Bill Text: TX SB488 | 2021-2022 | 87th Legislature | Introduced

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Bill Title: Relating to the practice of dentistry and the provision of teledentistry dental services.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2021-03-09 - Referred to Health & Human Services [SB488 Detail]

Download: Texas-2021-SB488-Introduced.html

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87R5130 JCG-D
By: Perry, et al. S.B. No. 488

A BILL TO BE ENTITLED
AN ACT
relating to the practice of dentistry and the provision of
teledentistry dental services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 111, Occupations Code, is
amended to read as follows:
CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
SECTION 2. Section 111.001, Occupations Code, is amended by
amending Subdivisions (1) and (3) and adding Subdivision (2-a) to
read as follows:
(1) "Dentist," "health [Health] professional," and
"physician" have the meanings assigned by Section 1455.001,
Insurance Code.
(2-a) "Teledentistry dental service" means a health
care service delivered by a dentist, or a health professional
acting under the delegation and supervision of a dentist, acting
within the scope of the dentist's or health professional's license
or certification to a patient at a different physical location than
the dentist or health professional using telecommunications or
information technology.
(3) "Telehealth service" means a health service, other
than a telemedicine medical service or a teledentistry dental
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.
SECTION 3. Section 111.002, Occupations Code, is amended to
read as follows:
Sec. 111.002. INFORMED CONSENT. (a) A treating physician,
dentist, or health professional who provides or facilitates the use
of telemedicine medical services, teledentistry dental services,
or telehealth services shall ensure that the informed consent of
the patient, or another appropriate individual authorized to make
health care treatment decisions for the patient, is obtained before
telemedicine medical services, teledentistry dental services, or
telehealth services are provided.
(b) A dentist who delegates a teledentistry dental service
shall ensure that the informed consent of the patient includes
disclosure to the patient that the dentist has delegated the
service.
SECTION 4. Section 111.003, Occupations Code, is amended to
read as follows:
Sec. 111.003. CONFIDENTIALITY. A treating physician,
dentist, or health professional who provides or facilitates the use
of telemedicine medical services, teledentistry dental services,
or telehealth services shall ensure that the confidentiality of the
patient's clinical [medical] information is maintained as required
by Chapter 159, by Subchapter C, Chapter 258, or by other applicable
law.
SECTION 5. Section 111.004, Occupations Code, is amended
to read as follows:
Sec. 111.004. RULES. (a) The Texas Medical Board, 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.
(b) The State Board of Dental Examiners, in consultation
with the commissioner of insurance, as appropriate, may adopt rules
necessary to:
(1) ensure that patients using teledentistry dental
services receive appropriate, quality care;
(2) prevent abuse and fraud in the use of
teledentistry dental services, including rules relating to the
filing of claims and records required to be maintained in
connection with teledentistry dental services;
(3) ensure adequate supervision of health
professionals who are not dentists and who provide teledentistry
dental services under the delegation and supervision of a dentist;
and
(4) establish the maximum number of health
professionals who are not dentists that a dentist may supervise
through a teledentistry dental service.
SECTION 6. The heading to Section 111.005, Occupations
Code, is amended to read as follows:
Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES.
SECTION 7. Section 111.005, Occupations Code, is amended by
amending Subsections (a) and (b) and adding Subsection (d) to read
as follows:
(a) For purposes of Section 562.056, a valid
practitioner-patient relationship is present between a
practitioner providing a telemedicine medical service or a
teledentistry dental 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:
(A) Texas Medical Board rules with a physician
requesting coverage of medical care for the patient; or
(B) State Board of Dental Examiners rules with a
dentist requesting coverage of dental care for the patient; or
(3) provides the telemedicine medical services or
teledentistry dental 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 clinical
[medical] records, such as the relevant medical or dental 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 or teledentistry dental services to a patient as described
in Subsection (a)(3) shall:
(1) provide the patient with guidance on appropriate
follow-up care; and
(2) except as provided by Subsection (d), if the
patient consents and the patient has a primary care physician or a
regular dentist, provide to the patient's primary care physician or
regular dentist, as appropriate, within 72 hours after the
practitioner provides the services to the patient, a clinical
[medical] record or other report containing an explanation of:
(A) the treatment provided by the practitioner to
the patient; and
(B) as authorized by the law under which the
practitioner is licensed, certified, or otherwise permitted to
provide the service, the practitioner's evaluation, analysis, or
diagnosis[, as appropriate,] of the patient's condition.
