Telemedicine in Texas — A Comprehensive Guide to Texas Telemedicine Laws, Rules, and Regulations

Posted by Michael Hsu on 5/27/20 5:35 AM
Michael Hsu

Texas is a state with some of the most detailed and restrictive regulations regarding telemedicine in the United States. Despite the multitude of bills and regulations surrounding providing remote medical care to patients, until recently, medical professionals in Texas were quite limited in how they could practice telemedicine.

The State of Texas enacted its telehealth parity law back in 1997. It makes sense that Texas was among the first to consider telehealth as a suitable alternative to in-person visits, given its large rural population and the shortage of healthcare providers. 

The ‘97 parity law stated that private payers must reimburse telemedicine services in the same way they would reimburse in-person visits. Before they could start offering remote medical services, healthcare organizations and professionals had to establish in-person relationships with the patients. 

This restriction stems from the fact that Texas legislators view telemedicine as an additional way to provide healthcare services, rather than a replacement for in-person visits. Teladoc sued the Texas government in 2015 and fought for their right to practice telemedicine and prescribe medicine via a telemedicine solution, not just in person.

Over time, the need to establish in-person contact prior to providing remote services proved to be a hindrance. Texas legislators started leaning towards a more flexible approach to telemedicine, and the 2017 Senate Bill 1107 marked a significant shift in how healthcare professionals could provide telemedicine services in Texas. 

Several more changes were made in the face of the COVID-19 emergency, but it is still unclear whether these are just temporary measures or if they’ll be made into permanent amendments to the current legislation.

Before we delve into the heart of the matter and take a closer look at all the relevant Texas telemedicine laws and regulations, it’s important to note that Texas law makes a distinction between two terms that are often used interchangeably — telemedicine and telehealth. 

Telemedicine and telehealth in Texas state law

Prior to Senate Bill 1107, the statutory definition of telemedicine implied that the physician had to initiate telemedicine with a patient they were already treating in-person and explicitly excluded telephone communication. 

These limitations no longer apply. The amended definition states that physicians licensed in the state or healthcare professionals under their delegation may deliver healthcare services to patients at a different location using telecommunications or information technology. 

Texas law also recognizes telemedicine and telehealth as separate remote healthcare services. Telemedicine is defined as a remote healthcare service delivered by a Texas physician, whereas telehealth is described as a healthcare service “other than telemedicine medical service” delivered by a healthcare professional. 

The definition isn’t the most straightforward, but it’s clear that Texas law views telemedicine and telehealth as mutually exclusive terms. The definition provided by the Senate Bill 1107 implies that only physicians can provide remote services that include:

  1. Clinical assessment
  2. Diagnosis
  3. Treatment

Telehealth refers to all other types of remote medical services that do not require clinical assessment, diagnosis, and treatment. This distinction serves as a basis for determining what other regulations apply in specific cases. One example is that only licensed physicians can provide online prescriptions. 

Texas telemedicine legal guidelines

Senate Bill 1107 provides legal guidelines for healthcare professionals that want to offer telemedicine and telehealth services to patients within the state. The Texas Medical Board (TMB) enforces additional Texas telemedicine rules and regulations that healthcare providers must abide by. 

We’ll break down the laws, rules, and regulations into several areas so that you have an easier time understanding the requirements for practicing telemedicine in this state. 

In this article, we’ll cover: 

  1. Who can provide remote healthcare services in Texas
  2. Requirements for establishing a doctor-patient relationship
  3. Obtaining a cross-state telemedicine license
  4. Patient consent requirements
  5. Prescription requirements
  6. Documenting telemedicine encounters
  7. Special requirements for mental health services
  8. Reimbursement
  9. Regulations waived in the face of COVID-19 emergency 

We’ll also show you how you can have a successful start with telemedicine in Texas with Curogram — a modern, fully HIPAA compliant telemedicine solution.

Who can provide remote healthcare services in Texas?

Texas law doesn’t specify which healthcare providers are eligible to practice telemedicine or telehealth, but Texas Medicaid does. 

Medicaid is a cooperative state and federal venture that aims to provide free medical care for persons in need who cannot otherwise afford it. This includes free telehealth and telemedicine visits. 

Under Medicaid’s definition, healthcare professionals eligible to provide these remote services include:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Advanced Practice Registered Nurses (APRNs)
  • Certified nurse-midwives
  • Certified nutritionists
  • Licensed dietitians
  • Licensed professional counselors
  • Psychologists
  • Provisionally licensed psychologists
  • Licensed psychological associate
  • Licensed marriage and family therapists

Requirements for establishing a doctor-patient relationship

As we’ve mentioned, before Senate Bill 1107 was enacted, physicians had to establish in-person contact with the patients prior to offering them telemedicine services. The bill removed this requirement by explicitly stating that rules enforced by the Texas Medical Board (TMB) must enable “the establishment of a practitioner-patient relationship by a telemedicine medical service.”

