Bill Text: TX SB1107 | 2017-2018 | 85th Legislature | Enrolled


Bill Title: Relating to telemedicine and telehealth services.

Spectrum: Bipartisan Bill

Status: (Passed) 2017-05-27 - See remarks for effective date [SB1107 Detail]

Download: Texas-2017-SB1107-Enrolled.html
 
 
  S.B. No. 1107
 
 
 
 
AN ACT
  relating to telemedicine and telehealth services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 111.001, Occupations Code, is amended by
  amending Subdivision (2) and adding Subdivisions (3) and (4) to
  read as follows:
               (2)  "Store and forward technology" means technology
  that stores and transmits or grants access to a person's clinical
  information for review by a health professional at a different
  physical location than the person.
               (3)  "Telehealth service" means a health service, other
  than a telemedicine medical service, delivered by a health
  professional licensed, certified, or otherwise entitled to
  practice in this state and acting within the scope of the health
  professional's license, certification, or entitlement to a patient
  at a different physical location than the health professional using
  telecommunications or information technology.
               (4)  "Telemedicine [and "telemedicine] medical
  service" means a health care service delivered by a physician
  licensed in this state, or a health professional acting under the
  delegation and supervision of a physician licensed in this state,
  and acting within the scope of the physician's or health
  professional's license to a patient at a different physical
  location than the physician or health professional using
  telecommunications or information technology [have the meanings
  assigned by Section 57.042, Utilities Code].
         SECTION 2.  Section 111.004, Occupations Code, is amended to
  read as follows:
         Sec. 111.004.  RULES. The Texas [State Board of] Medical
  Board [Examiners], in consultation with the commissioner of
  insurance, as appropriate, may adopt rules necessary to:
               (1)  ensure that patients using telemedicine medical
  services receive appropriate, quality care;
               (2)  prevent abuse and fraud in the use of telemedicine
  medical services, including rules relating to the filing of claims
  and records required to be maintained in connection with
  telemedicine medical services;
               (3)  ensure adequate supervision of health
  professionals who are not physicians and who provide telemedicine
  medical services; and
               (4)  establish the maximum number of health
  professionals who are not physicians that a physician may supervise
  through a telemedicine medical service[; and
               [(5)     require a face-to-face consultation between a
  patient and a physician providing a telemedicine medical service
  within a certain number of days following an initial telemedicine
  medical service only if the physician has never seen the patient].
         SECTION 3.  Chapter 111, Occupations Code, is amended by
  adding Sections 111.005 through 111.008 to read as follows:
         Sec. 111.005.  PRACTITIONER-PATIENT RELATIONSHIP FOR
  TELEMEDICINE MEDICAL SERVICES. (a)  For purposes of Section
  562.056, a valid practitioner-patient relationship is present
  between a practitioner providing a telemedicine medical service and
  a patient receiving the telemedicine medical service as long as the
  practitioner complies with the standard of care described in
  Section 111.007 and the practitioner:
               (1)  has a preexisting practitioner-patient
  relationship with the patient established in accordance with rules
  adopted under Section 111.006;
               (2)  communicates, regardless of the method of
  communication, with the patient pursuant to a call coverage
  agreement established in accordance with Texas Medical Board rules
  with a physician requesting coverage of medical care for the
  patient; or
               (3)  provides the telemedicine medical services
  through the use of one of the following methods, as long as the
  practitioner complies with the follow-up requirements in
  Subsection (b), and the method allows the practitioner to have
  access to, and the practitioner uses, the relevant clinical
  information that would be required in accordance with the standard
  of care described in Section 111.007:
                     (A)  synchronous audiovisual interaction between
  the practitioner and the patient in another location;
                     (B)  asynchronous store and forward technology,
  including asynchronous store and forward technology in conjunction
  with synchronous audio interaction between the practitioner and the
  patient in another location, as long as the practitioner uses
  clinical information from:
                           (i)  clinically relevant photographic or
  video images, including diagnostic images; or
                           (ii)  the patient's relevant medical
  records, such as the relevant medical history, laboratory and
  pathology results, and prescriptive histories; or
                     (C)  another form of audiovisual
  telecommunication technology that allows the practitioner to
  comply with the standard of care described in Section 111.007.
         (b)  A practitioner who provides telemedicine medical
  services to a patient as described in Subsection (a)(3) shall:
               (1)  provide the patient with guidance on appropriate
  follow-up care; and
               (2)  if the patient consents and the patient has a
  primary care physician, provide to the patient's primary care
  physician within 72 hours after the practitioner provides the
  services to the patient a medical record or other report containing
