SRC-SEW, MKV S.B. 789 77(R)BILL ANALYSIS Senate Research CenterS.B. 789 By: Moncrief Health & Human Services 7/10/2001 Enrolled DIGEST 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. S.B. 789 sets forth provisions regarding the reimbursement and the regulation of telemedicine medical services in Texas. RULEMAKING AUTHORITY Rulemaking authority is expressly granted to the Health and Human Services Commission in SECTION 1 (Section 531.0216, Government Code) and SECTION 17 (Section 32.053, Human Resources Code) of this bill. Rulemaking authority is expressly granted to the Health and Human Services Commission in conjunction with the Telecommunications Infrastructure Board in SECTION 2 (Section 531.02161, Government Code) and SECTION 15 (Section 57.0475, Utilities Code) of this bill. Rulemaking authority previously granted to the Texas State Board of Medical Examiners is modified in SECTION 9 (Section 6(b), Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997) of this bill. Rulemaking authority is expressly granted to the Texas Board of Mental Health and Mental Retardation in SECTION 18 (Section 533.102, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 531.0216, Government Code, as follows: Sec. 531.0216. New heading: PARTICIPATION AND REIMBURSEMENT OF TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. Changes a reference from "telemedicine" to "telemedicine medical services." (b) Requires the Health and Human Services Commission (commission), by rule, in developing the reimbursement system, to perform certain functions. (c) Adds a reference to physicians relating to the commission encouraging certain groups to participate as telemedicine medical service providers and makes conforming changes. (d) Authorizes the commission to adopt rules as necessary to implement this section, subject to Section 153.004 (Rules Regarding Telemedicine Services), Occupations Code, rather than being subject to Section 5.11, Medical Practices Act (Article 4495b, V.T.C.S.). (e) Prohibits the commission from reimbursing a health care facility for telemedicine medical services provided to a Medicaid recipient unless the facility complies with the minimum standards adopted under Section 531.02161. (f) Requires the commission, not later than December 1 of each even-numbered year, to report to the speaker of the house of representatives and the lieutenant governor on the effects of telemedicine medical services on the Medicaid program in the state, including the number of physicians and health professionals using telemedicine medical services, the geographic and demographic disposition of the physicians and health professionals, the number of patients receiving telemedicine medical services, the types of services being provided, and the cost and utilization of telemedicine medical services on the program. (g) Defines "telehealth service" and makes a conforming change. SECTION 2. Amends Chapter 531B, Government Code, by adding Section 531.02161, as follows: Sec. 531.02161. TELEMEDICINE TECHNOLOGY STANDARDS. (a) Defines "telemedicine medical service." (b) Requires the commission and the Telecommunications Infrastructure Fund Board (TIFB) by joint rule to establish and adopt minimum standards for an operating system used in the provisions of telemedicine medical services by a health care facility participating in the state Medicaid program, including certain standards. (c) Requires the commission and TIFB, in developing standards under this section, to address certain issues. SECTION 3. Amends Section 531.0217, Government Code, to redefine "health professional," "physician," "telehealth service," and "telemedicine medical service." (b) Makes conforming changes. (c) Makes conforming changes. (d) Makes conforming changes. (e) Makes conforming changes. (f) Requires the commission to require facilities and providers of telemedicine medical services 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. Makes a conforming change. (g) Requires the commission to require that a primary health care physician be notified of a telemedicine medical service for the purpose of sharing medical information, if a patient receiving such a service has primary care physician or provider and consents to the notification. (h) Requires the commission, in consultation with the Texas State Board of Medical Examiners (board), to monitor and regulate the use of telemedicine medical services to ensure compliance with this section. Authorizes the commission to use a corrective action plan to ensure compliance with this section in addition to any other method of enforcement. (i) Adds language regarding certain rules that the board and commission are authorized to adopt to include establishing supervisory requirements for a service delegated to and performed by an individual who is not a physician and defining those situations when a face-to-face consultation with a physician is required after a telemedicine medical service. Makes conforming changes. (j) Requires the commissioner to establish an advisory committee for certain purposes. (k) Provides that this section does not affect any requirement relating to: a federally qualified health center; a rural health clinic,or a physician delegation of the authority to carry out or sign prescription