HBA-JEK H.B. 1615 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1615 By: Maxey Public Health 3/2/2001 Introduced BACKGROUND AND PURPOSE Texas faces unique challenges with its health care system. The state has experienced a larger population increase than any other state in the nation in the past decade, especially in its Hispanic and aging babyboomer populations. Rural Texas has difficulty recruiting doctors, and several counties in Texas do not even have a physician. Telemedicine has the potential to bring health services to rural and underserved communities. House Bill 1615 provides for Medicaid reimbursement and the regulation of telemedicine medical services in Texas. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 1 (Section 531.0216, Government Code), SECTION 2 (Section 531.02161, Government Code), SECTION 3 (Section 531.0217, Government Code), SECTION 5 (Section 32.053, Human Resources Code), SECTION 15 (Section 57.0475, Utilities Code), and SECTION 17, to the telecommunications infrastructure fund board in SECTION 2 (Section 531.02161, Government Code) and SECTION 15 (Section 57.0475, Utilities Code), and to the Texas State Board of Medical Examiners in SECTION 3 (Section 531.0217, Government Code) and SECTION 10 (Section 6, Article 21.53F, Insurance Code) of this bill. ANALYSIS House Bill 1615 amends the Government Code to require the Health and Human Services Commission (HHSC) and the telecommunications infrastructure fund board (TIF board) by joint rule to establish and adopt minimum standards for an operating system used in the provision of telemedicine medical services (telemedicine) by a health care facility participating in the state Medicaid program no later than October 1, 2001. The bill sets forth requirements for minimum standards for the system (Sec. 531.02161 and SECTION 16). The bill requires HHSC no later than January 1, 2002 to require by rule each human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for telemedicine that is initiated or provided by a physician (Sec. 531.0217 and SECTION 17). H.B. 1615 prohibits HHSC from reimbursing a health care facility for telemedicine provided to a Medicaid recipient unless the facility complies with the minimum standards adopted by HHSC and the TIF board. The bill requires HHSC to consult with the Texas Department of Health (TDH) and the telemedicine advisory committee to develop a procedure to deny reimbursement for a health care service that, based on credible, clinical evidence, is shown to be medically inappropriate for delivery using a telecommunications system. The bill requires HHSC to report to the speaker of the house of representatives and the lieutenant governor on the effects of telemedicine on the Medicaid program in the state no later than December 1 of each even-numbered year, and authorizes HHSC to adopt rules as necessary to implement provisions related to telemedicine reimbursement (Sec. 531.0216). H.B. 1615 requires HHSC to make a good faith effort to identify and coordinate with existing providers to preserve and protect existing health care systems and medical relationships in an area. The bill requires HHSC to require a patient's primary care physician to be notified of telemedicine for the purpose of sharing information. The bill requires HHSC in consultation with the Texas State Board of Medical Examiners (TSBME) to monitor and regulate the use of telemedicine to ensure compliance with these provisions, and authorizes HHSC to use a corrective action plan to ensure compliance (Sec. 531.0217). H.B. 1615 amends the Government and Insurance codes to authorize TSBME to adopt rules as necessary to ensure the quality of care provided to patients who receive telemedicine, to ensure adequate supervision of health professionals who are not physicians and who provide telemedicine, to establish the maximum number of health professionals who are not physicians that a physician may supervise through telemedicine, and to require a face-to-face consultation with a physician within a certain number of days following a telemedicine service (Sec. 531.0217, Government Code and Sec. 6, Art. 21.53F, Insurance Code). The bill amends the Government Code to require the advisory committee established by HHSC to coordinate state telemedicine efforts and assist the commission in evaluating, monitoring, and coordinating telemedicine services and reimbursement. The bill provides that the telemedicine provisions do not affect any requirement relating to a rural health clinic or physician delegation of the authority to carry out or sign prescription drug orders to an advanced practice nurse or physician assistant (Sec. 531.0217). H.B. 1615 amends the Health and Safety Code to provide that a health plan provider that is providing state child health plan (CHIP) covered benefits to a child must permit benefits to be provided through telemedicine in accordance with policies developed by HHSC. The bill sets forth benefits for which the policies must provide (Sec. 62.157). H.B. 1615 amends the Human Resources Code to require HHSC to establish a pilot program under which certain recipients of medical assistance receive home health care services through telemedicine in addition to other home health care services for which the recipients are eligible (pilot program). The bill sets forth provisions regarding the designing and implementation of the pilot program and requires HHSC to adopt eligibility criteria for the pilot program as specified in the bill. The bill requires HHSC to report to the legislature regarding the pilot program no later than December 1, 2004, and to adopt all rules necessary for implementing the pilot program. The provisions regarding the pilot program expire on September 1, 2005 (Sec. 32.053). H.B. 1615 amends the Utilities Code to require the TIF board to establish an assistance program to provide education concerning the telecommunications infrastructure fund and to facilitate access to funds and programs by eligible health care facilities and physicians. The bill provides that the assistance program must include a toll-free telephone number and provide access to information through the Internet (Sec. 57.045). The bill also requires the TIF board and HHSC to jointly adopt rules prescribing the criteria that certain health care facilities must meet to be eligible to receive a grant from the TIF board and sets forth requirements regarding the criteria (Sec. 57.0475). The bill requires HHSC to submit for approval a plan amendment relating to CHIP if it believes such an amendment is necessary for compliance with this bill. The bill authorizes HHSC and the Texas Board of Health to delay the implementation of the CHIP provisions of this bill until the approval of the amended plan (SECTION 18). EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001.