Bill Text: TX HB1726 | 2023-2024 | 88th Legislature | Comm Sub
Bill Title: Relating to the reimbursement and payment of claims by certain health benefit plan issuers for telemedicine medical services, teledentistry dental services, and telehealth services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-05-11 - Placed on General State Calendar [HB1726 Detail]
Download: Texas-2023-HB1726-Comm_Sub.html
88R7280 MEW-D | ||
By: Hernandez | H.B. No. 1726 |
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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; [ |
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(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. |