76R14452 E
By Gray H.B. No. 517
Substitute the following for H.B. No. 517:
By McClendon C.S.H.B. No. 517
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to Medicaid reimbursement for certain medical
1-3 consultations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 531.047, Government Code, as added by
1-6 Chapter 1251, Acts of the 75th Legislature, Regular Session, 1997,
1-7 is amended by amending Subsections (a), (b), (c), (d), and (e) and
1-8 adding Subsection (h) to read as follows:
1-9 (a) In this section:
1-10 (1) "Health professional" means an advanced nurse
1-11 practitioner, an allied health professional, a mental health
1-12 professional, a physician, or a physician assistant who is licensed
1-13 in this state.
1-14 (2) "Rural county" means a county that:
1-15 (A) has [with] a population of [less than]
1-16 50,000 or less; or
1-17 (B) contains an area that was not designated as
1-18 an urban area by the United States Bureau of the Census according
1-19 to the 1990 federal census and does not have within the boundaries
1-20 of the county a hospital that:
1-21 (i) is licensed under Chapter 241, Health
1-22 and Safety Code; and
1-23 (ii) has less than 100 beds.
1-24 (3) "Rural health facility" means a health facility
2-1 that is located in a rural county and at least 30 miles from any
2-2 accredited medical school or any teaching hospital affiliated with
2-3 an accredited medical school and that is:
2-4 (A) a hospital that:
2-5 (i) is licensed under Chapter 241, Health
2-6 and Safety Code;
2-7 (ii) is owned or operated by a
2-8 municipality, county, hospital district, or hospital authority; and
2-9 (iii) provides inpatient or outpatient
2-10 services [licensed, nonprofit hospital]; or
2-11 (B) a health clinic that is affiliated with:
2-12 (i) an accredited medical school; [or]
2-13 (ii) a teaching hospital that is
2-14 affiliated with an accredited medical school;
2-15 (iii) a hospital described by Paragraph
2-16 (A); or
2-17 (iv) a federally-qualified health center,
2-18 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended.
2-19 (4) "Telemedical consultation" means a medical
2-20 consultation for purposes of patient diagnosis or treatment that
2-21 requires the use of advanced telecommunications technology,
2-22 including:
2-23 (A) compressed digital interactive video, audio,
2-24 or data transmission;
2-25 (B) clinical data transmission via computer
2-26 imaging for teleradiology or telepathology; and
2-27 (C) other technology that facilitates access in
3-1 rural counties to health care services or medical specialty
3-2 expertise.
3-3 (b) The commission by rule shall require each health and
3-4 human services agency that administers a part of the Medicaid
3-5 program to provide Medicaid reimbursement for a telemedical
3-6 consultation provided by:
3-7 (1) a physician licensed in this state who practices
3-8 in:
3-9 (A) [(1)] a rural health facility;
3-10 (B) [(2)] an accredited medical school; or
3-11 (C) [(3)] a teaching hospital that is affiliated
3-12 with an accredited medical school; or
3-13 (2) a health professional who provides the telemedical
3-14 consultation for a patient who resides in an area designated as a
3-15 medically underserved area or a health professionals shortage area
3-16 if:
3-17 (A) the medical examination of the patient is
3-18 under the control of the consultant health professional;
3-19 (B) the consultation involves the participation
3-20 of the health professional who obtains the consultation as
3-21 appropriate to meet the medical needs of the patient and as
3-22 necessary to provide information requested by the consultant health
3-23 professional; and
3-24 (C) the results of the consultation are provided
3-25 in a written report to the health professional who obtains the
3-26 consultation.
3-27 (c) The commission shall ensure that reimbursement is
4-1 provided only for a consultation provided by:
4-2 (1) a physician described in Subsection (b) to a
4-3 health professional who practices in a rural county; or
4-4 (2) a health professional described in Subsection (b)
4-5 to a health professional who practices in an area designated as a
4-6 medically underserved area or a health professionals shortage area.
4-7 (d) The commission shall require reimbursement for a
4-8 telemedical consultation at the same rate as the Medicaid program
4-9 reimburses for a comparable in-person consultation. A request for
4-10 reimbursement may not be denied solely because an in-person
4-11 consultation between a physician or another health professional who
4-12 provides the telemedical consultation and a patient did not occur.
4-13 (e) A health care facility that receives reimbursement under
4-14 this section for consultations provided by physicians or other
4-15 health professionals who practice in that facility and a health
4-16 professional who obtains consultations under this section shall
4-17 establish quality of care protocols and patient confidentiality
4-18 guidelines to ensure that telemedical consultations meet legal
4-19 requirements and acceptable patient care standards.
4-20 (h) The commissioner shall establish an advisory committee
4-21 to assist the commission in developing policies for telemedical
4-22 consultations under this section.
4-23 SECTION 2. This Act takes effect September 1, 1999.
4-24 SECTION 3. If before implementing any provision of this Act
4-25 a state agency determines that a waiver or authorization from a
4-26 federal agency is necessary for implementation of that provision,
4-27 the agency affected by the provision shall request the waiver or
5-1 authorization and may delay implementing that provision until the
5-2 waiver or authorization is granted.
5-3 SECTION 4. The importance of this legislation and the
5-4 crowded condition of the calendars in both houses create an
5-5 emergency and an imperative public necessity that the
5-6 constitutional rule requiring bills to be read on three several
5-7 days in each house be suspended, and this rule is hereby suspended.