(d) This subsection applies only to a teledentistry dental
service consisting of a digital three-dimensional scan of the
patient that does not affect the hard or soft tissues of the oral
cavity and that is performed at a location other than the dentist's
location. A practitioner providing a treatment based on a
teledentistry dental service to which this subsection applies is
not required to comply with Subsection (b)(2) but shall, on request
of the patient, provide to the patient the record or report
described by that subdivision after the patient has completed the
treatment.
SECTION 8. Section 111.006, Occupations Code, is amended by
adding Subsection (c) to read as follows:
(c) The State Board of Dental Examiners 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 subsection must allow for the
establishment of a practitioner-patient relationship by a
teledentistry dental service provided by a dentist to a patient in a
manner that complies with Section 111.005(a)(3) and must be
substantially similar to the rules adopted under Subsection (a) of
this section. The State Board of Dental Examiners 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 teledentistry dental
services.
SECTION 9. Section 111.007, Occupations Code, is amended to
read as follows:
Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.
(a) A health professional providing a health care service or
procedure as a telemedicine medical service, a teledentistry dental
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, teledentistry dental services, or telehealth services
that would impose a higher standard of care than the standard
described in Subsection (a).
SECTION 10. Chapter 111, Occupations Code, is amended by
adding Section 111.0075 to read as follows:
Sec. 111.0075. LICENSING FOR TELEDENTISTRY DENTAL
SERVICES. A health professional providing a health care service or
procedure as a teledentistry dental service is subject to the
licensing requirements that would apply to the provision of the
same health care service or procedure in an in-person setting.
SECTION 11. Chapter 111, Occupations Code, is amended by
adding Section 111.009 to read as follows:
Sec. 111.009. LIMITATION ON CERTAIN PRESCRIPTIONS. (a) In
this section, "controlled substance" and "prescribe" have the
meanings assigned by Section 481.002, Health and Safety Code.
(b) The State Board of Dental Examiners by rule shall
establish limits on the quantity of a controlled substance that a
dentist may prescribe to a patient as a teledentistry dental
service. The rules may not authorize a dentist to prescribe more
than a five-day supply of the controlled substance.
SECTION 12. Section 251.003, Occupations Code, is amended
by adding Subsection (d) to read as follows:
(d) For purposes of this subtitle, a person located in
another state practices dentistry in this state and is required to
hold a license to practice dentistry in this state if the person
through the use of any medium, including an electronic medium,
performs an act that constitutes the practice of dentistry on a
patient in this state.
SECTION 13. Chapter 254, Occupations Code, is amended by
adding Section 254.0035 to read as follows:
Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS.
The board shall adopt rules governing a call coverage agreement
between dentists.
SECTION 14. Section 258.001, Occupations Code, is amended
to read as follows:
Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not
delegate:
(1) an act to an individual who, by board order, is
prohibited from performing the act;
(2) any of the following acts to a person not licensed
as a dentist or dental hygienist:
(A) the removal of calculus, deposits, or
accretions from the natural and restored surfaces of exposed human
teeth and restorations in the human mouth;
(B) root planing or the smoothing and polishing
of roughened root surfaces or exposed human teeth; or
(C) any other act the delegation of which is
prohibited by board rule;
(3) any of the following acts to a person not licensed
as a dentist:
(A) comprehensive examination or diagnosis and
treatment planning;
(B) a surgical or cutting procedure on hard or
soft tissue;
(C) the prescription of a drug, medication, or
work authorization;
(D) the taking of an impression for a final
restoration, appliance, or prosthesis;
(E) the making of an intraoral occlusal
adjustment;
(F) direct pulp capping, pulpotomy, or any other
endodontic procedure;
(G) the final placement and intraoral adjustment
of a fixed or removable appliance; or
(H) the placement of any final restoration; or
(4) the authority to an individual to administer a
local anesthetic agent, inhalation sedative agent, parenteral
sedative agent, or general anesthetic agent, including as a
teledentistry dental service as that term is defined by Section
111.001, if the individual is not licensed as:
(A) a dentist with a permit issued by the board
for the procedure being performed, if a permit is required;
(B) a certified registered nurse anesthetist
licensed by the Texas Board of Nursing, only if the delegating
dentist holds a permit issued by the board for the procedure being
performed, if a permit is required; or
(C) a physician anesthesiologist licensed by the
Texas Medical Board.
SECTION 15. Section 262.152, Occupations Code, is amended
to read as follows:
Sec. 262.152. PERFORMANCE OF DELEGATED DUTIES. (a) Except
as provided by Section 262.1515, a dental hygienist shall practice
dental hygiene:
(1) in the dental office of a supervising dentist
licensed by the board; or
(2) in an alternate setting, including a nursing home,
the patient's home, a school, a hospital, a state institution, a
public health clinic, or another institution, under the supervision
of a supervising dentist.
