By: Moncrief, et al. S.B. No. 789
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation and reimbursement of telemedicine
1-3 medical services and telehealth 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 by rule 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;
1-19 (4) establish a separate provider identifier for
1-20 telemedicine medical services providers; and
1-21 (5) consult with the Texas Department of Health and
1-22 the telemedicine advisory committee to establish procedures to:
1-23 (A) identify clinical evidence supporting
1-24 delivery of health care services using a telecommunications system;
1-25 (B) establish pilot studies for telemedicine
2-1 medical service delivery; and
2-2 (C) annually review health care services,
2-3 considering new clinical findings, to determine whether
2-4 reimbursement for particular services should be denied or
2-5 authorized.
2-6 (c) The commission shall establish pilot programs in
2-7 designated areas of this state under which the commission, in
2-8 administering government-funded health programs, may reimburse a
2-9 health professional participating in the pilot program for
2-10 telehealth services authorized under the licensing law applicable
2-11 to the health professional.
2-12 (d) The commission shall encourage physicians, teaching
2-13 hospitals, small rural hospitals, federally qualified health
2-14 centers, and state-owned health care facilities to participate as
2-15 telemedicine medical services [service] providers in the health
2-16 care delivery system. The commission may not require that a
2-17 service be provided to a patient through telemedicine medical
2-18 services when the service can reasonably be provided by a physician
2-19 through a face-to-face consultation with the patient in the
2-20 community in which the patient resides or works. This subsection
2-21 does not prohibit the authorization of the provision of any service
2-22 to a patient through telemedicine medical services at the patient's
2-23 request.
2-24 (e) Not later than December 1 of each even-numbered year,
2-25 the commission shall report to the speaker of the house of
2-26 representatives and the lieutenant governor on the effects of
3-1 telemedicine medical services on the Medicaid program in the state,
3-2 including the number of physicians and health professionals using
3-3 telemedicine medical services, the geographic and demographic
3-4 disposition of the physicians and health professionals, the number
3-5 of patients receiving telemedicine medical services, the types of
3-6 services being provided, and the cost of utilization of
3-7 telemedicine medical services to the program.
3-8 (f) [(d)] Subject to Section 153.004, Occupations Code
3-9 [5.11, Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-10 Statutes)], the commission may adopt rules as necessary to
3-11 implement this section.
3-12 (g) [(e)] In this section:
3-13 (1) "Telehealth service" has the meaning assigned by
3-14 Section 57.042, Utilities Code; and
3-15 (2) "Telemedicine medical service"[, "telemedicine"]
3-16 has the meaning assigned by Section 57.042, Utilities Code.
3-17 SECTION 2. Section 531.0217, Government Code, is amended to
3-18 read as follows:
3-19 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
3-20 CONSULTATIONS. (a) In this section:
3-21 (1) "Health professional" means:
3-22 (A) a physician;
3-23 (B) an individual who is licensed or certified
3-24 in this state to perform health care services and who is authorized
3-25 to assist a physician in providing telemedicine medical services
3-26 that are delegated and supervised by the physician; or
4-1 (C) a licensed or certified health professional
4-2 acting within the scope of the license or certification who does
4-3 not perform a telemedicine medical service [an advanced nurse
4-4 practitioner, an allied health professional, a mental health
4-5 professional, a physician, or a physician assistant who is licensed
4-6 in this state].
4-7 (2) "Physician" means a person licensed to practice
4-8 medicine in this state under Subtitle B, Title 3, Occupations Code
4-9 ["Rural county" means a county that:]
4-10 [(A) has a population of 50,000 or less; or]
4-11 [(B) contains an area that was not designated as
4-12 an urban area by the United States Bureau of the Census according
4-13 to the 1990 federal census and does not have within the boundaries
4-14 of the county a hospital that:]
4-15 [(i) is licensed under Chapter 241, Health
4-16 and Safety Code; and]
4-17 [(ii) has more than 100 beds].
4-18 (3) "Telehealth service" has the meaning assigned by
4-19 Section 57.042, Utilities Code.
4-20 (4) "Telemedicine medical service" has the meaning
4-21 assigned by Section 57.042, Utilities Code. ["Rural health
4-22 facility" means a health facility that is located in a rural county
4-23 and at least 30 miles from any accredited medical school or any
4-24 teaching hospital affiliated with an accredited medical school and
4-25 that is:]
4-26 [(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.]
6-1 (b) The commission by rule shall require each health and
6-2 human services agency that administers a part of the Medicaid
6-3 program to provide Medicaid reimbursement for a telemedicine
6-4 medical service initiated or [telemedical consultation] provided by
6-5 a physician [licensed in this state who practices in:]
6-6 [(1) a rural health facility;]
6-7 [(2) an accredited medical school; or]
6-8 [(3) a teaching hospital that is affiliated with an
6-9 accredited medical school].