drug orders to an advanced practice nurse or physician assistant. SECTION 4. Amends Chapter 62D, Health and Safety Code, by adding Section 62.157, as follows: Sec. 62.157. TELEMEDICINE MEDICAL SERVICES. Requires a health plan provider, in providing covered benefits to a child, to permit benefits to be provided through telemedicine medical services in accordance with policies developed by the commission. Sets forth requirements regarding such policies. Requires the commission, in developing the required policies, to consult with the telemedicine advisory committee. Defines "telemedicine medical service." SECTION 5. Amends Section 1, Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997, to define "health professional," "physician," "telehealth service," and "telemedicine medical service." Deletes definition of "telemedicine." SECTION 6. Amends Section 3, Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997, as follows: Sec. 3. New heading: COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES. Makes conforming changes. SECTION 7. Amends Section 4, Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997, to make conforming changes. SECTION 8. Amends Section 5, Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997, to require that the confidentiality of a patient's medical information is maintained as required by Chapter 159 (Physician-Patient Communication), Occupations Code, instead of Section 5.08, Medical Practice Act (Article 4495b, V.T.C.S.). Makes conforming changes. SECTION 9. Amends Section 6(b), Article 21.53F, Insurance Code, as added by Section 1, Chapter 880, Acts of the 75th Legislature, Regular Session, 1997, to authorize the Texas State Board of Medical Examiners, in consultation with the commissioner, to adopt certain rules. SECTION 10. Amends Section 153.004, Occupations Code, as follows: Sec. 153.004. New heading: RULES REGARDING TELEMEDICINE MEDICAL SERVICES. Makes conforming changes. SECTION 11. Amends Section 57.042, Utilities Code, by amending Subdivision (11) and adding Subdivision (12) to define "telehealth service," "telemedicine medical service" and to delete the definition of "telemedicine." SECTION 12. Amends Section 57.045, Utilities Code, to require the telecommunications infrastructure fund board (board) to establish an assistance program to provide education concerning the telecommunications infrastructure fund and to facilitate access to funds and programs under this subchapter by health care facilities and by physicians licensed to practice medicine in this state. Requires the assistance program to include a toll-free telephone number and provide access to information through the Internet. SECTION 13. Amends Section 57.046(b), Utilities Code, to require the board to use money in the qualifying entities account for any purposes authorized by this subchapter, including funding an automated system to integrate client services and eligibility requirements for health and human services across agencies. SECTION 14. Amends Sections 57.047(a) and (b), Utilities Code, to make conforming changes. SECTION 15. Amends Chapter 57C, Utilities Code, by adding Section 57.0475, as follows: Sec. 57.0475. ELIGIBILITY FOR GRANTS TO HEALTH CARE FACILITIES. (a) Authorizes the board to award a grant under Section 57.047(a)(1)(C) only to certain health care facilities. (b) Requires the board and the Health and Human Services Commission (commission) to jointly adopt rules prescribing the criteria a health care facility not described by Subsection (a)(1) must meet to be eligible to receive a grant under Section 57.047(a)(1)(C). Requires the board and the commission, in determining the criteria, to prioritize health care facilities based on certain factors. (c) Sets forth requirements regarding the criteria adopted under Subsection (b). SECTION 16. Amends Section 58.253(a), Utilities Code, to require an electing company, on customer request, to provide private network services to a project that would have been eligible to be funded by the telecommunications infrastructure fund under Chapter 57C, as that subchapter existed on January 1, 2001 SECTION 17. Amends Chapter 32B, Human Resources Code, by adding Section 32.053, as follows: Sec. 32.053. HOME TELEMEDICINE PILOT PROGRAM. (a) Requires the Health and Human Services Commission to establish a pilot program under which certain recipients of medical assistance receive, in addition to other home health care services for which the recipients are eligible, home health care services through home telemonitoring systems located in the recipients' homes. (b) Requires the Health and Human Services Commission to implement the program in certain areas. (c) Authorizes the Health and Human Services Commission to reimburse a home and community support services agency participating in the program for services provided by the agency through home telemonitoring systems in an amount not to exceed $300 a month for each home at which services are provided. (d) Requires the Health and Human Services Commission to adopt eligibility criteria for the program. Sets forth requirements for the criteria. (e) Requires the Health and Human Services Commission to determine home health care services to be provided to program participants through a home telemonitoring