By Maxey H.B. No. 1615
77R323 MCK-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation and reimbursement of telemedicine
1-3 medical services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 531.0216, Government Code, is amended to
1-6 read as follows:
1-7 Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
1-8 TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The
1-9 commission by rule shall develop and implement a system to
1-10 reimburse providers of services under the state Medicaid program
1-11 for services performed using telemedicine medical services.
1-12 (b) In developing the system, the commission shall:
1-13 (1) review programs and pilot projects in other states
1-14 to determine the most effective method for reimbursement;
1-15 (2) establish billing codes and a fee schedule for
1-16 services; [and]
1-17 (3) provide for an approval process before a provider
1-18 can receive reimbursement for services; and
1-19 (4) consult with the Texas Department of Health and
1-20 the telemedicine advisory committee to develop a procedure to deny
1-21 reimbursement for a health care service that, based on credible,
1-22 clinical evidence, is shown to be medically inappropriate for
1-23 delivery using a telecommunications system.
1-24 (c) The commission shall encourage teaching hospitals, small
2-1 rural hospitals, federally qualified health centers, and
2-2 state-owned health care facilities to participate as telemedicine
2-3 medical services [service] providers in the health care delivery
2-4 system. The commission may not require that a service be provided
2-5 to a patient through telemedicine medical services when the service
2-6 can reasonably be provided by a physician through a face-to-face
2-7 consultation with the patient in the community in which the patient
2-8 resides or works. This subsection does not prohibit the
2-9 authorization of the provision of any service to a patient through
2-10 telemedicine medical services at the patient's request.
2-11 (d) Subject to Section 153.004, Occupations Code [5.11,
2-12 Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-13 Statutes)], the commission may adopt rules as necessary to
2-14 implement this section.
2-15 (e) The commission may not reimburse a health care facility
2-16 for telemedicine medical services provided to a Medicaid recipient
2-17 unless the facility complies with the minimum standards adopted
2-18 under Section 531.02161.
2-19 (f) Not later than December 1 of each even-numbered year,
2-20 the commission shall report to the speaker of the house of
2-21 representatives and the lieutenant governor on the effects of
2-22 telemedicine medical services on the Medicaid program in the state,
2-23 including the number of physicians and health professionals using
2-24 telemedicine medical services, the geographic and demographic
2-25 disposition of the physicians and health professionals, the number
2-26 of patients receiving telemedicine medical services, and the cost
2-27 and utilization of telemedicine medical services on the program.
3-1 (g) In this section, "telemedicine medical service" has the
3-2 meaning assigned by Section 57.042, Utilities Code.
3-3 SECTION 2. Subchapter B, Chapter 531, Government Code, is
3-4 amended by adding Section 531.02161 to read as follows:
3-5 Sec. 531.02161. TELEMEDICINE TECHNOLOGY STANDARDS. (a) In
3-6 this section, "telemedicine medical service" has the meaning
3-7 assigned by Section 57.042, Utilities Code.
3-8 (b) The commission and the telecommunications infrastructure
3-9 fund board by joint rule shall establish and adopt minimum
3-10 standards for an operating system used in the provision of
3-11 telemedicine medical services by a health care facility
3-12 participating in the state Medicaid program, including standards
3-13 for electronic transmission, software, and hardware.
3-14 (c) In developing standards under this section, the
3-15 commission and the telecommunications infrastructure fund board
3-16 shall address:
3-17 (1) authentication and authorization of users;
3-18 (2) authentication of the origin of information;
3-19 (3) the prevention of unauthorized access to the
3-20 system or information;
3-21 (4) system security, including the integrity of
3-22 information that is collected, program integrity, and system
3-23 integrity;
3-24 (5) maintenance of documentation about system and
3-25 information usage; and
3-26 (6) information storage, maintenance, and
3-27 transmission.
4-1 SECTION 3. Section 531.0217, Government Code, is amended to
4-2 read as follows:
4-3 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
4-4 CONSULTATIONS. (a) In this section:
4-5 (1) "Health professional" means a physician or an
4-6 individual licensed in this state to perform health care services
4-7 that are delegated and supervised by a physician [an advanced nurse
4-8 practitioner, an allied health professional, a mental health
4-9 professional, a physician, or a physician assistant who is licensed
4-10 in this state].
