Texas House Passes Bill to Allow Virtual Visits

Ken Terry

May 11, 2017

By a unanimous vote, the Texas House of Representatives today passed a bill that will allow physicians licensed in Texas to supply telemedicine services to patients they have never met in person. The bill must now be reconciled with a similar state Senate version that was passed earlier. It is expected to go to Texas Governor Greg Abbott and be signed into law by the end of the month.

The legislation stipulates that a valid practitioner-patient relationship is considered to exist between a telemedicine provider and a patient he or she has not previously encountered if the telemedicine provider meets certain requirements.

The virtual visit must either be audiovisual or use "store-and-forward" technology in conjunction with an audio-only interaction. In addition, the telemedicine practitioner is required to access and use relevant clinical information to meet the same standard of care as in-person encounters. And, within 72 hours, the telemedicine provider must send a report on the encounter to the patient's primary care provider.

The bill also directs the Texas Medical Board (TMB), the Texas Board of Nursing, the Texas Physician Assistant Board, and the Texas State Board of Pharmacy to jointly develop rules that define valid prescriptions for telemedicine visits. The measure states, however, that a telemedicine provider cannot prescribe abortion drugs.

Access to Rural Areas

Gerald Ray Callas, MD, chair of the Texas Medical Association (TMA) Council on Legislation, told Medscape Medical News that the TMA supported the legislation because it would increase access to care in rural areas while maintaining the standard of care in virtual visits.

"Telemedicine is a great avenue to improve patients' access and allow them to have access to physicians in rural communities and other communities where physicians are at a shortage, but still giving them the same advantage that people in big cities and suburbs have," he said.

The final bill was the result of a collaboration among physicians, telemedicine companies, and legislators, Dr Callas noted. Its passage followed protracted litigation between the TMB and Teladoc, a telemedicine firm based in Lewisville, Texas. In 2015, after a TMB decision that barred telemedicine doctors from prescribing medications, Teladoc filed a federal antitrust suit against the TMB and obtained an injunction against the enforcement of the prescribing rule. The suit was suspended a few months ago at the request of both sides.

Asked how the telemedicine bill allays the concerns of the TMA and the TMB about telemedicine doctors prescribing drugs, Dr Callas explained that, up to now, there was no guarantee that a telemedicine provider would have a Texas medical license or uphold the standard of care. The bill addresses both of those concerns. In addition, he noted, the TMA wanted to ensure that doctors had medical records on the patients they were treating remotely.

"We didn't want it to be just 'swipe a credit card and you get a prescription,' because we felt that wasn't delivering high quality care," he explained "We wanted to maintain the standard of care, but also to use videoconferencing to improve access."

Dr Callas said he believes that telehealth providers will make good-faith efforts to obtain medical records before they care for patients online. However, he admitted that, because of the lack of interoperability between different electronic health record  systems, this might be impossible in many cases.

At the time that a draft version of the Senate bill was introduced, Dr Callas told Medscape Medical News that he expected it would go through some changes before it was introduced and voted on. Regarding the alterations in what appears to be a very similar measure, he said, "The changes that were made allowed this bill to be collaborative rather than a turf war."

The House version includes a section that says health plans cannot exclude from coverage services that are provided through telemedicine. In addition, a health plan's deductible, copayment, or coinsurance for telemedicine services cannot exceed those for in-person services.

The American Medical Association (AMA) last June changed its policy on telemedicine, admitting that it was ethical to diagnose patients online, with certain caveats. The new policy reflects the evolution of state laws on telemedicine. According to an AMA survey, "all states allow a physician to establish a relationship with a new patient via telemedicine, although state laws differ." Some states require that the patient be in an established medical site during a telemedicine consult, for example, and others limit the types of modalities that can be used.

A Teladoc spokesman was not available for comment at press time. But American Well, one of Teladoc's competitors, was pleased by the bill's passage. "We are thrilled that this bill has passed and we can now bring safe and effective telehealth to patients in Texas," said Roy Schoenberg, MD, CEO of American Well, in an email to Medscape Medical News. "Beginning June 1, primary care and specialty care providers in Online Care Group, our clinical partner, will be available for telehealth visits in Texas."

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