(b) For purposes of this section, a dental hygienist who
practices dental hygiene as a teledentistry dental service, as
defined by Section 111.001, is practicing in an alternate setting
in compliance with Subsection (a)(2).
SECTION 16. Section 562.056(c), Occupations Code, is
amended to read as follows:
(c) For purposes of this section and Section 562.112, a
valid practitioner-patient relationship is present between a
practitioner providing telemedicine medical services or
teledentistry dental 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 17. Section 531.001, Government Code, is amended by
amending Subdivision (4-d) and adding Subdivision (6-a) to read as
follows:
(4-d) "Platform" means the technology, system,
software, application, modality, or other method through which a
health professional remotely interfaces with a patient when
providing a health care service or procedure as a telemedicine
medical service, teledentistry dental service, or telehealth
service.
(6-a) "Teledentistry dental service" has the meaning
assigned by Section 111.001, Occupations Code.
SECTION 18. Section 531.0216, Government Code, is amended
to read as follows:
Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL
SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER
MEDICAID. (a) The executive commissioner by rule shall develop and
implement a system to reimburse providers of services under
Medicaid for services performed using telemedicine medical
services, teledentistry dental services, or telehealth services.
(c) The commission shall encourage health care providers
and health care facilities to provide telemedicine medical
services, teledentistry dental services, and telehealth services
in the health care delivery system. The commission may not require
that a service be provided to a patient through telemedicine
medical services, teledentistry dental services, or telehealth
services.
(c-1) The commission shall explore opportunities to
increase STAR Health program providers' use of telemedicine medical
services in medically underserved areas of this state.
(d) Subject to Sections 111.004 and [Section] 153.004,
Occupations Code, the executive commissioner may adopt rules as
necessary to implement this section. In the rules adopted under
this section, the executive commissioner shall:
(1) refer to the site where the patient is physically
located as the patient site; and
(2) refer to the site where the physician, dentist, or
health professional providing the telemedicine medical service,
teledentistry dental service, or telehealth service is physically
located as the distant site.
(f) Not later than December 1 of each even-numbered year,
the commission shall report to the speaker of the house of
representatives and the lieutenant governor on the effects of
telemedicine medical services, teledentistry dental services,
telehealth services, and home telemonitoring services on Medicaid
in the state, including the number of physicians, dentists, health
professionals, and licensed health care facilities using
telemedicine medical services, teledentistry dental services,
telehealth services, or home telemonitoring services, the
geographic and demographic disposition of the physicians,
dentists, and health professionals, the number of patients
receiving telemedicine medical services, teledentistry dental
services, telehealth services, and home telemonitoring services,
the types of services being provided, the cost of utilization, and
the cost savings of telemedicine medical services, teledentistry
dental services, telehealth services, and home telemonitoring
services to Medicaid.
(g) The commission shall ensure that a Medicaid managed care
organization:
(1) does not deny reimbursement for a covered health
care service or procedure delivered by a health care provider with
whom the managed care organization contracts to a Medicaid
recipient as a telemedicine medical service, a teledentistry dental
service, or a telehealth service solely because the covered service
or procedure is not provided through an in-person consultation;
(2) does not limit, deny, or reduce reimbursement for
a covered health care service or procedure delivered by a health
care provider with whom the managed care organization contracts to
a Medicaid recipient as a telemedicine medical service, a
teledentistry dental service, or a telehealth service based on the
health care provider's choice of platform for providing the health
care service or procedure; and
(3) ensures that the use of telemedicine medical
services, teledentistry dental services, or telehealth services
promotes and supports patient-centered medical homes by allowing a
Medicaid recipient to receive a telemedicine medical service,
teledentistry dental service, or telehealth service from a provider
other than the recipient's primary care physician or provider,
except as provided by Section 531.0217(c-4), only if:
(A) the telemedicine medical service,
teledentistry dental service, or telehealth service is provided in
accordance with the law and contract requirements applicable to the
provision of the same health care service in an in-person setting,
including requirements regarding care coordination; and
(B) the provider of the telemedicine medical
service, teledentistry dental service, or telehealth service gives
notice to the Medicaid recipient's primary care physician or
provider regarding the [telemedicine medical service or
telehealth] service, including a summary of the service, exam
findings, a list of prescribed or administered medications, and
patient instructions, for the purpose of sharing medical
information, provided that the recipient has a primary care
physician or provider and the recipient or, if appropriate, the
recipient's parent or legal guardian, consents to the notice.
