88R7280 MEW-D
By: Blanco, LaMantia S.B. No. 1043
A BILL TO BE ENTITLED
AN ACT
relating to the reimbursement and payment of claims by certain
health benefit plan issuers for telemedicine medical services,
teledentistry dental services, and telehealth services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1455.001(1-a), Insurance Code, is
amended to read as follows:
(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,
including a mental 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; or
(E) an individual who is credentialed to provide
qualified mental health professional community services, has
demonstrated and documented competency in the work to be performed,
is acting within the scope of the individual's license or other
authorization issued by this state and does not perform a
telemedicine medical service, 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 Health and Human Services
Commission.
SECTION 2. 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,
teledentistry dental 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:
(1) pay more than the billed charge on a claim for
payment by a preferred or contracted health professional; or
(2) reimburse a preferred or contracted health
professional as specified in Subsection (a) if the telemedicine
medical service, teledentistry dental service, or telehealth
service is provided to a covered patient by that health
professional as part of a mutually agreed upon risk-based payment
arrangement.
(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, teledentistry
dental 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 3. 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, 2024. A health benefit
plan delivered, issued for delivery, or renewed before January 1,
2024, 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 4. This Act takes effect September 1, 2023.