6-10 (c) The commission shall ensure that reimbursement is
6-11 provided only for a telemedicine medical service initiated or
6-12 [consultation] provided by a physician [described in Subsection (b)
6-13 to a health professional who practices in a rural county].
6-14 (d) The commission shall require reimbursement for a
6-15 telemedicine medical service [telemedical consultation] at the same
6-16 rate as the Medicaid program reimburses for a comparable in-person
6-17 medical service [consultation]. A request for reimbursement may
6-18 not be denied solely because an in-person medical service
6-19 [consultation] between a physician and a patient did not occur.
6-20 (e) A health care facility that receives reimbursement under
6-21 this section for a telemedicine medical service [consultations]
6-22 provided by a physician [physicians] who practices [practice] in
6-23 that facility or [and] a health professional who participates in a
6-24 telemedicine medical service [obtains consultations] under this
6-25 section shall establish quality of care protocols and patient
6-26 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 require facilities and providers of
7-7 telemedicine medical services to make a good faith effort to
7-8 identify and coordinate with existing providers to preserve and
7-9 protect existing health care systems and medical relationships in
7-10 an area.
7-11 (g) If a patient receiving a telemedicine medical service
7-12 has a primary care physician, the commission shall require that the
7-13 primary care physician be notified of the telemedicine medical
7-14 service for the purpose of sharing medical information.
7-15 (h) The commission in consultation with the Texas State
7-16 Board of Medical Examiners shall monitor and regulate the use of
7-17 telemedicine medical services to ensure compliance with this
7-18 section. In addition to any other method of enforcement, the
7-19 commission may use a corrective action plan to ensure compliance
7-20 with this section.
7-21 (i) [(g)] The Texas State Board of Medical Examiners, in
7-22 consultation with the commission, as appropriate, may adopt rules
7-23 as necessary to:
7-24 (1) ensure that appropriate care, including quality of
7-25 care, is provided to patients who receive telemedicine medical
7-26 services [that are provided through a telemedical consultation];
8-1 [and]
8-2 (2) prevent abuse and fraud through the use of
8-3 telemedicine medical services [telemedical consultations],
8-4 including rules relating to filing of claims and records required
8-5 to be maintained in connection with telemedicine;
8-6 (3) establish supervisory requirements for a service
8-7 delegated to and performed by an individual who is not a physician;
8-8 and
8-9 (4) define those situations when a face-to-face
8-10 consultation with a physician is required after a telemedicine
8-11 medical service.
8-12 (j) [(h)] The commissioner shall establish an advisory
8-13 committee to assist the commission in coordinating state
8-14 telemedicine efforts [developing policies for telemedical
8-15 consultations under this section].
8-16 (k) This section does not affect any requirement relating
8-17 to:
8-18 (1) a rural health clinic or federally qualified
8-19 health center; or
8-20 (2) physician delegation of the authority to carry out
8-21 or sign prescription drug orders to an advanced practice nurse or
8-22 physician assistant.
8-23 SECTION 3. Section 1, Article 21.53F, Insurance Code, as
8-24 added by Section 1, Chapter 880, Acts of the 75th Legislature,
8-25 Regular Session, 1997, is amended to read as follows:
8-26 Sec. 1. DEFINITIONS. In this article:
9-1 (1) "Health benefit plan" means a plan described by
9-2 Section 2 of this article.
9-3 (2) "Health professional" means:
9-4 (A) a physician;
9-5 (B) an individual who is licensed or certified
9-6 in this state to perform health care services that are delegated
9-7 and supervised by the physician; or
9-8 (C) a licensed or certified health professional
9-9 acting within the scope of the license or certification who does
9-10 not perform a telemedicine medical service.
9-11 (3) "Physician" means a person licensed to practice
9-12 medicine in this state under Subtitle B, Title 3, Occupations Code.
9-13 (4) "Telehealth service" has the meaning assigned by
9-14 Section 57.042, Utilities Code.
9-15 (5) "Telemedicine medical service" has the meaning
9-16 assigned by Section 57.042, Utilities Code. ["Telemedicine" means
9-17 the use of interactive audio, video, or other electronic media to
9-18 deliver health care. The term includes the use of electronic media
9-19 for diagnosis, consultation, treatment, transfer of medical data,
9-20 and medical education. The term does not include services
9-21 performed using a telephone or facsimile machine.]