4-11 (2) "Physician" means a person licensed to practice
4-12 medicine in this state under Subtitle B, Title 3, Occupations Code
4-13 ["Rural county" means a county that:]
4-14 [(A) has a population of 50,000 or less; or]
4-15 [(B) contains an area that was not designated as
4-16 an urban area by the United States Bureau of the Census according
4-17 to the 1990 federal census and does not have within the boundaries
4-18 of the county a hospital that:]
4-19 [(i) is licensed under Chapter 241, Health
4-20 and Safety Code; and]
4-21 [(ii) has more than 100 beds].
4-22 (3) "Telemedicine medical service" has the meaning
4-23 assigned by Section 57.042, Utilities Code ["Rural health facility"
4-24 means a health facility that is located in a rural county and at
4-25 least 30 miles from any accredited medical school or any teaching
4-26 hospital affiliated with an accredited medical school and that is:]
4-27 [(A) a licensed, nonprofit hospital;]
5-1 [(B) a health clinic that is affiliated with:]
5-2 [(i) an accredited medical school;]
5-3 [(ii) a teaching hospital that is
5-4 affiliated with an accredited medical school;]
5-5 [(iii) a hospital described by Paragraph
5-6 (C);] or
5-7 [(iv) a federally qualified health center,
5-8 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
5-9 [(C) a hospital that:]
5-10 [(i) is licensed under Chapter 241, Health
5-11 and Safety Code;]
5-12 [(ii) is owned or operated by a
5-13 municipality, county, hospital district, or hospital authority; and]
5-14 [(iii) provides inpatient or outpatient
5-15 services.]
5-16 [(4) "Telemedical consultation" means a medical
5-17 consultation for purposes of patient diagnosis or treatment that
5-18 requires the use of advanced telecommunications technology,
5-19 including:]
5-20 [(A) compressed digital interactive video,
5-21 audio, or data transmission;]
5-22 [(B) clinical data transmission via computer
5-23 imaging for teleradiology or telepathology; and]
5-24 [(C) other technology that facilitates access in
5-25 rural counties to health care services or medical specialty
5-26 expertise].
5-27 (b) The commission by rule shall require each health and
6-1 human services agency that administers a part of the Medicaid
6-2 program to provide Medicaid reimbursement for a telemedicine
6-3 medical service initiated or [telemedical consultation] provided by
6-4 a physician [licensed in this state who practices in:]
6-5 [(1) a rural health facility;]
6-6 [(2) an accredited medical school; or]
6-7 [(3) a teaching hospital that is affiliated with an
6-8 accredited medical school].
6-9 (c) The commission shall ensure that reimbursement is
6-10 provided only for a telemedicine medical service initiated or
6-11 [consultation] provided by a physician [described in Subsection (b)
6-12 to a health professional who practices in a rural county].
6-13 (d) The commission shall require reimbursement for a
6-14 telemedicine medical service [telemedical consultation] at the same
6-15 rate as the Medicaid program reimburses for a comparable in-person
6-16 medical service [consultation]. A request for reimbursement may
6-17 not be denied solely because an in-person medical service
6-18 [consultation] between a physician or another health professional
6-19 who provides the telemedicine medical service and a patient did not
6-20 occur.
6-21 (e) A health care facility that receives reimbursement under
6-22 this section for a telemedicine medical service [consultations]
6-23 provided by a physician [physicians] who practices [practice] in
6-24 that facility or [and] a health professional who participates in a
6-25 telemedicine medical service [obtains consultations] under this
6-26 section shall establish quality of care protocols and patient
6-27 confidentiality guidelines to ensure that the telemedicine medical
7-1 service meets [telemedical consultations meet] legal requirements
7-2 and acceptable patient care standards.
7-3 (f) The commission may not require a telemedicine medical
7-4 service [telemedical consultation] if an in-person consultation
7-5 with a physician is reasonably available where the patient resides
7-6 or works. The commission shall make a good faith effort to
7-7 identify and coordinate with existing providers to preserve and
7-8 protect existing health care systems and medical relationships in
7-9 an area.
7-10 (g) If a patient receiving a telemedicine medical service
7-11 has a primary care physician, the commission shall require that the
7-12 primary care physician be notified of the telemedicine medical
7-13 service for the purpose of sharing medical information.
7-14 (h) The commission in consultation with the Texas State
7-15 Board of Medical Examiners shall monitor and regulate the use of
7-16 telemedicine medical services to ensure compliance with this
7-17 section. In addition to any other method of enforcement, the
7-18 commission may use a corrective action plan to ensure compliance
7-19 with this section.
