Texas has some of the most detailed telemedicine regulations in the country. For years, providers faced tight limits on how they could treat patients from a distance. That has changed a great deal, and virtual care is now a normal part of practice across the state. Still, the rules can feel dense if you have never worked through them, so it helps to see them laid out plainly.
The state passed its telehealth parity law back in 1997, which made it an early mover on remote care. Given its large rural population and its shortage of providers, Texas had good reason to treat remote care as a real option.
That law said private payers must reimburse telemedicine visits the same way they reimburse in-person visits. At first, though, providers still had to build an in-person relationship with a patient before offering any remote service.
That requirement eventually became a barrier. Lawmakers moved toward a more flexible approach, and the 2017 Senate Bill 1107 reshaped how physicians could deliver telemedicine in the state. The COVID-19 emergency brought even more changes, some of which have shifted the landscape further.
Before we get into the details, one point matters a great deal. Texas law treats telemedicine and telehealth as two different things, even though people often use the words as if they mean the same.
This guide walks through the laws, rules, and regulations you need to know, from consent to prescribing to record-keeping. It also shows how the right platform helps you launch virtual care in Texas without the usual headaches.
Texas draws a clear line between telemedicine and telehealth. Knowing the difference helps you understand which rules apply to your practice and your patients.
Before Senate Bill 1107, the legal definition of telemedicine was narrow. A physician had to start remote care with a patient they were already treating in person, and phone calls were left out entirely.
Those limits are gone. The updated definition says a physician licensed in the state, or a health professional working under that physician, may deliver care to a patient at another location using telecommunications or information technology.
Texas law also treats telemedicine and telehealth as separate services. Telemedicine is a remote medical service delivered by a Texas physician. Telehealth is a remote service other than telemedicine, delivered by a health professional.
The wording is a little clunky, but the takeaway is simple. Under Texas law, telemedicine and telehealth are not the same thing.
Senate Bill 1107 makes clear that only physicians can provide remote services that involve these three tasks:
Telehealth covers every other kind of remote service that does not require assessment, diagnosis, or treatment. This split decides which extra rules apply in a given case. For example, only licensed physicians can issue online prescriptions.
Senate Bill 1107 sets the legal foundation, while the Texas Medical Board layers on the practical rules. Together, they define what practicing virtual care looks like day to day.
It also provides the legal guidelines for anyone who wants to offer telemedicine and telehealth in the state. The Texas Medical Board (TMB) enforces the additional Texas telemedicine rules that providers have to follow.
To make this easier to digest, we have broken the requirements into clear areas. Each one covers a piece of what you need to practice telemedicine in Texas.
In this article, we cover who can provide care, how to establish a doctor-patient relationship, and how to obtain a cross-state license. We also look at patient consent, prescriptions, and documentation. Finally, we walk through mental health rules, reimbursement, and the waivers tied to the COVID-19 emergency.
We will also show how you can get started with virtual care using Curogram, a modern, fully HIPAA-compliant telemedicine platform built for busy practices.
Texas law itself stays quiet on which provider types qualify, but the Medicaid program fills in that gap with a clear list.
Texas law does not spell out which providers may practice telemedicine or telehealth, but Texas Medicaid does.
Medicaid is a joint state and federal program that provides free medical care to people in need who cannot otherwise afford it. That coverage includes free telehealth and telemedicine visits.
Under the Medicaid definition, the professionals who may deliver these remote services include:
One of the biggest shifts under Senate Bill 1107 is how a provider-patient relationship begins. You no longer need to meet a patient in person first.
As we noted, physicians once had to meet patients in person before offering telemedicine. Senate Bill 1107 removed that rule. It states that TMB rules must allow a practitioner-patient relationship to form through a telemedicine service alone.
This means you are no longer limited to treating only your existing patients. Patients can now reach out, request a virtual appointment, and receive care without ever setting foot in your office first.
There is one thing to keep in mind. The TMB still holds the authority to make sure telemedicine patients receive the proper standard of care. It has not used that authority to require in-person visits, but it could in the future.
So the smart move is to stay current with TMB rules. Even without an in-person meeting, your remote care must match the quality of an in-office visit. Seeing a doctor virtually should deliver the same standard of care as seeing one face-to-face, and the board has said it will hold providers to that.
With the ability to see new patients virtually, you really want a platform like Curogram that collects new patient intake forms automatically by text or email before the visit.
A practitioner-patient relationship is understood to begin when both sides enter an expressed or implied agreement. No formal signature is required.
In a telemedicine setting, it is enough for the patient to agree to remote treatment and for the provider to agree to give it. Even so, it is good practice to obtain verbal consent for telemedicine and note it in your EMR.
Put simply, under Texas law, the relationship forms the moment a patient joins a virtual appointment. That is a big step forward from the old in-person rule. During COVID-19, the board formally approved new patient encounters by telemedicine, something that was previously off-limits.
Texas does not restrict virtual care to providers inside its borders. Out-of-state clinicians can serve Texas patients under a specific license with defined limits.
Texas does not limit telemedicine and telehealth to providers within its borders. The Texas Medical Board lets out-of-state clinicians obtain a telemedicine license that allows them to treat Texas patients remotely.
There are limits, though. An out-of-state telemedicine license applies only in specific situations, and practice under it is restricted to two areas:
Anyone holding an out-of-state license must follow the same laws, rules, and regulations as a fully licensed Texas provider.
Providers already located in Texas do not need a special license for virtual care, as long as they are licensed to practice medicine in the state. They simply need to obtain patient consent before starting a virtual appointment.
