bill requiring equal pay for telehealth and in-person care

The text as introduced · 624 words

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.