7-20 (i) [(g)] The Texas State Board of Medical Examiners, in
7-21 consultation with the commission, as appropriate, may adopt rules
7-22 as necessary to:
7-23 (1) ensure that appropriate care, including quality of
7-24 care, is provided to patients who receive telemedicine medical
7-25 services [that are provided through a telemedical consultation];
7-26 [and]
7-27 (2) prevent abuse and fraud through the use of
8-1 telemedicine medical services [telemedical consultations],
8-2 including rules relating to filing of claims and records required
8-3 to be maintained in connection with telemedicine;
8-4 (3) ensure adequate supervision of health
8-5 professionals who are not physicians and who provide telemedicine
8-6 medical services;
8-7 (4) establish the maximum number of health
8-8 professionals who are not physicians that a physician may supervise
8-9 through a telemedicine medical service; and
8-10 (5) require a face-to-face consultation with a
8-11 physician within a certain number of days following a telemedicine
8-12 medical service.
8-13 (j) [(h)] The commissioner shall establish an advisory
8-14 committee to coordinate state telemedicine efforts and assist the
8-15 commission in:
8-16 (1) evaluating [developing] policies for telemedicine
8-17 medical services under Section 531.0216 and this section;
8-18 (2) monitoring the types of programs receiving
8-19 reimbursement under this section; and
8-20 (3) coordinating the activities of state agencies
8-21 interested in the use of telemedicine medical services [telemedical
8-22 consultations under this section].
8-23 (k) This section does not affect any requirement relating
8-24 to:
8-25 (1) a rural health clinic; or
8-26 (2) physician delegation of the authority to carry out
8-27 or sign prescription drug orders to an advanced practice nurse or
9-1 physician assistant.
9-2 SECTION 4. Subchapter D, Chapter 62, Health and Safety Code,
9-3 is amended by adding Section 62.157 to read as follows:
9-4 Sec. 62.157. TELEMEDICINE MEDICAL SERVICES. (a) In
9-5 providing covered benefits to a child, a health plan provider must
9-6 permit benefits to be provided through telemedicine medical
9-7 services in accordance with policies developed by the commission.
9-8 (b) The policies must provide for:
9-9 (1) the availability of covered benefits appropriately
9-10 provided through telemedicine medical services that are comparable
9-11 to the same types of covered benefits provided without the use of
9-12 telemedicine medical services; and
9-13 (2) the availability of covered benefits for different
9-14 services performed by multiple health care providers during a
9-15 single session of telemedicine medical services, if the commission
9-16 determines that delivery of the covered benefits in that manner is
9-17 cost-effective in comparison to the costs that would be involved in
9-18 obtaining the services from providers without the use of
9-19 telemedicine medical services, including the costs of
9-20 transportation and lodging and other direct costs.
9-21 (c) In developing the policies required by Subsection (a),
9-22 the commission shall consult with:
9-23 (1) The University of Texas Medical Branch at
9-24 Galveston;
9-25 (2) the Texas Department of Health; and
9-26 (3) providers of telemedicine hub sites in this state.
9-27 (d) In this section, "telemedicine medical service" has the
10-1 meaning assigned by Section 57.042, Utilities Code.
10-2 SECTION 5. Subchapter B, Chapter 32, Human Resources Code, is
10-3 amended by adding Section 32.053 to read as follows:
10-4 Sec. 32.053. HOME TELEMEDICINE PILOT PROGRAM. (a) The
10-5 department shall establish a pilot program under which certain
10-6 recipients of medical assistance receive home health care services
10-7 through telemedicine in addition to other home health care services
10-8 for which the recipients are eligible.
10-9 (b) The department shall adopt eligibility criteria for the
10-10 program. The criteria must:
10-11 (1) require that a program participant:
10-12 (A) be diagnosed with:
10-13 (i) depression and a chronic illness,
10-14 including hypertension, congestive heart failure, diabetes
10-15 mellitus, chronic obstructive pulmonary disease, or a chronic
10-16 wound; or
10-17 (ii) depression, if it is secondary to a
10-18 chronic illness;
10-19 (B) have telephone service in the participant's
10-20 home;
10-21 (C) be able to use telemedicine equipment or be
10-22 assisted by a regular caregiver who is willing and able to use
10-23 telemedicine equipment;
10-24 (D) provide written consent to receipt of home
10-25 health care services through telemedicine; and
10-26 (E) be under the care of a physician who
10-27 consents to the participant's receipt of home health care services
11-1 through telemedicine; and
11-2 (2) prohibit a recipient of medical assistance from
11-3 participating in the program if the recipient:
11-4 (A) is diagnosed with a terminal condition and
11-5 expected to live for less than six months; or
11-6 (B) requires daily, in person, home health care
11-7 visits or invasive procedures.