(h) The commission shall develop, document, and implement a
monitoring process to ensure that a Medicaid managed care
organization ensures that the use of telemedicine medical services,
teledentistry dental services, or telehealth services promotes and
supports patient-centered medical homes and care coordination in
accordance with Subsection (g)(3). The process must include
monitoring of the rate at which a telemedicine medical service,
teledentistry dental service, or telehealth service provider gives
notice in accordance with Subsection (g)(3)(B).
(i) The executive commissioner by rule shall ensure that a
federally-qualified [federally qualified] health center as defined
by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the
originating site facility fee or the distant site practitioner fee
or both, as appropriate, for a covered telemedicine medical
service, teledentistry dental service, or telehealth service
delivered by a health care provider to a Medicaid recipient. The
commission is required to implement this subsection only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the commission may, but is not required to, implement this
subsection using other money available to the commission for that
purpose.
(j) In complying with state and federal requirements to
provide access to medically necessary services under the Medicaid
managed care program, a Medicaid managed care organization
determining whether reimbursement for a telemedicine medical
service, teledentistry dental service, or telehealth service is
appropriate shall continue to consider other factors, including
whether reimbursement is cost-effective and whether the provision
of the service is clinically effective.
SECTION 19. The heading to Section 531.02162, Government
Code, is amended to read as follows:
Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH
TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND
TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.
SECTION 20. Sections 531.02162(b) and (c), Government Code,
are amended to read as follows:
(b) The executive commissioner by rule shall establish
policies that permit reimbursement under Medicaid and the child
health plan program for services provided through telemedicine
medical services, teledentistry dental services, and telehealth
services to children with special health care needs.
(c) The policies required under this section must:
(1) be designed to:
(A) prevent unnecessary travel and encourage
efficient use of telemedicine medical services, teledentistry
dental services, and telehealth services for children with special
health care needs in all suitable circumstances; and
(B) ensure in a cost-effective manner the
availability to a child with special health care needs of services
appropriately performed using telemedicine medical services,
teledentistry dental services, and telehealth services that are
comparable to the same types of services available to that child
without the use of telemedicine medical services, teledentistry
dental services, and telehealth services; and
(2) provide for reimbursement of multiple providers of
different services who participate in a single session of
telemedicine medical services, teledentistry dental services,
[and] telehealth services, or any combination of those services,
[session] for a child with special health care needs, if the
commission determines that reimbursing each provider for the
session is cost-effective in comparison to the costs that would be
involved in obtaining the services from providers without the use
of telemedicine medical services, teledentistry dental services,
and telehealth services, including the costs of transportation and
lodging and other direct costs.
SECTION 21. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02172 to read as follows:
Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL
SERVICES. (a) The commission by rule shall require each health and
human services agency that administers a part of the Medicaid
program to provide Medicaid reimbursement for teledentistry dental
services provided by a dentist licensed to practice dentistry in
this state.
(b) The commission shall require reimbursement for a
teledentistry dental service at the same rate as the Medicaid
program reimburses for the same in-person dental service. A
request for reimbursement may not be denied solely because an
in-person dental service between a dentist and a patient did not
occur. The commission may not limit a dentist's choice of platform
for providing a teledentistry dental service by requiring that the
dentist use a particular platform to receive reimbursement for the
service.
(c) The State Board of Dental Examiners, in consultation
with the commission and the commission's office of inspector
general, as appropriate, may adopt rules as necessary to:
(1) ensure that appropriate care, including quality of
care, is provided to patients who receive teledentistry dental
services; and
(2) prevent abuse and fraud through the use of
teledentistry dental services, including rules relating to filing
claims and the records required to be maintained in connection with
teledentistry dental services.
SECTION 22. The heading to Section 62.157, Health and
Safety Code, is amended to read as follows:
Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY
DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL
HEALTH CARE NEEDS.
SECTION 23. Sections 62.157(a) and (b), Health and Safety
Code, are amended to read as follows:
(a) In providing covered benefits to a child with special
health care needs, a health plan provider must permit benefits to be
provided through telemedicine medical services, teledentistry
dental services, and telehealth services in accordance with
policies developed by the commission.
