SRC-MKV S.B. 789 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 789
77R7347 MCK-DBy: Moncrief
Health & Human Services
3/1/2001
As Filed


DIGEST AND PURPOSE 

S.B. 789 requires the Health and Human Services Commission (commission) to
consult with the Texas Department of Health, the Medicaid clinical review
committee, the telemedicine advisory committee, and the physician payment
advisory committee to establish procedures to determine which telemedicine
services should be reimbursed.  This bill requires the commission by rule
to require health and human service agencies to reimburse telemedicine
services at the same rate as in-person medical services, regardless of
whether there was a face-to-face consultation, and it requires primary care
physicians to be notified if a patient receives a telemedicine service so
that medical information can be shared. Finally, this bill allows the
commission to work with the Board of Medical Examiners to ensure
compliance, quality of care, prevent abuse and fraud, establish supervisory
requirements and face-toface consultation requirements. 

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the Health and Human Services
Commission in SECTION 1 (Section 531.0216, Government Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 531.0216, Government Code, to change 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 consult with the Texas
Department of Health, the Medicaid clinical review committee, the
telemedicine advisory committee, and the physician payment advisory
committee to establish procedures to carry out certain tasks.  

 (c) Makes conforming changes.

(d) 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. 

(e) Authorizes the commission to adopt rules as necessary to implement this
section, subject to Section 153.004 (Rules Regarding Telemedicine
Services), Occupations Code, instead of being subject to Section 5.11,
Medical Practices Act (Article 4495b, V.T.C.S.). 

 (f) Makes a conforming change.  

SECTION 2.  Amends Section 531.0217, Government Code, to redefine "health
professional,"  "physician," and "telemedicine medical service."   

 (b) Makes conforming changes.

 (c) Makes conforming changes.

(d) Adds language regarding another health professional besides a physician
providing a telemedicine medical service and makes conforming changes. 

 (e) Makes conforming changes.

(f) Requires the commission 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. 

(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 enure 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 requiring a face-to-face consultation with a physician within a certain
number of days following a telemedicine medical service.  Makes conforming
changes. 

 (j) Makes conforming changes.

(k) Provides that this section does not affect any requirement relating to
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. 

(l) Requires the commission to create and maintain a telemedicine medical
services registry that is available to licensing and regulatory agencies. 

SECTION 3.  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" and "telemedicine
medical service."  Deletes definition of "telemedicine." 

SECTION 4.  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. Makes
conforming changes. 

SECTION 5.  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 6.  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 7.  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 make conforming changes. 

SECTION 8.  Amends Section 153.004, Occupations Code, to make conforming
changes. 

SECTION 9.  Amends Section 57.042(11), Utilities Code, to define
"telemedicine medical service" and to delete definition of "telemedicine." 

SECTION 10.  Amends Section 57.045, Utilities Code, to require the
telecommunications infrastructure fund 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 11.  Amends Sections 57.047(a) and (b), Utilities Code, to make
conforming changes. 

SECTION 12.  Requires that not later than January 1, 2002, the Health and
Human Services Commission adopt rules required by Section 531.0217,
Government Code, as amended by this Act. 

SECTION 13.  Requires that, 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, the state agency request the waiver
or authorization and authorizes the delay of implementation of that
provision until the waiver or authorization is granted. 

SECTION 14.  Effective date: upon passage or September 1, 2001.