HB5343 - Relating to the reimbursement and payment of claims by certain health benefit plan issuers for telemedicine medical services, teledentistry dental services, and telehealth services.

  89R5799 MEW-D     By: Guillen H.B. No. 5343       A BILL TO BE ENTITLED   AN ACT   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; [ or ]                      (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, 2026. A health benefit   plan delivered, issued for delivery, or renewed before January 1,   2026, 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, 2025.