  an explanation of the treatment provided by the practitioner to the
  patient and the practitioner's evaluation, analysis, or diagnosis,
  as appropriate, of the patient's condition.
         (c)  Notwithstanding any other provision of this section, a
  practitioner-patient relationship is not present if a practitioner
  prescribes an abortifacient or any other drug or device that
  terminates a pregnancy.
         Sec. 111.006.  COORDINATION TO ADOPT RULES THAT DETERMINE
  VALID PRESCRIPTION. (a)  The Texas Medical Board, the Texas Board
  of Nursing, the Texas Physician Assistant Board, and the Texas
  State Board of Pharmacy shall jointly adopt rules that establish
  the determination of a valid prescription in accordance with
  Section 111.005.  Rules adopted under this section must allow for
  the establishment of a practitioner-patient relationship by a
  telemedicine medical service provided by a practitioner to a
  patient in a manner that complies with Section 111.005(a)(3).
         (b)  The Texas Medical Board, the Texas Board of Nursing, the
  Texas Physician Assistant Board, and the Texas State Board of
  Pharmacy shall jointly develop and publish on each respective
  board's Internet website responses to frequently asked questions
  relating to the determination of a valid prescription issued in the
  course of the provision of telemedicine medical services.
         Sec. 111.007.  STANDARD OF CARE FOR TELEMEDICINE MEDICAL
  SERVICES AND TELEHEALTH SERVICES. (a)  A health professional
  providing a health care service or procedure as a telemedicine
  medical service or a telehealth service is subject to the standard
  of care that would apply to the provision of the same health care
  service or procedure in an in-person setting.
         (b)  An agency with regulatory authority over a health
  professional may not adopt rules pertaining to telemedicine medical
  services or telehealth services that would impose a higher standard
  of care than the standard described in Subsection (a).
         Sec. 111.008.  MENTAL HEALTH SERVICES EXCLUDED. This
  chapter does not apply to mental health services.
         SECTION 4.  Section 562.056, Occupations Code, is amended by
  adding Subsection (c) to read as follows:
         (c)  For purposes of this section, a valid
  practitioner-patient relationship is present between a
  practitioner providing telemedicine medical services and the
  patient receiving the telemedicine medical services if the
  practitioner has complied with the requirements for establishing
  such a relationship in accordance with Section 111.005.
         SECTION 5.  Section 1455.001(3), Insurance Code, is amended
  to read as follows:
               (3)  "Telehealth service" and "telemedicine medical
  service" have the meanings assigned by Section 111.001 [57.042],
  Occupations [Utilities] Code.
         SECTION 6.  Section 1455.004, Insurance Code, is amended to
  read as follows:
         Sec. 1455.004.  COVERAGE FOR TELEMEDICINE MEDICAL SERVICES
  AND TELEHEALTH SERVICES. (a)  A health benefit plan may not
  exclude from coverage a covered health care service or procedure
  delivered by a preferred or contracted health professional to a
  covered patient as a telemedicine medical service or a telehealth
  service [from coverage under the plan] solely because the covered
  health care service or procedure is not provided through an
  in-person [a face-to-face] consultation.
         (b)  A health benefit plan may require a deductible, a
  copayment, or coinsurance for a covered health care service or
  procedure delivered by a preferred or contracted health
  professional to a covered patient as a telemedicine medical service
  or a telehealth service. The amount of the deductible, copayment,
  or coinsurance may not exceed the amount of the deductible,
  copayment, or coinsurance required for the covered health care [a
  comparable medical] service or procedure provided through an
  in-person [a face-to-face] consultation.
         (c)  Notwithstanding Subsection (a), a health benefit plan
  is not required to provide coverage for a telemedicine medical
  service or a telehealth service provided by only synchronous or
  asynchronous audio interaction, including:
               (1)  an audio-only telephone consultation;
               (2)  a text-only e-mail message; or
               (3)  a facsimile transmission. 
         SECTION 7.  Chapter 1455, Insurance Code, is amended by
  adding Section 1455.006 to read as follows:
         Sec. 1455.006.  TELEMEDICINE MEDICAL SERVICES AND
  TELEHEALTH SERVICES STATEMENT. (a)  Each issuer of a health
  benefit plan shall adopt and display in a conspicuous manner on the
  health benefit plan issuer's Internet website the issuer's policies
  and payment practices for telemedicine medical services and
  telehealth services.
         (b)  This section does not require an issuer of a health
  benefit plan to display negotiated contract payment rates for
  health professionals who contract with the issuer to provide
  telemedicine medical services or telehealth services.
         SECTION 8.  Sections 531.001(7) and (8), Government Code,
  are amended to read as follows:
               (7)  "Telehealth service" has the meaning assigned by
  Section 111.001, Occupations Code [means a health service, other
  than a telemedicine medical service, that is delivered by a
  licensed or certified health professional acting within the scope
  of the health professional's license or certification who does not
  perform a telemedicine medical service and that requires the use of
  advanced telecommunications technology, other than telephone or
  facsimile technology, including:
                     [(A)     compressed digital interactive video,
