521	dental services, and telehealth services in accordance with
522	522	policies developed by the commission.
523	523	(b) The policies must provide for:
524	524	(1) the availability of covered benefits
525	525	appropriately provided through telemedicine medical services,
526	526	teledentistry dental services, and telehealth services that are
527	527	comparable to the same types of covered benefits provided without
528	528	the use of telemedicine medical services, teledentistry dental
529	529	services, and telehealth services; and
530	530	(2) the availability of covered benefits for different
531	531	services performed by multiple health care providers during a
532	532	single [telemedicine medical services and telehealth services]
533	533	session of telemedicine medical services, teledentistry dental
534	534	services, telehealth services, or any combination of those
535	535	services, if the executive commissioner determines that delivery of
536	536	the covered benefits in that manner is cost-effective in comparison
537	537	to the costs that would be involved in obtaining the services from
538	538	providers without the use of telemedicine medical services,
539	539	teledentistry dental services, and telehealth services, including
540	540	the costs of transportation and lodging and other direct costs.
541	541	SECTION 24. Section 62.1571, Health and Safety Code, is
542	542	amended to read as follows:
543	543	Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND
544	544	TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits
545	545	to a child, a health plan provider must permit benefits to be
546	546	provided through telemedicine medical services and teledentistry
547	547	dental services in accordance with policies developed by the
548	548	commission.
549	549	(b) The policies must provide for:
550	550	(1) the availability of covered benefits
551	551	appropriately provided through telemedicine medical services and
552	552	teledentistry dental services that are comparable to the same types
553	553	of covered benefits provided without the use of telemedicine
554	554	medical services and teledentistry dental services; and
555	555	(2) the availability of covered benefits for different
556	556	services performed by multiple health care providers during a
557	557	single session of telemedicine medical services, teledentistry
558	558	dental services, or both services, if the executive commissioner
559	559	determines that delivery of the covered benefits in that manner is
560	560	cost-effective in comparison to the costs that would be involved in
561	561	obtaining the services from providers without the use of
562	562	telemedicine medical services or teledentistry dental services,
563	563	including the costs of transportation and lodging and other direct
564	564	costs.
565	565	(c) [(d)] In this section, "teledentistry dental service"
566	566	and "telemedicine medical service" have [has] the meanings
567	567	[meaning] assigned by Section 531.001, Government Code.
568	568	SECTION 25. The heading to Chapter 1455, Insurance Code, is
569	569	amended to read as follows:
570	570	CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
571	571	SECTION 26. Section 1455.001, Insurance Code, is amended by
572	572	amending Subdivisions (1) and (3) and adding Subdivision (1-a) to
573	573	read as follows:
574	574	(1) "Dentist" means a person licensed to practice
575	575	dentistry in this state under Subtitle D, Title 3, Occupations
576	576	Code.
577	577	(1-a) "Health professional" means:
578	578	(A) a physician;
579	579	(B) an individual who is:
580	580	(i) licensed or certified in this state to
581	581	perform health care services; and
582	582	(ii) authorized to assist:
583	583	(a) a physician in providing
584	584	telemedicine medical services that are delegated and supervised by
585	585	the physician; or
586	586	(b) a dentist in providing
587	587	teledentistry dental services that are delegated and supervised by
588	588	the dentist;
589	589	(C) a licensed or certified health professional
590	590	acting within the scope of the license or certification who does not
591	591	perform a telemedicine medical service or a teledentistry dental
592	592	service; or
593	593	(D) a dentist.
594	594	(3) "Teledentistry dental service," "telehealth
595	595	["Telehealth] service," and "telemedicine medical service" have
596	596	the meanings assigned by Section 111.001, Occupations Code.
