Relating to health benefit plan coverage of telemedicine, teledentistry, and telehealth appointments with an originating site or distant site located outside this state.

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.