  audio, or data transmission;
                     [(B)     clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     [(C)     other technology that facilitates access to
  health care services or medical specialty expertise].
               (8)  "Telemedicine medical service" has the meaning
  assigned by Section 111.001, Occupations Code [means a health care
  service that is initiated by a physician or provided by a health
  professional acting under physician delegation and supervision,
  that is provided for purposes of patient assessment by a health
  professional, diagnosis or consultation by a physician, or
  treatment, or for the transfer of medical data, and that requires
  the use of advanced telecommunications technology, other than
  telephone or facsimile technology, including:
                     [(A)     compressed digital interactive video,
  audio, or data transmission;
                     [(B)     clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     [(C)     other technology that facilitates access to
  health care services or medical specialty expertise].
         SECTION 9.  Section 531.0216(b), Government Code, is amended
  to read as follows:
         (b)  In developing the system, the executive commissioner by
  rule shall:
               (1)  review programs and pilot projects in other states
  to determine the most effective method for reimbursement;
               (2)  establish billing codes and a fee schedule for
  services;
               (3)  [provide for an approval process before a provider
  can receive reimbursement for services;
               [(4)]  consult with the Department of State Health
  Services to establish procedures to:
                     (A)  identify clinical evidence supporting
  delivery of health care services using a telecommunications system;
  and
                     (B)  annually review health care services,
  considering new clinical findings, to determine whether
  reimbursement for particular services should be denied or
  authorized;
               (4) [(5)]  establish a separate provider identifier
  for telemedicine medical services providers, telehealth services
  providers, and home telemonitoring services providers; and
               (5) [(6)]  establish a separate modifier for
  telemedicine medical services, telehealth services, and home
  telemonitoring services eligible for reimbursement.
         SECTION 10.  Sections 531.0217(c-1) and (i), Government
  Code, are amended to read as follows:
         (c-1)  Notwithstanding Subsection (b) or (c), the commission
  shall provide for reimbursement under Medicaid for an office visit
  provided through telemedicine by a physician who is assessing and
  evaluating the patient from a distant site if[:
               [(1)     a health professional acting under the delegation
  and supervision of that physician is present with the patient at the
  time of the visit; and
               [(2)]  the medical condition, illness, or injury for
  which the patient is receiving the service is not likely, within a
  reasonable degree of medical certainty, to undergo material
  deterioration within the 30-day period following the date of the
  visit.
         (i)  The Texas Medical Board, in consultation with the
  commission, as appropriate, may adopt rules as necessary to:
               (1)  ensure that appropriate care, including quality of
  care, is provided to patients who receive telemedicine medical
  services; and
               (2)  prevent abuse and fraud through the use of
  telemedicine medical services, including rules relating to filing
  of claims and records required to be maintained in connection with
  telemedicine[; and
               [(3)     define those situations when a face-to-face
  consultation with a physician is required after a telemedicine
  medical service].
         SECTION 11.  Section 771.151(7), Health and Safety Code, is
  amended to read as follows:
               (7)  "Telemedicine medical service" has the meaning
  assigned by Section 111.001, Occupations Code [means a health care
  service that is initiated by a physician or provided by a health
  professional acting under physician delegation and supervision,
  that is provided for purposes of patient assessment by a health
  professional, diagnosis or consultation by a physician, or
  treatment, or for the transfer of medical data, and that requires
  the use of advanced telecommunications technology, other than
  telephone or facsimile technology, including:
                     [(A)     compressed digital interactive video,
  audio, or data transmission;
                     [(B)     clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     [(C)     other technology that facilitates access to
  health care services or medical specialty expertise].
         SECTION 12.  Sections 531.02163 and 531.0217(i-1),
  Government Code, are repealed.
         SECTION 13.  (a)  Except as provided by Subsection (b) of
  this section, this Act takes effect immediately if it receives a
  vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2017.
         (b)  Sections 1455.001(3) and 1455.004, Insurance Code, as
  amended by this Act, and Section 1455.006, Insurance Code, as added
  by this Act, take effect January 1, 2018.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1107 passed the Senate on
  March 29, 2017, by the following vote: Yeas 31, Nays 0; and that
  the Senate concurred in House amendment on May 18, 2017, by the
  following vote: Yeas 30, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1107 passed the House, with
  amendment, on May 11, 2017, by the following vote: Yeas 135,
  Nays 0, one present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor
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