By: Moncrief S.B. No. 69
2001S0003/2
A BILL TO BE ENTITLED
AN ACT
1-1 relating to Medicaid reimbursement for certain telemedicine
1-2 services.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 531.0217, Government Code, is amended to
1-5 read as follows:
1-6 Sec. 531.0217. Reimbursement for Certain Medical
1-7 Consultations. (a) In this section:
1-8 (1) "Health professional" means a licensed physician
1-9 or, under the appropriate delegation and supervision of a licensed
1-10 physician, an advanced nurse practitioner[, an allied health
1-11 professional, a mental health professional, a physician,] or a
1-12 physician assistant [who is licensed in this state].
1-13 (2) "Telemedicine medical service" ["Rural county"
1-14 means a county that:]
1-15 [(A) has a population of 50,000 or less; or]
1-16 [(B) contains an area that was not designated as
1-17 an urban area by the United States Bureau of the Census according
1-18 to the 1990 federal census and does not have within the boundaries
1-19 of the county a hospital that:]
1-20 [(i) is licensed under Chapter 241, Health
1-21 and Safety Code; and]
1-22 [(ii) has more than 100 beds.]
1-23 [(3) "Rural health facility" means a health facility
1-24 that is located in a rural county and at least 30 miles from any
1-25 accredited medical school or any teaching hospital affiliated with
2-1 an accredited medical school and that is:]
2-2 [(A) a licensed, nonprofit hospital;]
2-3 [(B) a health clinic that is affiliated with:]
2-4 [(i) an accredited medical school;]
2-5 [(ii) a teaching hospital that is
2-6 affiliated with an accredited medical school;]
2-7 [(iii) a hospital described by Paragraph
2-8 (C); or]
2-9 [(iv) a federally qualified health center,
2-10 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
2-11 [(C) a hospital that:]
2-12 [(i) is licensed under Chapter 241, Health
2-13 and Safety Code;]
2-14 [(ii) is owned or operated by a
2-15 municipality, county, hospital district, or hospital authority; and]
2-16 [(iii) provides inpatient or outpatient
2-17 services.]
2-18 [(4) "Telemedical consultation"] means a health care
2-19 service initiated by a health professional [medical consultation]
2-20 for purposes of patient assessment by an advanced nurse
2-21 practitioner or a physician assistant, diagnosis by a physician, or
2-22 treatment, or the transfer of medical data, that requires the use
2-23 of advanced telecommunications technology, including:
2-24 (A) compressed digital interactive video, audio,
2-25 or data transmission;
2-26 (B) clinical data transmission via computer
3-1 imaging by way of still image capture [for teleradiology or
3-2 telepathology]; and
3-3 (C) other technology that facilitates access [in
3-4 rural counties] to a health care service [services] or medical
3-5 specialty expertise.
3-6 (b) The commission by rule shall require each health and
3-7 human services agency that administers a part of the Medicaid
3-8 program to provide Medicaid reimbursement for a telemedicine
3-9 medical service [telemedical consultation] provided by:
3-10 (1) a physician licensed in this state who practices
3-11 in:
3-12 (A) [(1)] a [rural] health facility;
3-13 (B) [(2)] an accredited medical school; or
3-14 (C) [(3)] a teaching hospital that is affiliated
3-15 with an accredited medical school; or
3-16 (2) a health professional who provides the
3-17 telemedicine medical service for a patient if:
3-18 (A) the medical examination of the patient is
3-19 under the control of the health professional;
3-20 (B) the telemedicine medical service involves
3-21 the participation of the health professional who obtains the
3-22 telemedicine medical service as appropriate to meet the medical
3-23 needs of the patient and as necessary to provide information
3-24 requested by the health professional; and
3-25 (C) the results of the telemedicine medical
3-26 service are provided in a written report to the health professional
4-1 involved in the telemedicine medical service.
4-2 (c) The commission shall ensure that reimbursement is
4-3 provided only for a telemedicine medical service [consultation]
4-4 provided by:
4-5 (1) a physician described in Subsection (b) to a
4-6 health professional who practices in Texas; or
4-7 (2) a health professional described in Subsection (b)
4-8 to a health professional who practices in an area designated as a
4-9 medically underserved area or a health professional shortage area
4-10 [a rural county].
4-11 (d) The commission shall require reimbursement for a
4-12 telemedicine medical service [telemedical consultation] at the same
4-13 rate as the Medicaid program reimburses for a comparable in-person
4-14 health service [consultation]. A request for reimbursement may not
4-15 be denied solely because an in-person health service [consultation]
4-16 between a physician or another health professional who provides the
4-17 telemedicine medical service and a patient did not occur.
4-18 (e) A health care facility that receives reimbursement under
4-19 this section for telemedicine medical services [consultations]
4-20 provided by physicians or other health professionals who practice
4-21 in that facility and a health professional who obtains telemedicine
4-22 medical services [consultations] under this section shall establish
4-23 quality of care protocols and patient confidentiality guidelines to
4-24 ensure that telemedicine medical services [telemedical
4-25 consultations] meet legal requirements and acceptable patient care
4-26 standards.
5-1 (f) The commission may not require a telemedicine medical
5-2 service [telemedical consultation] if an in-person consultation
5-3 with a physician is reasonably available where the patient resides
5-4 or works.
5-5 (g) The Texas State Board of Medical Examiners and the Board
5-6 of Nurse Examiners, in consultation with the commission, as
5-7 appropriate, may adopt rules as necessary to:
5-8 (1) ensure that appropriate care is provided to
5-9 patients who receive services that are provided through a
5-10 telemedicine medical service [telemedical consultation]; and
5-11 (2) prevent abuse and fraud through the use of
5-12 telemedicine medical services [telemedical consultations],
5-13 including rules relating to filing of claims and records required
5-14 to be maintained in connection with telemedicine.
5-15 (h) The commissioner shall establish an advisory committee
5-16 to assist the commission in developing policies for telemedicine
5-17 medical services [telemedical consultations] under this section.
5-18 (i) The provisions of this section do not provide any
5-19 authority to replace, substitute, or circumvent the requirements
5-20 for a rural health clinic or for physician delegation of
5-21 prescriptive authority to an advanced practice nurse or physician
5-22 assistant.
5-23 (j) The commission shall create and maintain a telemedicine
5-24 medical services registry that is available to licensing and
5-25 regulatory boards.
5-26 SECTION 2. This Act takes effect September 1, 2001.
6-1 SECTION 3. If before implementing any provision of this Act
6-2 a state agency determines that a waiver or authorization from a
6-3 federal agency is necessary for implementation of that provision,
6-4 the agency affected by the provision shall request the waiver or
6-5 authorization and may delay implementing that provision until the
6-6 waiver or authorization is granted.