The bill, H.B. No. 5343, amends the Texas Insurance Code to establish guidelines for the reimbursement and payment of claims by health benefit plan issuers for telemedicine, teledentistry, and telehealth services. It expands the definition of "health professional" to include not only physicians and dentists but also licensed or certified individuals who assist in providing these services under supervision, as well as credentialed mental health professionals. The bill introduces new sections that mandate health benefit plan issuers to reimburse contracted health professionals for telehealth services at least at the same rate as in-person services, while also specifying conditions under which issuers are not required to pay more than billed charges or reimburse for services provided under risk-based payment arrangements.

Additionally, the bill prohibits health benefit plan issuers from requiring excessive documentation for telehealth services compared to in-person services and ensures that the provisions of this chapter cannot be waived or nullified by contract. The changes will apply to health benefit plans delivered or renewed on or after January 1, 2026, with the law prior to this amendment continuing to govern plans issued before that date. The act is set to take effect on September 1, 2025.

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