system. Authorizes home health care services provided through the system to include certain services. (f) Requires the Health and Human Services Commission, in designing and implementing the program, to make certain assurances. (g) Requires the Health and Human Services Commission to adopt all rules necessary for implementation of the program. (h) Requires the Health and Human Services Commission, not later than December 1, 2004, to submit a report to the legislature regarding the program that includes certain items. (i) Provides that this section expires September 1, 2005. SECTION 18. Amends Chapter 533, Health and Safety Code, by adding Subchapter E, as follows: SUBCHAPTER E. JAIL DIVERSION PROGRAM Sec. 533.101. JAIL DIVERSION PILOT PROGRAM. (a) Requires the Texas Board of Mental Health and Mental Retardation (board) and the Texas Department of Mental Health and Mental Retardation (department) to develop and implement a pilot program in one rural area and one urban area designed to incorporate audiovisual telecommunications systems for certain purposes. (b) Requires the commission, in designing the program, to employ to the greatest extent practicable certain available electronic information systems for the program. (c) Requires the department and participating local mental health authorities, prosecutorial agencies, law enforcement agencies, jail facilities, courts, county or municipal governments, and providers of psychiatric services to enter into an agreement regarding the procedures to follow in implementing the program and the duties of each participating entity. Requires the participating county to be responsible for establishing the diversion team as prescribed by the department. (d) Provides that, if appropriate treatment services are not available, a person with mental illness does not have to be diverted from the criminal justice system. Sec. 533.102. PREBOOKING DIVERSION. (a) Requires the pilot program to incorporate a system for diverting a person with mental illness from the criminal justice system before the person's contact with a law enforcement officer results in: charges being brought against the person; or the person being detained in a jail. (b) Requires the prebooking diversion system to provide for a law enforcement officer or booking center staff member to request a mental health or crisis stabilization evaluation of a person by a local mental health authority crisis counselor or the equivalent through an audiovisual teleconference. Requires the board by rule to establish procedures for evaluations performed under the system. Sec. 533.103. POSTBOOKING DIVERSION BY COURT. Requires the pilot program to incorporate a system for diverting a person with mental illness from the criminal justice system by a court at the person's arraignment or a court hearing. Authorizes a court participating in the pilot program to order: the assessment of a person before the court by the local mental health authority to assess appropriate community mental health treatment options as alternatives to prosecution; and a person before the court to undertake appropriate psychiatric treatment as a condition of the dismissal of criminal charges, deferral of prosecution, bail, or probation. Sec. 533.104. POSTBOOKING DIVERSION FOR PERSON IN JAIL. (a) Requires the pilot program to incorporate a system to provide routine mental health treatment to a person in jail by the local mental health authority through an audiovisual teleconferencing system. (b) Requires the program to include a jail diversion liaison employed by the local mental health authority who shall: determine whether certain jailed individuals are eligible for diversion treatment programs; and facilitate the interaction of jail staff and court officials to further the program. (c) Requires the local mental health authority to employ a jail diversion team to select candidates for diversion into mental health treatment based on certain criteria. Sec. 533.105. INFORMATION SYSTEM TO SUPPORT POSTBOOKING DIVERSION. (a) Requires the pilot program, to support the postbooking jail diversion program, to provide for implementation of an information system designed to quickly identify a person with a serious mental illness who has entered the local jail system. (b) Requires the pilot program to provide for electronic transmission of information concerning all admissions to jails participating in the program to an information system at the local mental health authority. (c) Requires the local mental health authority to ensure that the authority's information system automatically performs certain functions. Sec. 533.106. REPORTS TO LEGISLATURE. Requires the board to evaluate the pilot program under this subchapter and publish a report on the performance of the program in providing needed treatment and in saving or increasing costs to the jail and mental health systems. Requires the board to deliver the report to the governor, lieutenant governor, and speaker of the house of representatives not later than November 1 of each even-numbered year. Sec. 533.107. EXPIRATION. Provides that this subchapter expires September 1, 2005. SECTION 19. (a) Authorizes a licensed dentist, for purposes of this section, to delegate orally, in writing, or through advanced