85R22531 EES-F     By: Schwertner, et al. S.B. No. 1107     (Price, Coleman, Springer, et al.)     Substitute the following for S.B. No. 1107:  No.       A BILL TO BE ENTITLED   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.