Relating to health benefit plan coverage of telemedicine, teledentistry, and telehealth appointments with an originating site or distant site located outside this state.
ModeratePlan for compliance
Low Cost
Effective:2025-09-01
Enforcing Agencies
Texas Department of Insurance (TDI)
01
Compliance Analysis
Key implementation requirements and action items for compliance with this legislation
Implementation Timeline
Effective Date: September 1, 2025
Compliance Deadline:January 1, 2026 (Applies to health benefit plans delivered, issued for delivery, or renewed on or after this date).
Agency Rulemaking: The Texas Department of Insurance (TDI) has authority to implement rules. Expect guidance between September 2025 and December 2025 regarding the definition of "physical office" and verification standards for patient residency.
Immediate Action Plan
Audit Claims Logic: Immediately flag and review adjudication rules that deny telehealth claims based on out-of-state ZIP codes or location modifiers.
Review Provider Networks: Segment your telehealth network into "Hybrid" (Physical Texas Office) vs. "Virtual-Only." Only the former are guaranteed coverage under this mandate.
Update 2026 Plan Filings: Ensure all policy filings submitted to TDI for the 2026 plan year explicitly include this cross-border coverage language.
Verify Malpractice Coverage: Providers must confirm their professional liability insurance covers telemedicine encounters where the patient or provider is located in another state.
Operational Changes Required
Contracts
Plan Documents (EOC/SBC): You must amend Evidence of Coverage and Summary of Benefits documents for 2026 renewals to remove exclusions for out-of-state telehealth encounters.
Provider Agreements: Update Master Service Agreements (MSAs) to require providers to attest to maintaining a physical office in Texas. "Virtual-only" networks without a brick-and-mortar Texas footprint do not qualify for this statutory protection.
Hiring/Training
Claims Adjudication: Train claims staff and reconfigure automated adjudication logic. Systems must stop auto-denying claims based on "Place of Service" or provider location codes that originate outside Texas.
Patient Intake: Providers must train intake staff to verify that a patient "primarily resides" in Texas before conducting an out-of-state telehealth visit to ensure reimbursement eligibility.
Reporting & Record-Keeping
Credentialing Updates: Insurers must add a data field to provider credentialing files to verify the existence of a "physical office" in Texas.
Residency Verification: Carriers must ensure their enrollment data accurately reflects the primary residence of dependents (e.g., college students) to avoid improper denials.
Fees & Costs
Claims Utilization: Anticipate a slight increase in claims volume as previously blocked out-of-state interactions become reimbursable.
Administrative Costs: One-time IT costs to reprogram claims logic to accommodate the new geographic exceptions.
Strategic Ambiguities & Considerations
"Physical Office" Definition: The statute requires the provider to have a physical office in Texas but does not define the operational status of that office. It is unclear if a shared workspace (e.g., WeWork) or a satellite office staffed once a month satisfies this requirement. Monitor TDI rulemaking closely for anti-fraud restrictions here.
"Resides Primarily" Verification: The law applies to patients who "reside primarily" in Texas. It is currently undefined how a carrier can challenge a claim for a dependent living out-of-state for significant periods (e.g., 9 months for university).
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The bill author has informed the committee that the restriction on out-of-state providers of telemedicine has hindered its full potential for Texas residents. H.B. 1052 seeks to address this gap by ensuring that Texans have access through their health benefit plans to telemedicine, teledentistry, and telehealth services provided by distant providers, so long as the provider has a physical office in Texas.
CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
ANALYSIS
H.B. 1052 amends the Insurance Code to require a health benefit plan to provide coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service with an originating site or distant site located outside Texas on the same basis and to the same extent that the plan provides coverage for the service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service with an originating site and distant site located in Texas if the following conditions are satisfied:
·the individual who receives the service resides primarily in Texas; and
·the health professional who provides the service is licensed or otherwise authorized to provide the service in Texas and has a physical office in Texas.
H.B. 1052 defines "originating site" as the location where an individual receives a telemedicine medical service, teledentistry dental service, or telehealth service and "distant site" as the location where a health professional provides such a service. The bill applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2026. A health benefit plan delivered, issued for delivery, or renewed before January 1, 2026, is governed by the law as it existed immediately before the bill's effective date, and that law is continued in effect for that purpose.
Honorable Jay Dean, Chair, House Committee on Insurance
FROM:
Jerry McGinty, Director, Legislative Budget Board
IN RE:
HB1052 by Bhojani (Relating to health benefit plan coverage of telemedicine, teledentistry, and telehealth appointments with an originating site or distant site located outside this state.), As Introduced
No significant fiscal implication to the State is anticipated.
It is assumed that any costs associated with the bill could be absorbed using existing resources.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies:
327 Employees Retirement System, 454 Department of Insurance, 529 Health and Human Services Commission, 710 Texas A&M University System Administrative and General Offices, 720 The University of Texas System Administration
LBB Staff:
JMc, AAL, BFa
Related Legislation
Explore more bills from this author and on related topics
HB1052 mandates that state-regulated health benefit plans cover telemedicine, teledentistry, and telehealth services regardless of whether the patient or provider is physically located in Texas at the time of service. This law prohibits claim denials based solely on geography, provided the patient primarily resides in Texas and the provider holds a Texas license and maintains a physical office within the state. Implementation Timeline Effective Date: September 1, 2025 Compliance Deadline: January 1, 2026 (Applies to health benefit plans delivered, issued for delivery, or renewed on or after this date).
Q
Who authored HB1052?
HB1052 was authored by Texas Representative Salman Bhojani during the Regular Session.
Q
When was HB1052 signed into law?
HB1052 was signed into law by Governor Greg Abbott on June 22, 2025.
Q
Which agencies enforce HB1052?
HB1052 is enforced by Texas Department of Insurance (TDI).
Q
How urgent is compliance with HB1052?
The compliance urgency for HB1052 is rated as "moderate". Businesses and organizations should review the requirements and timeline to ensure timely compliance.
Q
What is the cost impact of HB1052?
The cost impact of HB1052 is estimated as "low". This may vary based on industry and implementation requirements.
Q
What topics does HB1052 address?
HB1052 addresses topics including electronic information systems, health care providers, insurance, insurance--health & accident and telemedicine.
Legislative data provided by LegiScanLast updated: November 25, 2025
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