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 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) consult with the Texas Department of Health and
1-20 the telemedicine advisory committee to establish procedures to:
1-21 (A) identify clinical evidence supporting
1-22 delivery of health care services using a telecommunications system
1-23 by January 1, 2001;
1-24 (B) establish pilot studies for telemedicine
1-25 medical service delivery; and
2-1 (C) annually review health care services,
2-2 considering new clinical findings, to determine whether
2-3 reimbursement for particular services should be denied or
2-4 authorized;
2-5 (5) establish pilot programs in designated areas of
2-6 this state under which the commission, in administering
2-7 government-funded health programs, may reimburse a health
2-8 professional participating in the pilot program for telehealth
2-9 services authorized under the licensing law applicable to the
2-10 health professional; and
2-11 (6) establish a separate provider identifier for
2-12 telemedicine medical services providers.
2-13 (c) The commission shall encourage physicians, teaching
2-14 hospitals, small rural hospitals, federally qualified health
2-15 centers, and state-owned health care facilities to participate as
2-16 telemedicine medical service providers in the health care delivery
2-17 system. The commission may not require that a service be provided
2-18 to a patient through telemedicine medical services when the service
2-19 can reasonably be provided by a physician through a face-to-face
2-20 consultation with the patient in the community in which the patient
2-21 resides or works. This subsection does not prohibit the
2-22 authorization of the provision of any service to a patient through
2-23 telemedicine medical services at the patient's request.
2-24 (d) Subject to Section 153.004, Occupations Code [5.11,
2-25 Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-26 Statutes)], the commission may adopt rules as necessary to
3-1 implement this section.
3-2 (e) The commission may not reimburse a health care facility
3-3 for telemedicine medical services provided to a Medicaid recipient
3-4 unless the facility complies with the minimum standards adopted
3-5 under Section 531.02161.
3-6 (f) Not later than December 1 of each even-numbered year,
3-7 the commission shall report to the speaker of the house of
3-8 representatives and the lieutenant governor on the effects of
3-9 telemedicine medical services on the Medicaid program in the state,
3-10 including the number of physicians and health professionals using
3-11 telemedicine medical services, the geographic and demographic
3-12 disposition of the physicians and health professionals, the number
3-13 of patients receiving telemedicine medical services, the types of
3-14 services being provided, and the cost of utilization of
3-15 telemedicine medical services to the program.
3-16 (g) In this section:
3-17 (1) "Telehealth service" has the meaning assigned by
3-18 Section 57.042, Utilities Code.
3-19 (2) "Telemedicine medical service"[, "telemedicine"]
3-20 has the meaning assigned by Section 57.042, Utilities Code.
3-21 SECTION 2. Subchapter B, Chapter 531, Government Code, is
3-22 amended by adding Section 531.02161 to read as follows:
3-23 Sec. 531.02161. TELEMEDICINE TECHNOLOGY STANDARDS. (a) In
3-24 this section, "telemedicine medical service" has the meaning
3-25 assigned by Section 57.042, Utilities Code.
3-26 (b) The commission and the Telecommunications Infrastructure
4-1 Fund Board by joint rule shall establish and adopt minimum
4-2 standards for an operating system used in the provision of
4-3 telemedicine medical services by a health care facility
4-4 participating in the state Medicaid program, including standards
4-5 for electronic transmission, software, and hardware.
4-6 (c) In developing standards under this section, the
4-7 commission and the Telecommunications Infrastructure Fund Board
4-8 shall address:
4-9 (1) authentication and authorization of users;
4-10 (2) authentication of the origin of information;
4-11 (3) the prevention of unauthorized access to the
4-12 system or information;
4-13 (4) system security, including the integrity of
4-14 information that is collected, program integrity, and system
4-15 integrity;
4-16 (5) maintenance of documentation about system and
4-17 information usage;
4-18 (6) information storage, maintenance, and
4-19 transmission; and
4-20 (7) synchronization and verification of patient
4-21 profile data.
4-22 SECTION 3. Section 531.0217, Government Code, is amended to
4-23 read as follows:
4-24 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
4-25 CONSULTATIONS. (a) In this section:
4-26 (1) "Health professional" means:
5-1 (A) a physician;
5-2 (B) an individual who is:
5-3 (i) licensed or certified in this state to
5-4 perform health care services; and
5-5 (ii) authorized to assist a physician in
5-6 providing telemedicine medical services that are delegated and
5-7 supervised by the physician; or
5-8 (C) a licensed or certified health professional
5-9 acting within the scope of the license or certification who does
5-10 not perform a telemedicine medical service [an advanced nurse
5-11 practitioner, an allied health professional, a mental health
5-12 professional, a physician, or a physician assistant who is licensed
5-13 in this state].
5-14 (2) "Physician" means a person licensed to practice
5-15 medicine in this state under Subtitle B, Title 3, Occupations Code.
5-16 ["Rural county" means a county that:]
5-17 [(A) has a population of 50,000 or less; or]
5-18 [(B) contains an area that was not designated as
5-19 an urban area by the United States Bureau of the Census according
5-20 to the 1990 federal census and does not have within the boundaries
5-21 of the county a hospital that:]
5-22 [(i) is licensed under Chapter 241, Health
5-23 and Safety Code; and]
5-24 [(ii) has more than 100 beds.]