9-22 SECTION 4. Section 3, Article 21.53F, Insurance Code, as
9-23 added by Section 1, Chapter 880, Acts of the 75th Legislature,
9-24 Regular Session, 1997, is amended to read as follows:
9-25 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND
9-26 TELEHEALTH SERVICES. (a) A health benefit plan may not exclude a
10-1 telemedicine medical service or a telehealth service from coverage
10-2 under the plan solely because the service is [provided through
10-3 telemedicine and] not provided through a face-to-face consultation.
10-4 (b) Benefits [for a service provided through telemedicine]
10-5 required under this article may be made subject to a deductible,
10-6 copayment, or coinsurance requirement. A deductible, copayment, or
10-7 coinsurance applicable to a particular service provided through
10-8 telemedicine medical services or telehealth services may not exceed
10-9 the deductible, copayment, or coinsurance required by the health
10-10 benefit plan for a comparable [the same] service provided through a
10-11 face-to-face consultation.
10-12 SECTION 5. Section 4, Article 21.53F, Insurance Code, as
10-13 added by Section 1, Chapter 880, Acts of the 75th Legislature,
10-14 Regular Session, 1997, is amended to read as follows:
10-15 Sec. 4. INFORMED CONSENT. A treating physician or [other]
10-16 health professional [care provider] who provides or facilitates the
10-17 use of telemedicine medical services or telehealth services shall
10-18 ensure that the informed consent of the patient, or another
10-19 appropriate person with authority to make health care treatment
10-20 decisions for the patient, is obtained before telemedicine medical
10-21 services or telehealth services are provided [through
10-22 telemedicine].
10-23 SECTION 6. Section 5, Article 21.53F, Insurance Code, as
10-24 added by Section 1, Chapter 880, Acts of the 75th Legislature,
10-25 Regular Session, 1997, is amended to read as follows:
10-26 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
11-1 health professional [care provider] who provides or facilitates the
11-2 use of telemedicine medical services or telehealth services shall
11-3 ensure that the confidentiality of the patient's medical
11-4 information is maintained as required by Chapter 159, Occupations
11-5 Code [Section 5.08, Medical Practice Act (Article 4495b, Vernon's
11-6 Texas Civil Statutes)], or other applicable law.
11-7 SECTION 7. Section 6, Article 21.53F, Insurance Code, as
11-8 added by Section 1, Chapter 880, Acts of the 75th Legislature,
11-9 Regular Session, 1997, is amended by amending Subsection (b) and
11-10 adding Subsection (c) to read as follows:
11-11 (b) The Texas State Board of Medical Examiners, in
11-12 consultation with the commissioner, as appropriate, may adopt rules
11-13 as necessary to:
11-14 (1) ensure that appropriate care, including quality of
11-15 care, is provided to patients who receive telemedicine medical
11-16 services [that are provided through telemedicine]; and
11-17 (2) prevent abuse and fraud through use of
11-18 telemedicine medical services, including rules relating to filing
11-19 of claims and records required to be maintained in connection with
11-20 telemedicine medical services.
11-21 (c) The appropriate licensing agency for a person providing
11-22 telehealth services, in consultation with the commissioner, as
11-23 appropriate, may adopt rules as necessary to:
11-24 (1) ensure that appropriate care, including quality of
11-25 care, is provided to patients who receive telehealth services; and
11-26 (2) prevent abuse and fraud through use of telehealth
12-1 services, including rules relating to filing of claims and records
12-2 required to be maintained in connection with telehealth services.
12-3 SECTION 8. Section 153.004, Occupations Code, is amended to
12-4 read as follows:
12-5 Sec. 153.004. RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
12-6 (a) In consultation with the Health and Human Services Commission
12-7 and the commissioner of insurance, the board may adopt rules as
12-8 necessary to:
12-9 (1) ensure that appropriate care is provided to
12-10 Medicaid and Medicare patients who receive telemedicine medical
12-11 services [that are provided through telemedicine]; and
12-12 (2) prevent abuse and fraud in the use of telemedicine
12-13 medical services for Medicaid and Medicare patients.
12-14 (b) The rules adopted under Subsection [Section] (a)(2) may
12-15 include rules relating to filing of claims and records required to
12-16 be maintained in relation to telemedicine medical services.
12-17 SECTION 9. Section 57.042, Utilities Code, is amended by
12-18 amending Subdivision (11) and adding Subdivision (12) to read as
12-19 follows:
12-20 (11) "Telehealth service" means a health service,
12-21 other than a telemedicine medical service, delivered by a licensed
12-22 or certified health professional acting within the scope of the
12-23 health professional's license or certification who does not perform
12-24 a telemedicine medical service that requires the use of advanced
12-25 telecommunications technology, other than by telephone or
12-26 facsimile, including:
13-1 (A) compressed digital interactive video, audio,
13-2 or data transmission;
13-3 (B) clinical data transmission using computer
13-4 imaging by way of still-image capture and store and forward; and
13-5 (C) other technology that facilitates access to
13-6 health care services or medical specialty expertise.