11-8 (c) The department shall determine home health care services
11-9 to be provided to program participants through telemedicine. Home
11-10 health care services provided through telemedicine may include:
11-11 (1) educating a program participant regarding
11-12 self-care and preventive health;
11-13 (2) monitoring a program participant's compliance with
11-14 medication requirements;
11-15 (3) monitoring a program participant's vital signs;
11-16 (4) providing a program participant with counseling
11-17 and social support; and
11-18 (5) any other service the department determines is
11-19 appropriate.
11-20 (d) In designing and implementing the program, the
11-21 department shall ensure that:
11-22 (1) home health care services provided to a program
11-23 participant through telemedicine supplement necessary in-person
11-24 home visits by home health care providers and do not replace those
11-25 visits;
11-26 (2) a program participant receives, for the duration
11-27 of services and at no cost to the participant, telemedicine
12-1 equipment other than a telephone line and telephone that is
12-2 necessary for receipt of home health care services through
12-3 telemedicine;
12-4 (3) a program participant or the participant's regular
12-5 caregiver receives personal training and written instructions in
12-6 the use and maintenance of the telemedicine equipment;
12-7 (4) a program participant's satisfaction with home
12-8 health care services provided through telemedicine is frequently
12-9 monitored and evaluated; and
12-10 (5) the quality of home health care services provided
12-11 through telemedicine to a program participant is frequently
12-12 monitored and evaluated.
12-13 (e) The department shall adopt all rules necessary for
12-14 implementation of the program.
12-15 (f) Not later than December 1, 2004, the department shall
12-16 submit a report to the legislature regarding the program that
12-17 includes:
12-18 (1) an analysis of:
12-19 (A) the program's cost-effectiveness; and
12-20 (B) the program's effect on the quality of
12-21 health care received by program participants; and
12-22 (2) recommendations regarding elimination,
12-23 continuation, or expansion of the program.
12-24 (g) This section expires September 1, 2005.
12-25 SECTION 6. Section 1, Article 21.53F, Insurance Code, as
12-26 added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-27 Regular Session, 1997, is amended to read as follows:
13-1 Sec. 1. DEFINITIONS. In this article:
13-2 (1) "Health benefit plan" means a plan described by
13-3 Section 2 of this article.
13-4 (2) "Health professional" means a physician or an
13-5 individual licensed in this state to perform health care services
13-6 that are delegated and supervised by a physician.
13-7 (3) "Physician" means a person licensed to practice
13-8 medicine in this state under Subtitle B, Title 3, Occupations Code.
13-9 (4) "Telemedicine medical service" has the meaning
13-10 assigned by Section 57.042, Utilities Code ["Telemedicine" means
13-11 the use of interactive audio, video, or other electronic media to
13-12 deliver health care. The term includes the use of electronic media
13-13 for diagnosis, consultation, treatment, transfer of medical data,
13-14 and medical education. The term does not include services
13-15 performed using a telephone or facsimile machine].
13-16 SECTION 7. Section 3, Article 21.53F, Insurance Code, as
13-17 added by Section 1, Chapter 880, Acts of the 75th Legislature,
13-18 Regular Session, 1997, is amended to read as follows:
13-19 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES. (a) A
13-20 health benefit plan may not exclude a telemedicine medical service
13-21 from coverage under the plan solely because the service is
13-22 [provided through telemedicine and] not provided through a
13-23 face-to-face consultation.
13-24 (b) Benefits [for a service provided through telemedicine]
13-25 required under this article may be made subject to a deductible,
13-26 copayment, or coinsurance requirement. A deductible, copayment, or
13-27 coinsurance applicable to a particular service provided through
14-1 telemedicine medical services may not exceed the deductible,
14-2 copayment, or coinsurance required by the health benefit plan for a
14-3 comparable [the same] service provided through a face-to-face
14-4 consultation.
14-5 SECTION 8. Section 4, Article 21.53F, Insurance Code, as
14-6 added by Section 1, Chapter 880, Acts of the 75th Legislature,
14-7 Regular Session, 1997, is amended to read as follows:
14-8 Sec. 4. INFORMED CONSENT. A treating physician or [other]
14-9 health professional [care provider] who provides or facilitates the
14-10 use of telemedicine medical services shall ensure that the informed
14-11 consent of the patient, or another appropriate person with
14-12 authority to make health care treatment decisions for the patient,
14-13 is obtained before telemedicine medical services are provided
14-14 [through telemedicine].