597	597	SECTION 27. Section 1455.004, Insurance Code, is amended to
598	598	read as follows:
599	599	Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES,
600	600	TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A
601	601	health benefit plan:
602	602	(1) must provide coverage for a covered health care
603	603	service or procedure delivered by a preferred or contracted health
604	604	professional to a covered patient as a telemedicine medical
605	605	service, teledentistry dental service, or telehealth service on the
606	606	same basis and to the same extent that the plan provides coverage
607	607	for the service or procedure in an in-person setting; and
608	608	(2) may not:
609	609	(A) exclude from coverage a covered health care
610	610	service or procedure delivered by a preferred or contracted health
611	611	professional to a covered patient as a telemedicine medical
612	612	service, a teledentistry dental service, or a telehealth service
613	613	solely because the covered health care service or procedure is not
614	614	provided through an in-person consultation; and
615	615	(B) subject to Subsection (c), limit, deny, or
616	616	reduce coverage for a covered health care service or procedure
617	617	delivered as a telemedicine medical service, teledentistry dental
618	618	service, or telehealth service based on the health professional's
619	619	choice of platform for delivering the service or procedure.
620	620	(b) A health benefit plan may require a deductible, a
621	621	copayment, or coinsurance for a covered health care service or
622	622	procedure delivered by a preferred or contracted health
623	623	professional to a covered patient as a telemedicine medical
624	624	service, a teledentistry dental service, or a telehealth service.
625	625	The amount of the deductible, copayment, or coinsurance may not
626	626	exceed the amount of the deductible, copayment, or coinsurance
627	627	required for the covered health care service or procedure provided
628	628	through an in-person consultation.
629	629	(b-1) Subsection (b) does not authorize a health benefit
630	630	plan to charge a separate deductible that applies only to a covered
631	631	health care service or procedure delivered as a telemedicine
632	632	medical service, teledentistry dental service, or telehealth
633	633	service.
634	634	(c) Notwithstanding Subsection (a), a health benefit plan
635	635	is not required to provide coverage for a telemedicine medical
636	636	service, a teledentistry dental service, or a telehealth service
637	637	provided by only synchronous or asynchronous audio interaction,
638	638	including:
639	639	(1) an audio-only telephone consultation;
640	640	(2) a text-only e-mail message; or
641	641	(3) a facsimile transmission.
642	642	(d) A health benefit plan may not impose an annual or
643	643	lifetime maximum on coverage for covered health care services or
644	644	procedures delivered as telemedicine medical services,
645	645	teledentistry dental services, or telehealth services other than
646	646	the annual or lifetime maximum, if any, that applies in the
647	647	aggregate to all items and services and procedures covered under
648	648	the plan.
649	649	SECTION 28. Section 1455.006, Insurance Code, is amended to
650	650	read as follows:
651	651	Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES,
652	652	TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES STATEMENT.
653	653	(a) Each issuer of a health benefit plan shall adopt and display in
654	654	a conspicuous manner on the health benefit plan issuer's Internet
655	655	website the issuer's policies and payment practices for
656	656	telemedicine medical services, teledentistry dental services, and
657	657	telehealth services.
658	658	(b) This section does not require an issuer of a health
659	659	benefit plan to display negotiated contract payment rates for
660	660	health professionals who contract with the issuer to provide
661	661	telemedicine medical services, teledentistry dental services, or
662	662	telehealth services.
663	663	SECTION 29. Not later than March 1, 2022:
664	664	(1) the State Board of Dental Examiners and the Texas
665	665	State Board of Pharmacy shall jointly adopt rules as required by
666	666	Section 111.006(c), Occupations Code, as added by this Act;
667	667	(2) the State Board of Dental Examiners shall adopt:
668	668	(A) rules necessary to implement Chapter 111,
669	669	Occupations Code, as amended by this Act; and
670	670	(B) rules as required by Section 254.0035,
671	671	Occupations Code, as added by this Act; and
672	672	(3) the Health and Human Services Commission shall
673	673	adopt rules as required by Section 531.02172, Government Code, as
674	674	added by this Act.
675	675	SECTION 30. If before implementing any provision of this
676	676	Act a state agency determines that a waiver or authorization from a
677	677	federal agency is necessary for implementation of that provision,
678	678	the agency affected by the provision shall request the waiver or
679	679	authorization and may delay implementing that provision until the
680	680	waiver or authorization is granted.
681	681	SECTION 31. (a) Except as provided by Subsection (b) of
682	682	this section, this Act takes effect September 1, 2021.
683	683	(b) Sections 1455.004 and 1455.006, Insurance Code, as
684	684	amended by this Act, take effect January 1, 2022.