What does the emergency rule require?
Under the emergency rule, state-regulated health insurers and health maintenance organizations must:
- Pay in-network health professionals at least the same rate for telemedicine services as for in-person services, including covered mental health services.
- Cover telemedicine services using any platform permitted by state law.
- Not require more documentation for telemedicine services than they require for in-person services.
Governor Greg Abbott also suspended a law limiting coverage for medical services or consultations by phone. By suspending the law, insurers must pay for covered visits or consultations provided over the phone.
In addition, the Texas Medical Board (TMB) issued guidance March 14 to allow physicians and other health-care professionals to use phone consultations to establish a physician-patient relationship. Before the change, telemedicine services could be provided only after the physician-patient relationship had been established during an in-person visit.
For provider questions on what types of care can be provided by telephone or telemedicine, documentation, and billing, providers should see the Texas Medical Board FAQ, which includes billing guidance, or check with the agency that issued your license.
What health insurers must comply with this rule?
The emergency rule applies to fully funded health plans regulated by the state. This accounts for about 15% of the Texas market and includes plans purchased through Healthcare.gov.
It doesn’t apply to Medicare or Medicaid. (The federal government also has issued information expanding access to telemedicine for Medicare services.)
- For questions about Medicare call 800-252-9240
- For questions about Medicaid plans call 800-252-8263
It also doesn’t apply to the state employee or teacher retirement systems or self-funded employer-sponsored health plans. For these plans, contact the health plan administrator.
- For Employee Retirement System plans, call 877-275-4377
- For Teacher Retirement Systems plans, call 888-237-6762
How do I know if someone has state-regulated coverage?
State-regulated plans include:
- Plans that have “TDI” or “DOI” on the ID cards. (See examples)
- Short-term insurance, disability plans, and other limited benefit plans.
What providers are included in TDI’s emergency rule on telemedicine?
TDI’s emergency rule uses the definition of health professional from Insurance Code 1455.001. This definition includes licensed physicians and others, such as:
- Licensed or certified mental health professionals
- Physician assistants
- Nurse practitioners
- Dentists
- Physical therapists
How will health-care professionals code claims for telemedicine services?
Please see the Texas Medical Board FAQ. If you still have questions, call 800-248-4062. For providers not licensed by the Texas Medical Board, please contact the regulatory agency that issued your license.
The U.S. Centers for Medicare and Medicaid Services also has issued guidance on Medicare billing for telemedicine.
How long does the emergency rule last?
The rule, extended in June, will remain in effect through September 12.
Are there concerns these temporary changes could create opportunities for fraud?
The Texas Department of Insurance, Texas Medical Board, and other relevant state agencies will investigate allegations of fraud and take action as warranted. Violations of law will be subject to civil or criminal penalties.