audio and video telecommunications services a service, task, or procedure to a dental hygienist who is under the supervision and responsibility of the dentist, under certain conditions. (b) Defines "dental professional," "student," "teledentistry dental services," (c) Requires the Commissioner of Human Services to appoint a program administrator to administer a pilot program that uses teledentistry and other methods of delivering dental services to provide dental services to students in one public school district in the state. (d) Requires the program administrator to establish an advisory committee to assist the program administrator in developing and implementing the pilot program. (e) Requires the program administrator, in developing the pilot program, to design the program in a certain manner. (f) Requires the program administrator to adopt procedures as necessary for certain purposes. (g) Authorizes only a teledentistry dental service initiated or provided by a licensed dentist in this state to be reimbursed under the Medicaid program. Requires Medicaid reimbursement for a teledentistry dental service to be at the same rate as the Medicaid program reimburses for a comparable in-person dental service. Prohibits a request for reimbursement from being denied solely because an in-person consultation between a dentist or other dental professional and a patient did not occur. Requires reimbursement for a dental hygienist for service to be made through the supervising dentist. (h) Requires a dental hygienist to act under the remote supervision of a local dentist. Requires both the dentist and the hygienist to be located within the boundaries of the school district served by the pilot program. (i) Requires images and assessment information to be sent by the dental hygienist to a supervising dentist either live or by means of store and forward technology. Authorizes a dentist, after having reviewed the required information, to authorize the provision of preventive services by the dental hygienist located at the school. (j) Authorizes a dental hygienist participating in the pilot program to initiate screening and assessment services and, under the supervision of a dentist, to perform any procedure the hygienist is authorized to perform under law. (k) Prohibits a teledentistry dental service from being provided if an in-person consultation with a dentist is reasonably available to a student. Requires dentists and other dental professionals participating in the pilot program to make a good faith effort to identify and coordinate with existing providers to preserve and protect existing dental care systems and dental relationships. (l) Requires the program administrator to establish a control group not to exceed 1,000 students to provide a benchmark for measuring the performance of the pilot program. Requires each student in the control group to be examined by a dentist, in person, at the end of the program to evaluate the effectiveness of teledentistry dental services provided during the program. Requires the examining dentist to practice in a dental office located outside the boundaries of the school district served by the pilot program. (m) Requires the program administrator to use the results of the pilot program to for certain purposes. (n) Requires a dental professional who provides teledentistry dental services to ensure that the informed consent of the student or a person authorized to provide consent for the student is obtained before teledentistry dental services are provided. (o) Requires students participating in the pilot program to be referred to local dentists for restorative care and monitored to ensure that restorative services are provided. (p) Requires the program administrator, not later than December 31, 2002, to submit a report to the legislature containing certain information. (q) Provides that this section expires and the advisory committee is abolished December 31, 2002. SECTION 20. Requires the Health and Human Services Commission and the Telecommunications Infrastructure Fund Board, not later than October 1, 2001, to adopt minimum standards for an operating system used by a health care facility in providing telemedicine medical services to a Medicaid recipient as required by Section 531.02161, Government Code, as added by this Act. SECTION 21. Requires the Health and Human Services Commission, not later than January 1, 2002, to adopt rules required by Section 531.0217, Government Code, as amended by this Act. SECTION 22. (a) Requires the Commissioner of Human Services to appoint a program administrator for the teledentistry pilot program, as added by Section 19 of this Act, not later than the 30th day after the effective date of this Act. (b) Requires the program administrator to appoint an advisory committee and to begin implementing the teledentistry pilot program not later than the 30th day after the date the program administrator is appointed. SECTION 23. Provides that Section 57.046(b)(8), Utilities Code, as added by this Act, expires September 1, 2003. SECTION 24. Requires, if before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision to request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted. SECTION 25. Effective date: upon passage or September 1, 2001.