(b) The policies must provide for:
(1) the availability of covered benefits
appropriately provided through telemedicine medical services,
teledentistry dental services, and telehealth services that are
comparable to the same types of covered benefits provided without
the use of telemedicine medical services, teledentistry dental
services, and telehealth services; and
(2) the availability of covered benefits for different
services performed by multiple health care providers during a
single [telemedicine medical services and telehealth services]
session of telemedicine medical services, teledentistry dental
services, telehealth services, or any combination of those
services, if the executive commissioner determines that delivery of
the covered benefits in that manner is cost-effective in comparison
to the costs that would be involved in obtaining the services from
providers without the use of telemedicine medical services,
teledentistry dental services, and telehealth services, including
the costs of transportation and lodging and other direct costs.
SECTION 24. Section 62.1571, Health and Safety Code, is
amended to read as follows:
Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND
TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits
to a child, a health plan provider must permit benefits to be
provided through telemedicine medical services and teledentistry
dental services in accordance with policies developed by the
commission.
(b) The policies must provide for:
(1) the availability of covered benefits
appropriately provided through telemedicine medical services and
teledentistry dental services that are comparable to the same types
of covered benefits provided without the use of telemedicine
medical services and teledentistry dental services; and
(2) the availability of covered benefits for different
services performed by multiple health care providers during a
single session of telemedicine medical services, teledentistry
dental services, or both services, if the executive commissioner
determines that delivery of the covered benefits in that manner is
cost-effective in comparison to the costs that would be involved in
obtaining the services from providers without the use of
telemedicine medical services or teledentistry dental services,
including the costs of transportation and lodging and other direct
costs.
(c) [(d)] In this section, "teledentistry dental service"
and "telemedicine medical service" have [has] the meanings
[meaning] assigned by Section 531.001, Government Code.
SECTION 25. The heading to Chapter 1455, Insurance Code, is
amended to read as follows:
CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
SECTION 26. Section 1455.001, Insurance Code, is amended by
amending Subdivisions (1) and (3) and adding Subdivision (1-a) to
read as follows:
(1) "Dentist" means a person licensed to practice
dentistry in this state under Subtitle D, Title 3, Occupations
Code.
(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
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.
(3) "Teledentistry dental service," "telehealth
["Telehealth] service," and "telemedicine medical service" have
the meanings assigned by Section 111.001, Occupations Code.
SECTION 27. Section 1455.004, Insurance Code, is amended to
read as follows:
Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES,
TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A
health benefit plan:
(1) must provide coverage 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, teledentistry dental service, or telehealth service on the
same basis and to the same extent that the plan provides coverage
for the service or procedure in an in-person setting; and
(2) may not:
(A) 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, a teledentistry dental service, or a telehealth service
solely because the covered health care service or procedure is not
provided through an in-person consultation; and
(B) subject to Subsection (c), limit, deny, or
reduce coverage for a covered health care service or procedure
delivered as a telemedicine medical service, teledentistry dental
service, or telehealth service based on the health professional's
choice of platform for delivering the service or procedure.
(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, a teledentistry dental 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 service or procedure provided
through an in-person consultation.
(b-1) Subsection (b) does not authorize a health benefit
plan to charge a separate deductible that applies only to a covered
health care service or procedure delivered as a telemedicine
medical service, teledentistry dental service, or telehealth
service.
(c) Notwithstanding Subsection (a), a health benefit plan
is not required to provide coverage for a telemedicine medical
service, a teledentistry dental 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.
(d) A health benefit plan may not impose an annual or
lifetime maximum on coverage for covered health care services or
procedures delivered as telemedicine medical services,
teledentistry dental services, or telehealth services other than
the annual or lifetime maximum, if any, that applies in the
aggregate to all items and services and procedures covered under
the plan.
SECTION 28. Section 1455.006, Insurance Code, is amended to
read as follows:
Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES,
TELEDENTISTRY DENTAL 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, teledentistry dental 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, teledentistry dental services, or
telehealth services.
SECTION 29. Not later than March 1, 2022:
(1) the State Board of Dental Examiners and the Texas
State Board of Pharmacy shall jointly adopt rules as required by
Section 111.006(c), Occupations Code, as added by this Act;
(2) the State Board of Dental Examiners shall adopt:
(A) rules necessary to implement Chapter 111,
Occupations Code, as amended by this Act; and
(B) rules as required by Section 254.0035,
Occupations Code, as added by this Act; and
(3) the Health and Human Services Commission shall
adopt rules as required by Section 531.02172, Government Code, as
added by this Act.
SECTION 30. If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 31. (a) Except as provided by Subsection (b) of
this section, this Act takes effect September 1, 2021.
(b) Sections 1455.004 and 1455.006, Insurance Code, as
amended by this Act, take effect January 1, 2022.