HB 5343 — Relating to the reimbursement and payment of claims by certain health benefit plan issuers for telemedicine medical services, teledentistry dental services, and telehealth services.

Summary

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

Bill Text

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends 1 section(s) of the Texas statutes: Section 1455.001(1-a), Insurance Code.

• Section 1455.001(1-a), Insurance Code

  or → , including a mental health professional, ; 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

  amended

• 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.

  amended

Action History

1. April 07, 2025

   Referred to Insurance

2. April 07, 2025

   Read first time

3. March 14, 2025

   Filed

Sponsors

• Ryan Guillen · Primary

Subjects