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    Telemedicine and Telehealth

       

    Legislation 

    Passed during the 2017 Texas Legislative (Regular) Session, SB 1107 establishes statutory definitions of telehealth and telemedicine and clarifies that the standard of care for a traditional, in-person setting also applies to these services. A physician-patient relationship must be established either through a preexisting relationship, a call coverage agreement, or through a valid telemedicine delivery method.

    Language in the bill makes it clearer that telemedicine is not a distinct service, but a tool physicians can use.

     

    Payer Policies

    The bill also addresses insurer coverage for telemedicine services. A health plan may not exclude from coverage telemedicine services solely because the covered service or procedure is not provided through an in-person consultation. Health plans are to post on their websites an explanation of their payment practices for telemedicine services. Although the bill does not require payment parity, it does provide coverage parity.

    Coverage for telemedicine care varies by plan, so it is important to verify each patient's benefits to determine if payment will be made. Payer polices for the major market payers can be accessed on our Telemedicine Payer Policy tool. These policies are subject to change. Please verify individual payer rules and patient benefits prior to rendering telemedicine services.


    Rules 

    The Texas Medical Board (TMB) published the amended rules that went into effect Nov 26, 2017, under Chapter 174 of the Administrative Code.

    Other state agencies also have updated their rules under Chapter 111 of the Occupations Code and Section 1455 of the Insurance Code.

    Below is some info on these rules: 

    Minimum Standards Rule 174.6

    – A physician is subject to the same standard of care that would apply to the provision of the same health care service or procedure in an in-person setting; must establish a physician-patient relationship; and must maintain complete and accurate medical records as set out in TMB Rules Chapter 165.1 Medical Records.
    – Adequate measures must be implemented to ensure that patient communications, recordings and records are protected consistent with Federal and State privacy laws.

    Practitioner-Patient Relationship for Telemedicine Medical Services - Occupations Code 111.005 

    – A defined physician-patient relationship is established either through a preexisting relationship, a call coverage agreement, or through a valid telemedicine delivery method.
    – If the relationship is established using a valid telemedicine delivery method, the physician must be able to access and use clinically-relevant info that would be required to meet the standard of care.
    – Valid telemedicine delivery methods are defined in the link above.
    – The patient must be provided with guidance on appropriate follow-up care. If the patient consents, info about the care is to be provided to the patient's primary care physician within 72 hours following services rendered. 

    Prevention of Fraud and Abuse Rule 174.3

    – Physicians must adopt protocols to prevent fraud and abuse. The protocols must be consistent with standards established by the Health & Human Services Commission pursuant to Section 531.02161 of the Government Code. 

    Notice to Patients Rule 174.4

    – Physicians must provide notice to patients of the physician's privacy practices prior to evaluation or treatment and make a good faith effort to obtain the patient's written or electronic acknowledgement of the notice.
    – A notice of how patients may file a complaint with the TMB also must be provided on the physician's website or with informed consent materials prior to services being performed. Content and method of the notice must be consistent with TMB Rules Chapter 178.3 Complaint Procedure Notification.

    Issuance of Prescriptions Rule 174.5

    The validity of a prescription is determined by the same standards that would apply to the issuance of the prescription in an in-person setting. A physician is expected to meet the standard of care and demonstrate professional standards and judgment, consistent with all applicable statutes and rules. The rule defines a valid prescription and includes limitations on the treatment of chronic pain.

    Limitation on Treatment of Chronic Pain Rule 174.5(e)

    TMB has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service. TMB defines chronic pain under TMB Rules 170.2(4) Pain Management. Treatment of chronic pain with scheduled drugs through use of telemedicine medical services is prohibited, unless otherwise allowed under Federal and State law. This rule also discusses the treatment of acute pain.

    Mental Health Services Rule 174.9

    As many areas of the state lack access to mental health services and providers, the use of technology can help alleviate this shortage. Therefore, the TMB has enacted rules that provide greater access to care, while still insuring patent safety.

    State Licensure Rule 174.8

    – Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas.
    – An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Occupations Code Section 151.056, as well as TMB Rule 172.2(g)(4) Construction and Definitions, and TMB Rule 172.12(f) Out-of-State Telemedicine License. For more TMB info on the limited Out of State Telemedicine License.

    Purpose Rule 174.1 and Definitions Rule 174.2

    The "Purpose" of the rules clarify to whom the rules do not apply. The "Definitions" provide the meaning of a prescription and under which Code the meanings of other terms may be found.

    Insurance coverage for Telemedicine Medical Services - Insurance Code 1455 

    Defines the exceptions and coverage to be provided for telemedicine medical services. Health plans are to post on their websites an explanation of their payment practices.

    Below are links to the complete Texas Medical Board rules and answers to frequently asked questions:

    TMB rules Chapter 174 - Telemedicine
    – FAQs for Licensees - Click on the header 'telemedicine'

     

    Additional Resources

    American Telemedicine Association (ATA):
    The American Telemedicine Association has many resources, educational courses and events. The ATA is a non-profit association with a membership network of thousands of industry leaders and healthcare professionals.

     

    Texas Medical Association (TMA):
    – For TMA resources see Telemedicine in Texas
    – Coker Group offers TMA physician members free technology contract review services. It is a member of TMA-approved Group Discount Programs.
    – TMA has adopted policy 290.009 Guidelines for Electronic Communications with Patients.
    – To view all TMA telemedicine policy, go to the TMA Policy Index and scroll down to the header Telemedicine.

     

    America's Health Insurance Plans (AHIP):
     – A brief, Nov 2017 - Telehealth Connects Patients and Doctors in Real Time

     

    American Medical Association (AMA):
    – For AMA resources on telemedicine and new health technology, see Digital Health Payment
    – AMA Code of Medical Ethics under Consent, Communication Opinion 2.3.1 Electronic Communications with Patients.
    – To view all AMA telemedicine policy, go to the AMA PolicyFinder and use the search feature.