This no longer limits healthcare professionals to offer telemedicine and telehealth services only to their existing patients. 

Patients can now reach out to healthcare providers and request remote appointments and other services without having to establish an in-person connection first.

One thing to note here is that TMB has maintained the authority to ensure that telemedicine and telehealth patients are receiving the proper level of care known as “standard of care”. The Board hasn’t relied on this authority to specify when an in-person meeting is necessary, but they have the authority to do so. This means that telemedicine practitioners in the state of Texas should stay up-to-date with TMB rules and regulations, should the Board choose to enforce this rule in the future. 

Despite not having an in-person meeting beforehand, practitioners providing remote healthcare services must hold up to the standard of care. This essentially means that the telemedicine and telehealth services they provide must be on-par with the services and care in an in-person setting. In essence seeing a doctor in person or remotely using telemedicine services should yield the same type of care and the TMA board made it clear that medical legally this would be enforced. 

With the ability to see “new” patients via telemedicine, you really need a telemedicine solution such as Curogram that enables you to easily and automatically collect new patient intake forms electronically via text or email prior to the visit.

As far as the practitioner-patient relationships go, it is understood that such a relationship is established when the two parties enter an expressed or implied contract. 

The two parties don’t have to sign a contract formally. In the context of telemedicine, it’s enough for the patient to agree to receive remote medical treatment and the practitioner to agree to provide it. It is good practice, however, to verbally obtain consent for telemedicine and document it in one's EMR. 

Put simply, as far as Texas law is concerned, the practitioner-patient relationship is immediately established when a patient enters a virtual appointment with a healthcare professional. This is a significant improvement to the prior in-person meeting requirement. With Covid-19 the TMA formally approved of new patient encounters using telemedicine, when in the past, that was prohibited. 

Obtaining a cross-state telemedicine license

Texas law doesn’t limit providing telemedicine and telehealth services exclusively to practitioners located within the state’s borders. The Texas Medical Board allows out-of-state healthcare professionals to obtain a telemedicine license that would allow them to provide remote services to patients in Texas. 

There are some limitations. An out-of-state telemedicine license applies in specific circumstances, and telemedicine practice under this license is limited to:

  • Interpretation of diagnostic testing and reporting of results to a licensed physician practicing in Texas
  • Follow-up of patients that received the majority of patient care in another state

Practitioners holding the Texas out-of-state telemedicine license must abide by the same laws, rules, and regulations as fully licensed practitioners based in Texas. 

Healthcare providers located within the state of Texas don’t need a special license to provide telemedicine and telehealth services, as long as they’re licensed to practice medicine in the state. They merely need to obtain patient consent before admitting them to virtual appointments. 

Patient consent requirements

Texas law states that practitioners must first obtain informed consent from the patients or other individuals authorized to make healthcare decisions for the patient before offering telemedicine and telehealth services. 

Note that Senate Bill 1107 doesn’t state that you need to obtain written consent. The shift from the previously rigid regulations that hindered practitioners in their effort to provide remote healthcare services resulted in much more flexible legislation. As far as Texas law is concerned, consent is implied upon establishing a practitioner-patient relationship, so you do not have to worry about storing documents with explicit written consent from each patient.

Curogram offers built-in teleconsent templates that allow you to customize your consent language, and patients are automatically presented this consent electronically prior to entering a video chat.

That said, there are a few considerations here. Texas laws state that telemedicine services providers need to inform the patients of the privacy and confidentiality risks associated with sharing personal health information (PHI) via the telemedicine solution they’re using. Practitioners must explain thoroughly the complaint process in the event of any alleged misconduct on their part. 

Prescription requirements

Issuing prescriptions after virtual appointments falls under the same standards and requirements that apply in an in-person setting. Texas law also adds a prerequisite that states a valid practitioner-patient relationship must exist prior to the issuance of any prescriptions. 

Healthcare professionals who intend to issue online prescriptions can meet this requirement in one of three ways:

  1. By having an existing relationship with the patient that originated in an in-person setting
  2. By complying with the Texas Medical Board rules regarding patient communication via valid call coverage 
  3. By leveraging appropriate technology that enables access to the necessary clinical information

Having an existing relationship with the patient

This one is pretty straightforward — if you have a valid practitioner-patient relationship that started out with the patient visiting your practice in person, this relationship extends to telemedicine as well. 

In this case, physicians can issue online prescriptions without having to meet any additional requirements, given that they’re already well-aware of the patient’s condition and have their medical records. 

Call coverage

This TMB rule enables specialists to enter a call coverage agreement with another physician’s established patients. In order to do so, the requesting physician must provide detailed reports to the covering physician following each online meeting with the patients. 

The goal of this rule is to enable patients to receive remote healthcare services that their current physician cannot provide from another physician, without having to come in for an in-person meeting. This has proven to be a necessity, given the large rural population in Texas and the overall shortage of healthcare providers and specialists.