14-15 SECTION 9. Section 5, Article 21.53F, Insurance Code, as
14-16 added by Section 1, Chapter 880, Acts of the 75th Legislature,
14-17 Regular Session, 1997, is amended to read as follows:
14-18 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
14-19 health professional [care provider] who provides or facilitates the
14-20 use of telemedicine medical services shall ensure that the
14-21 confidentiality of the patient's medical information is maintained
14-22 as required by Chapter 159, Occupations Code [Section 5.08, Medical
14-23 Practice Act (Article 4495b, Vernon's Texas Civil Statutes)], or
14-24 other applicable law.
14-25 SECTION 10. Section 6(b), Article 21.53F, Insurance Code, as
14-26 added by Section 1, Chapter 880, Acts of the 75th Legislature,
14-27 Regular Session, 1997, is amended to read as follows:
15-1 (b) The Texas State Board of Medical Examiners, in
15-2 consultation with the commissioner, as appropriate, may adopt rules
15-3 as necessary to:
15-4 (1) ensure that appropriate care, including quality of
15-5 care, is provided to patients who receive telemedicine medical
15-6 services [that are provided through telemedicine]; [and]
15-7 (2) prevent abuse and fraud through use of
15-8 telemedicine medical services, including rules relating to filing
15-9 of claims and records required to be maintained in connection with
15-10 telemedicine medical services;
15-11 (3) ensure adequate supervision of health
15-12 professionals who are not physicians and who provide telemedicine
15-13 medical services;
15-14 (4) establish the maximum number of health
15-15 professionals who are not physicians that a physician may supervise
15-16 through a telemedicine medical service; and
15-17 (5) require a face-to-face consultation with a
15-18 physician within a certain number of days following a telemedicine
15-19 medical service.
15-20 SECTION 11. Section 153.004, Occupations Code, is amended to
15-21 read as follows:
15-22 Sec. 153.004. RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
15-23 (a) In consultation with the Health and Human Services Commission
15-24 and the commissioner of insurance, the board may adopt rules as
15-25 necessary to:
15-26 (1) ensure that appropriate care is provided to
15-27 Medicaid and Medicare patients who receive telemedicine medical
16-1 services [that are provided through telemedicine]; and
16-2 (2) prevent abuse and fraud in the use of telemedicine
16-3 medical services for Medicaid and Medicare patients.
16-4 (b) The rules adopted under Section (a)(2) may include rules
16-5 relating to filing of claims and records required to be maintained
16-6 in relation to telemedicine medical services.
16-7 SECTION 12. Section 57.042(11), Utilities Code, is amended to
16-8 read as follows:
16-9 (11) "Telemedicine medical service" means a health
16-10 care service initiated by a physician or provided by a health
16-11 professional acting under physician delegation or supervision for
16-12 purposes of patient assessment by a health professional, diagnosis
16-13 or consultation by a physician, treatment, or the transfer of
16-14 medical data, that requires the use of advanced telecommunications
16-15 technology, other than by telephone or facsimile, including:
16-16 (A) compressed digital interactive video, audio,
16-17 or data transmission;
16-18 (B) clinical data transmission using computer
16-19 imaging by way of still image capture; and
16-20 (C) other technology that facilitates access to
16-21 health care services or medical specialty expertise[:]
16-22 [(A) means medical services delivered by
16-23 telecommunications technologies to rural or underserved public
16-24 not-for-profit health care facilities or primary health care
16-25 facilities in collaboration with an academic health center and an
16-26 associated teaching hospital or tertiary center or with another
16-27 public not-for-profit health care facility; and]
17-1 [(B) includes consultive services, diagnostic
17-2 services, interactive video consultation, teleradiology,
17-3 telepathology, and distance education for working health care
17-4 professionals].
17-5 SECTION 13. Section 57.045, Utilities Code, is amended by
17-6 adding Subsection (e) to read as follows:
17-7 (e) The board shall establish an assistance program to
17-8 provide education concerning the telecommunications infrastructure
17-9 fund and to facilitate access to funds and programs under this
17-10 subchapter by health care facilities and by physicians licensed to
17-11 practice medicine in this state. The assistance program must
17-12 include a toll-free telephone number and provide access to
17-13 information through the Internet.