13-7 (12) "Telemedicine medical service" means a health
13-8 care service initiated by a physician or provided by a health
13-9 professional acting under physician delegation and supervision for
13-10 purposes of patient assessment by a health professional, diagnosis
13-11 or consultation by a physician, treatment, or the transfer of
13-12 medical data, that requires the use of advanced telecommunications
13-13 technology, other than by telephone or facsimile, including:
13-14 (A) compressed digital interactive video, audio,
13-15 or data transmission;
13-16 (B) clinical data transmission using computer
13-17 imaging by way of still-image capture and store and forward; and
13-18 (C) other technology that facilitates access to
13-19 health care services or medical specialty expertise[:]
13-20 [(A) means medical services delivered by
13-21 telecommunications technologies to rural or underserved public
13-22 not-for-profit health care facilities or primary health care
13-23 facilities in collaboration with an academic health center and an
13-24 associated teaching hospital or tertiary center or with another
13-25 public not-for-profit health care facility; and]
13-26 [(B) includes consultive services, diagnostic
14-1 services, interactive video consultation, teleradiology,
14-2 telepathology, and distance education for working health care
14-3 professionals].
14-4 SECTION 10. Section 57.045, Utilities Code, is amended by
14-5 adding Subsection (e) to read as follows:
14-6 (e) The board shall establish an assistance program to
14-7 provide education concerning the telecommunications infrastructure
14-8 fund and to facilitate access to funds and programs under this
14-9 subchapter by health care facilities and by physicians licensed to
14-10 practice medicine in this state. The assistance program must
14-11 include a toll-free telephone number and provide access to
14-12 information through the Internet.
14-13 SECTION 11. Subsections (a) and (b), Section 57.047,
14-14 Utilities Code, are amended to read as follows:
14-15 (a) The board may award a grant to a project or proposal
14-16 that:
14-17 (1) provides equipment and infrastructure necessary
14-18 for:
14-19 (A) distance learning;
14-20 (B) an information sharing program of a library;
14-21 [or]
14-22 (C) telemedicine medical services; or
14-23 (D) telehealth services;
14-24 (2) develops and implements the initial or
14-25 prototypical delivery of a course or other distance learning
14-26 material;
15-1 (3) trains teachers, faculty, librarians, or
15-2 technicians in the use of distance learning or information sharing
15-3 materials and equipment;
15-4 (4) develops a curriculum or instructional material
15-5 specially suited for telecommunications delivery;
15-6 (5) provides electronic information; or
15-7 (6) establishes or carries out an information sharing
15-8 program.
15-9 (b) The board may award a loan to a project or proposal to
15-10 acquire equipment needed for distance learning and telemedicine
15-11 medical service projects.
15-12 SECTION 12. Subsection (a), Section 58.253, Utilities Code,
15-13 is amended to read as follows:
15-14 (a) On customer request, an electing company shall provide
15-15 private network services to:
15-16 (1) an educational institution;
15-17 (2) a library;
15-18 (3) a nonprofit telemedicine center;
15-19 (4) a public or not-for-profit hospital;
15-20 (5) a project funded by the telecommunications
15-21 infrastructure fund under Subchapter C, Chapter 57, except to the
15-22 extent the project benefits a health care facility that:
15-23 (A) is not supported by local or regional tax
15-24 revenue;
15-25 (B) is not a certified nonprofit health
15-26 corporation under federal law; or
16-1 (C) is not an ambulatory health care center; or
16-2 (6) a legally constituted consortium or group of
16-3 entities listed in this subsection.
16-4 SECTION 13. Not later than January 1, 2002, the Health and
16-5 Human Services Commission shall adopt rules required by Section
16-6 531.0217, Government Code, as amended by this Act.
16-7 SECTION 14. If before implementing any provision of this Act
16-8 a state agency determines that a waiver or authorization from a
16-9 federal agency is necessary for implementation of that provision,
16-10 the agency affected by the provision shall request the waiver or
16-11 authorization and may delay implementing that provision until the
16-12 waiver or authorization is granted.
16-13 SECTION 15. This Act takes effect immediately if it receives
16-14 a vote of two-thirds of all the members elected to each house, as
16-15 provided by Section 39, Article III, Texas Constitution. If this
16-16 Act does not receive the vote necessary for immediate effect, this
16-17 Act takes effect September 1, 2001.