Leveraging appropriate technology

This requirement states that physicians can enter a valid practitioner-patient relationship if they utilize technology, which gives them access to relevant clinical information, enabling them to meet the standard of care.

This technology must be one of the following:

  • Audio-video interaction between the practitioner and patient in real-time
  • Asynchronous store-and-forward technology if the physician relies on photographic or video images or the patient’s medical records
  • Another type of audio-visual interaction that allows the physician to comply with the standards of care

The definitions provided by TMB are a bit unclear and are left for interpretation. The technology used in providing telemedicine services must be fully HIPAA compliant, meaning that apart from enabling audio-video interaction, any protected health information (PHI) must be stored and maintained, as well as secure, both at rest and in transit. 

Curogram is a fully HIPAA compliant telemedicine solution that enables secure two-way messaging between practitioners and patients, as well as internal staff messaging and file sharing. 

Our platform also enables you to hold virtual meetings in compliance with both federal and Texas state laws, allowing you to provide remote healthcare services to patients in an environment that mimics in-person workflows.

Documenting telemedicine encounters

Under Texas laws, physicians providing telemedicine services are under the obligation to store and maintain medical health records in the same way they would if the services were provided in-person. 

This means that you must maintain your electronic health record (EHR), update it, and add new medical information following a virtual appointment. You must also provide a visit summary to the patients after the virtual visit. 

This represents a challenge if you’re using a telemedicine solution that doesn’t integrate with your EHR. You would have to manually enter all the data after each visit, spending valuable time on administrative tasks, rather than treating more patients.

That’s why Curogram is the perfect solution. Our platform integrates with over 700 EHRs and eliminates the need for double and manual entry, allowing you to streamline your workflows and admit more telemedicine patients daily.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

You can send visit summaries and other relevant medical information to your patients with a single click. They’ll receive a link in a text message and can download the Curogram patient app to access the information. That way, sensitive medical information is only shared through secure communication channels, ensuring you’re 100% HIPAA compliant. 

Special requirements for mental health services

When it comes to providing mental health services, Texas law exempts practitioners from several remote care requirements, most notably establishing a relationship with the customer. 

This effectively means that medical professionals can offer remote mental health services to patients through telemedicine, regardless if they’re an existing patient of the provider or other licensed practitioner in Texas, or not. All other rules regarding licensing, certifications, and proper medical care still apply.

Reimbursement

Given the Texas telehealth parity law, private payers have to reimburse the healthcare providers for telemedicine and telehealth services in the same way they would if they received the services in-person.

It’s interesting to note that Texas laws prohibit certain state-regulated health plans from excluding telemedicine and telehealth from coverage if the only basis for doing so is that the service was not provided in-person. This doesn’t mean that telemedicine must be covered by the health plan, nor that the rates for in-person visits and virtual appointments have to be the same.

Texas law also requires health plan issuers to publish the issuer’s policies and payment practices for telemedicine medical services. If you intend to offer telemedicine services in the state of Texas, you should carefully check network agreements with health plans to ensure that they cover telemedicine services as well.

If a health plan does not cover telemedicine services, you may be able to bill the patient for the remote healthcare services your practice provides. You may also be eligible for payment if you’re providing telemedicine services to the beneficiaries of Medicaid and Medicare.

Regulations waived in the face of COVID-19 emergency 

In response to the COVID-19 emergency, Texas Gov. Greg Abbott waived several regulations pertaining to providing telemedicine services. He also directed the Texas Department of Insurance (TDI) to issue an emergency rule, which requires insurers to pay the same amount for telehealth services as they would for in-person medical care. 

Abbot also approved the TMB request to temporarily suspend the state rules that prohibit the use of phone consultation, which would serve as a basis for establishing the practitioner-patient relationship. 

Have a successful telemedicine start in Texas with Curogram

Curogram enables you to transition to telemedicine quickly and painlessly. Our telemedicine platform is fully compliant with HIPAA Rules and has all the necessary built-in safeguards that ensure you’re providing remote healthcare services in accordance with all applicable laws.

Curogram is easy to use for both medical professionals and patients. You set up a virtual clinic with a waiting room, host virtual appointments, communicate with patients and all your employees, send and receive PHI — all from a single dashboard.

Why choose Curogram for telemedicine 

Integrates with over 700 EHRs

You don’t have to worry about manually entering data in your EHR. Save valuable time with full EHR integration and admit more patients daily.

Provides a two-way messaging platform

Send appointment reminders to your patients as SMS. Patients can simply respond with a text message when they want to book a new appointment, need to reschedule or inquire about your services.

Facilitates internal communications and file sharing

Curogram includes a secure messaging platform that allows your medical staff to easily communicate and share relevant medical information quickly.

Mimics in-person workflow environments

Front desk staff and medical assistants can communicate with patients via text and/or video to start the appointment, and doctors can join the video call whenever the patient is ready.

If you’re looking to expand your services to include telemedicine and telehealth, Curogram is just the solution you’ve been looking for

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: texas, telemedicine

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