Over the weekend, Texas Governor Greg Abbott signed a bill modifying the state’s current regulatory structure regarding telemedicine.
Telemedicine is a fast-growing trend in the group health plan world. A telemedicine feature allows covered employees and dependents to have a virtual, or online, office visit with a healthcare provider, saving both time and money. However, in 2015 the Texas Medical Board amended its rules to restrict the practice of telemedicine by first requiring a face-to-face consultation to establish a practitioner-patient relationship.
That ruling put a crimp on employers’ ability to offer telemedicine in Texas, because it meant that a covered employee or dependent could only have a virtual office visit with a healthcare professional with whom the employee or dependent had previously met face-to-face. In response, Teladoc, a provider of telemedicine services, filed suit claiming the Medical Board’s rules violated federal law. The court barred the Medical Board from enforcing its rule, pending the outcome of the lawsuit.
The law signed by Gov. Abbott eliminates the face-to-face requirement imposed by the Medical Board and clears the way for the telemedicine trend to continue unhindered in Texas. In addition, the law prohibits insurers, in their policies covering Texas residents, from excluding services delivered via telecommunications simply because they were not provided during an in-person consultation. It also prohibits cost share differences. The law does prohibit a physician from prescribing drugs or devices related to abortions or rendering mental health services using telecommunications.
Lockton comment: The law’s restriction on an insurer’s ability to restrict coverage for telemedicine services does not affect sponsors of self-insured ERISA plans. Presumably, a self-funded ERISA plan may restrict benefits for services provided using telecommunications, although whether the plan could do so with respect to preventive care is unclear (the Affordable Care Act requires a plan to pay for a variety of preventive care treatment without any cost sharing on the part of the covered person and doesn’t differentiate between in-person care and care provided via telemedicine).
Many self-funded plan sponsors are willing to cover telemedicine services because the per-unit cost is cheaper than a face-to-face visit. As a result, it seems unlikely a self-insured plan sponsor would look to discourage telemedicine utilization, even if it can.
This portion of the law applicable to insurance carriers applies to policies issued on or after January 1, 2018.
Should you have any questions, please do not hesitate to contact Compliance Services.