87R4665 JCG-D     By: Guerra H.B. No. 1742       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 that a dentist may delegate to and   supervise through a teledentistry dental service not more than two   health professionals who are not dentists.          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)  subject to 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)  A practitioner who provides teledentistry dental   services to a patient as described in Subsection (a)(3):                (1)  on the date the practitioner first provides the   teledentistry dental services, shall inform the patient of the   limitation provided by Subdivision (2); and                (2)  may only provide teledentistry dental services   with respect to the patient for 12 months unless:                      (A)  a dentist performs an in-person tactile and   visual examination of the hard and soft tissues of the patient's   oral cavity; and                      (B)  the practitioner receives notice of the   examination described by Paragraph (A).          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). 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 Sections 111.009, 111.010, and 111.011 to read as follows:          Sec. 111.009.  CERTAIN PRESCRIPTIONS PROHIBITED. (a) In   this section, "controlled substance" and "prescribe" have the   meanings assigned by Section 481.002, Health and Safety Code.          (b)  A dentist may not prescribe a controlled substance to a   patient as a teledentistry dental service.          Sec. 111.010.  DENTIST'S DUTY REGARDING FOLLOW-UP CARE FOR   ACUTE DENTAL CONDITION. (a) A dentist who treats a patient for an   acute dental condition as a teledentistry dental service shall, not   later than six weeks after the date of the service:                (1)  contact or attempt to contact the patient to   schedule an in-person dental service for the patient in connection   with the acute dental condition; or                (2)  refer the patient to another dentist for the   service described by Subdivision (1).           (b)  A violation of Subsection (a) constitutes a ground for   disciplinary action under Section 263.002.          Sec. 111.011.  STUDY AND REPORT. (a) The State Board of   Dental Examiners shall study the extent to which teledentistry   dental services may be used to substantially increase access to   dental care for the children of low-income families, including the   use of teledentistry dental services to perform a consultation   before referring the child's parents or legal guardians to   charitable organizations providing access to affordable dental   care.          (b)  Not later than December 1, 2022, the board shall report   the results of the study conducted under Subsection (a) to the   standing committee of each house of the legislature with primary   jurisdiction over the board.          (c)  This section expires January 1, 2023.          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)  Subsection (c) does not prohibit the authorization of   the provision of any service to a patient through teledentistry   dental services if:                (1)  the patient requests the service; and                (2)  the provision of the service through teledentistry   does not violate the standard of care applicable to the service.          (c-2)  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.  Section 531.02162, Government Code, is amended   by amending Subsections (b) and (c) and adding Subsection (d) 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.          (d)  The policies established under this section may   authorize the provision of a service as a teledentistry dental   service only if the provision of the service through teledentistry   does not violate the standard of care applicable to the service.          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.