17-14 SECTION 14. Sections 57.047(a) and (b), Utilities Code, are
17-15 amended to read as follows:
17-16 (a) The board may award a grant to a project or proposal
17-17 that:
17-18 (1) provides equipment and infrastructure necessary
17-19 for:
17-20 (A) distance learning;
17-21 (B) an information sharing program of a library;
17-22 or
17-23 (C) telemedicine medical services;
17-24 (2) develops and implements the initial or
17-25 prototypical delivery of a course or other distance learning
17-26 material;
17-27 (3) trains teachers, faculty, librarians, or
18-1 technicians in the use of distance learning or information sharing
18-2 materials and equipment;
18-3 (4) develops a curriculum or instructional material
18-4 specially suited for telecommunications delivery;
18-5 (5) provides electronic information; or
18-6 (6) establishes or carries out an information sharing
18-7 program.
18-8 (b) The board may award a loan to a project or proposal to
18-9 acquire equipment needed for distance learning and telemedicine
18-10 medical service projects.
18-11 SECTION 15. Subchapter C, Chapter 57, Utilities Code, is
18-12 amended by adding Section 57.0475 to read as follows:
18-13 Sec. 57.0475. ELIGIBILITY FOR GRANTS TO HEALTH CARE
18-14 FACILITIES. (a) The board may award a grant under Section
18-15 57.047(a)(1)(C) only to a health care facility that:
18-16 (1) is a hospital or other entity, including a health
18-17 clinic, that:
18-18 (A) is supported by local or regional tax
18-19 revenue;
18-20 (B) is a certified nonprofit health corporation
18-21 under federal law; or
18-22 (C) is an ambulatory surgical center; or
18-23 (2) meets the criteria adopted by the board and the
18-24 Health and Human Services Commission under Subsection (b).
18-25 (b) The board and the Health and Human Services Commission
18-26 shall jointly adopt rules prescribing the criteria a health care
18-27 facility not described by Subsection (a)(1) must meet to be
19-1 eligible to receive a grant under Section 57.047(a)(1)(C). In
19-2 determining the criteria, the board and commission shall prioritize
19-3 health care facilities based on:
19-4 (1) the amount of charity care provided by each
19-5 facility during the year preceding the year in which the facility
19-6 applies for a grant; and
19-7 (2) the number of Medicaid patients and patients
19-8 enrolled in the state child health plan treated by each facility
19-9 during the year preceding the year in which the facility applies
19-10 for a grant.
19-11 (c) The criteria adopted under Subsection (b) must provide
19-12 that a health care facility is not eligible to receive a grant
19-13 under Section 57.047(a)(1)(C) if the health care facility did not
19-14 provide any charity care or treat any patients described by
19-15 Subdivision (b)(2) during the year preceding the year in which the
19-16 facility applies for a grant.
19-17 SECTION 16. Not later than October 1, 2001, the Health and
19-18 Human Services Commission and the telecommunications infrastructure
19-19 fund board shall adopt minimum standards for an operating system
19-20 used by a health care facility in providing telemedicine medical
19-21 services to a Medicaid recipient as required by Section 531.02161,
19-22 Government Code, as added by this Act.
19-23 SECTION 17. Not later than January 1, 2002, the Health and
19-24 Human Services Commission shall adopt rules required by Section
19-25 531.0217, Government Code, as amended by this Act.
19-26 SECTION 18. (a) If the Health and Human Services Commission
19-27 determines it is necessary, the commission, not later than
20-1 September 15, 2001, shall submit for approval a plan amendment
20-2 relating to the state child health plan under 42 U.S.C. Section
20-3 1397ff, as amended, as necessary to comply with Section 62.157,
20-4 Health and Safety Code, as added by this Act.
20-5 (b) The Health and Human Services Commission and the Texas
20-6 Board of Health may delay, until approval of the amended state
20-7 child health plan, implementation of Section 62.157, Health and
20-8 Safety Code, as added by this Act.
20-9 SECTION 19. If, before implementing any provision of this
20-10 Act, a state agency determines that a waiver or authorization from
20-11 a federal agency is necessary for implementation of that provision,
20-12 the agency affected by the provision shall request the waiver or
20-13 authorization and may delay implementing that provision until the
20-14 waiver or authorization is granted.
20-15 SECTION 20. This Act takes effect immediately if it receives
20-16 a vote of two-thirds of all the members elected to each house, as
20-17 provided by Section 39, Article III, Texas Constitution. If this
20-18 Act does not receive the vote necessary for immediate effect, this
20-19 Act takes effect September 1, 2001.