Texas 2023 - 88th Regular

Texas Senate Bill SB1043 Compare Versions

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Version 2 (New)

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1	1	88R7280 MEW-D
2	2	By: Blanco, LaMantia S.B. No. 1043
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 by certain
8	8	health benefit plan issuers for telemedicine medical services,
9	9	teledentistry dental services, and telehealth services.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 1455.001(1-a), Insurance Code, is
12	12	amended to read as follows:
13	13	(1-a) "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:
19	19	(a) a physician in providing
20	20	telemedicine medical services that are delegated and supervised by
21	21	the physician; or
22	22	(b) a dentist in providing
23	23	teledentistry dental services that are delegated and supervised by
24	24	the dentist;
25	25	(C) a licensed or certified health professional,
26	26	including a mental health professional, acting within the scope of
27	27	the license or certification who does not perform a telemedicine
28	28	medical service or a teledentistry dental service; [or]
29	29	(D) a dentist; or
30	30	(E) an individual who is credentialed to provide
31	31	qualified mental health professional community services, has
32	32	demonstrated and documented competency in the work to be performed,
33	33	is acting within the scope of the individual's license or other
34	34	authorization issued by this state and does not perform a
35	35	telemedicine medical service, and:
36	36	(i) holds a bachelor's or more advanced
37	37	degree from an accredited institution of higher education with a
38	38	minimum number of hours that is equivalent to a major in psychology,
39	39	social work, medicine, nursing, rehabilitation, counseling,
40	40	sociology, human growth and development, physician assistant
41	41	studies, gerontology, special education, educational psychology,
42	42	early childhood education, or early childhood intervention;
43	43	(ii) is a registered nurse; or
44	44	(iii) completes an alternative
45	45	credentialing process identified by the Health and Human Services
46	46	Commission.
47	47	SECTION 2. Chapter 1455, Insurance Code, is amended by
48	48	adding Sections 1455.007 and 1455.008 to read as follows:
49	49	Sec. 1455.007. REIMBURSEMENT AND PAYMENT. (a) A health
50	50	benefit plan issuer must reimburse a preferred or contracted health
51	51	professional for providing a covered health care service or
52	52	procedure to a covered patient as a telemedicine medical service,
53	53	teledentistry dental service, or telehealth service on the same
54	54	basis and at least at the same rate that the issuer provides
55	55	reimbursement to that health professional for the service or
56	56	procedure in an in-person setting.
57	57	(b) Notwithstanding Subsection (a), a health benefit plan
58	58	issuer is not required to:
59	59	(1) pay more than the billed charge on a claim for
60	60	payment by a preferred or contracted health professional; or
61	61	(2) reimburse a preferred or contracted health
62	62	professional as specified in Subsection (a) if the telemedicine
63	63	medical service, teledentistry dental service, or telehealth
64	64	service is provided to a covered patient by that health
65	65	professional as part of a mutually agreed upon risk-based payment
66	66	arrangement.
67	67	(c) For purposes of processing payment of a claim, a health
68	68	benefit plan issuer may not require a preferred or contracted
69	69	health professional to provide documentation of a covered health
70	70	care service or procedure delivered by the health professional to a
71	71	covered patient as a telemedicine medical service, teledentistry
72	72	dental service, or telehealth service beyond that which is required
73	73	for the service or procedure in an in-person setting.
74	74	Sec. 1455.008. WAIVER PROHIBITED. The provisions of this
75	75	chapter may not be waived, voided, or nullified by contract.
76	76	SECTION 3. Chapter 1455, Insurance Code, as amended by this
77	77	Act, applies only to a health benefit plan delivered, issued for
78	78	delivery, or renewed on or after January 1, 2024. A health benefit
79	79	plan delivered, issued for delivery, or renewed before January 1,
80	80	2024, is governed by the law as it existed immediately before the
81	81	effective date of this Act, and that law is continued in effect for
82	82	that purpose.
83	83	SECTION 4. This Act takes effect September 1, 2023.