Consent is required before any virtual visit, but Texas keeps the process flexible. You do not need a signed form for every patient.
Texas law says providers must get informed consent from the patient, or from someone authorized to make health decisions for them, before offering telemedicine or telehealth.
Note that Senate Bill 1107 does not require written consent. The move away from the old rigid rules produced much more flexible legislation. Consent is implied once a practitioner-patient relationship forms, so you do not have to store signed consent documents for each patient.
Curogram offers built-in teleconsent templates so you can customize your consent language. Patients see that consent electronically before they join a video visit.
That said, a few points deserve attention. Providers still need to tell patients about the privacy and confidentiality risks of sharing protected health information (PHI) through their telemedicine tool. You must also explain the complaint process clearly in case a patient alleges misconduct.
Prescribing after a virtual visit follows the same standards as prescribing in person, with one added condition around the provider-patient relationship.
Issuing prescriptions after a virtual visit falls under the same standards that apply in person. Texas law adds one condition: a valid practitioner-patient relationship must exist before any prescription is written.
Providers who want to issue online prescriptions can meet this requirement in one of three ways:
This one is simple. If you already have a valid relationship that started with an in-person visit, that relationship extends to telemedicine, too.
In this case, you can issue online prescriptions without meeting any additional requirements. You already know the patient's condition and have their medical records on hand.
This TMB rule lets a specialist enter a call coverage agreement with another physician's established patients. To use it, the requesting physician must send detailed reports to the covering physician after each online visit.
The goal is to help patients get care that their own physician cannot provide, without forcing an in-person trip. That flexibility is a real benefit, given the large rural population and the shortage of providers and specialists across the state.
A physician can form a valid relationship by using technology that gives access to relevant clinical information and helps them meet the standard of care. That technology must be one of the following:
The TMB definitions leave some room for interpretation. Whatever tool you use, it must be fully HIPAA compliant. That means any protected health information (PHI) has to stay secure and well-maintained, both at rest and in transit.
Curogram is a fully HIPAA-compliant telemedicine platform that supports secure two-way messaging between providers and patients, plus internal staff messaging and file sharing. It also lets you hold virtual visits that comply with federal and Texas law, in an environment that mirrors your in-person workflow.
Virtual visits carry the same record-keeping duties as in-person care. The challenge is doing it without doubling your admin work.
Under Texas law, physicians who provide telemedicine must keep medical records the same way they would for in-person care.
In practice, that means you update your electronic health record (EHR) and add new information after each virtual visit. You also have to give patients a visit summary afterward.
This gets hard if your telemedicine tool does not connect to your EHR. You end up entering data by hand after every visit, which eats into time you could spend treating patients.
That is where the right platform helps. Curogram integrates with any EHR and removes the need for double or manual entry, so you can streamline workflows and see more patients each day.
Curogram works with a wide range of systems, including these common ones:
|
EHR / PM system |
EHR / PM system |
|---|---|
|
eClinicalWorks |
athenahealth |
|
Epic |
Cerner |
|
DrChrono |
NextGen |
|
Practice Fusion |
CareCloud |
|
Kareo |
OfficeAlly |
You can send visit summaries and other records to patients in a single click. They get a link by text and can open it in the Curogram patient app. Sensitive information stays inside secure channels, which keeps you fully HIPAA compliant.
Behavioral health gets some extra flexibility under Texas law, which reflects how well remote care fits mental health support.
For mental health services, Texas law relaxes several remote care requirements. The most notable is the rule about establishing a relationship with the patient first.
In practice, this means providers can offer remote mental health care whether or not the person is an existing patient of theirs or of another licensed Texas provider. Every other rule on licensing, certifications, and quality of care still applies.
Thanks to the parity law, telemedicine services are treated much like in-person care for payment. The details still deserve a close read.
Because of the Texas telehealth parity law, private payers must reimburse providers for telemedicine and telehealth the same way they would for in-person care.
It is worth noting that Texas bars certain state-regulated health plans from excluding telemedicine solely because a service was not delivered in person. That does not force a plan to cover telemedicine, nor does it require identical rates for virtual and in-person visits.
Texas also requires health plan issuers to publish their policies and payment practices for telemedicine services. If you plan to offer virtual care, check your network agreements carefully to confirm they cover telemedicine.
If a plan does not cover telemedicine, you may be able to bill the patient directly for the remote care you provide. You may also qualify for payment when serving Medicaid and Medicare beneficiaries.
The pandemic prompted temporary changes that expanded access to virtual care. Some may stick around, and it is worth knowing where things stand.
In response to the COVID-19 emergency, Texas Gov. Greg Abbott waived several telemedicine regulations. He also directed the Texas Department of Insurance (TDI) to issue an emergency rule requiring insurers to pay the same for telehealth services as for in-person care.
Abbott also approved the TMB request to temporarily suspend rules that had blocked phone consultations. That change let a phone call serve as the basis for forming a practitioner-patient relationship.
Texas telemedicine has come a long way from its restrictive early days. Senate Bill 1107 opened the door to new patient visits, flexible consent, and remote prescribing under clear conditions. The rules still ask a lot, but they no longer stand in the way of good virtual care.
The key is meeting the standard of care while staying HIPAA compliant every step of the way. That is far easier with a platform built for the job. If you want to add telemedicine and telehealth to your practice, Curogram is ready to help.
Ready to launch telemedicine in Texas? See how Curogram helps you deliver secure, compliant virtual care that fits your existing workflow. Schedule a free demo and get personalized guidance for your practice.