5-25 (3) "Telehealth service" has the meaning assigned by
5-26 Section 57.042, Utilities Code.
6-1 (4) "Telemedicine medical service" has the meaning
6-2 assigned by Section 57.042, Utilities Code. ["Rural health
6-3 facility" means a health facility that is located in a rural county
6-4 and at least 30 miles from any accredited medical school or any
6-5 teaching hospital affiliated with an accredited medical school and
6-6 that is:]
6-7 [(A) a licensed, nonprofit hospital;]
6-8 [(B) a health clinic that is affiliated with:]
6-9 [(i) an accredited medical school;]
6-10 [(ii) a teaching hospital that is
6-11 affiliated with an accredited medical school;]
6-12 [(iii) a hospital described by Paragraph
6-13 (C); or]
6-14 [(iv) a federally qualified health center,
6-15 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
6-16 [(C) a hospital that:]
6-17 [(i) is licensed under Chapter 241, Health
6-18 and Safety Code;]
6-19 [(ii) is owned or operated by a
6-20 municipality, county, hospital district, or hospital authority; and]
6-21 [(iii) provides inpatient or outpatient
6-22 services.]
6-23 [(4) "Telemedical consultation" means a medical
6-24 consultation for purposes of patient diagnosis or treatment that
6-25 requires the use of advanced telecommunications technology,
6-26 including:]
7-1 [(A) compressed digital interactive video,
7-2 audio, or data transmission;]
7-3 [(B) clinical data transmission via computer
7-4 imaging for teleradiology or telepathology; and]
7-5 [(C) other technology that facilitates access in
7-6 rural counties to health care services or medical specialty
7-7 expertise.]
7-8 (b) The commission by rule shall require each health and
7-9 human services agency that administers a part of the Medicaid
7-10 program to provide Medicaid reimbursement for a telemedicine
7-11 medical service initiated or [telemedical consultation] provided by
7-12 a physician [licensed in this state who practices in:]
7-13 [(1) a rural health facility;]
7-14 [(2) an accredited medical school; or]
7-15 [(3) a teaching hospital that is affiliated with an
7-16 accredited medical school].
7-17 (c) The commission shall ensure that reimbursement is
7-18 provided only for a telemedicine medical service initiated or
7-19 [consultation] provided by a physician [described in Subsection (b)
7-20 to a health professional who practices in a rural county].
7-21 (d) The commission shall require reimbursement for a
7-22 telemedicine medical service [telemedical consultation] at the same
7-23 rate as the Medicaid program reimburses for a comparable in-person
7-24 medical service [consultation]. A request for reimbursement may
7-25 not be denied solely because an in-person medical service
7-26 [consultation] between a physician and a patient did not occur.
8-1 (e) A health care facility that receives reimbursement under
8-2 this section for a telemedicine medical service [consultations]
8-3 provided by a physician [physicians] who practices [practice] in
8-4 that facility or [and] a health professional who participates in a
8-5 telemedicine medical service [obtains consultations] under this
8-6 section shall establish quality of care protocols and patient
8-7 confidentiality guidelines to ensure that the telemedicine medical
8-8 service meets [telemedical consultations meet] legal requirements
8-9 and acceptable patient care standards.
8-10 (f) The commission may not require a telemedicine medical
8-11 service [telemedical consultation] if an in-person consultation
8-12 with a physician is reasonably available where the patient resides
8-13 or works. The commission shall require facilities and providers of
8-14 telemedicine medical services to make a good faith effort to
8-15 identify and coordinate with existing providers to preserve and
8-16 protect existing health care systems and medical relationships in
8-17 an area.
8-18 (g) If a patient receiving a telemedicine medical service
8-19 has a primary care physician or provider and consents to the
8-20 notification, the commission shall require that the primary care
8-21 physician or provider be notified of the telemedicine medical
8-22 service for the purpose of sharing medical information.
8-23 (h) The commission in consultation with the Texas State
8-24 Board of Medical Examiners shall monitor and regulate the use of
8-25 telemedicine medical services to ensure compliance with this
8-26 section. In addition to any other method of enforcement, the
9-1 commission may use a corrective action plan to ensure compliance
9-2 with this section.
9-3 (i) The Texas State Board of Medical Examiners, in
9-4 consultation with the commission, as appropriate, may adopt rules
9-5 as necessary to:
9-6 (1) ensure that appropriate care, including quality of
9-7 care, is provided to patients who receive telemedicine medical
9-8 services [that are provided through a telemedical consultation];
9-9 [and]
9-10 (2) prevent abuse and fraud through the use of
9-11 telemedicine medical services [telemedical consultations],
9-12 including rules relating to filing of claims and records required
9-13 to be maintained in connection with telemedicine;
9-14 (3) establish supervisory requirements for a service
9-15 delegated to and performed by an individual who is not a physician;
9-16 and
9-17 (4) define those situations when a face-to-face
9-18 consultation with a physician is required after a telemedicine
9-19 medical service.
9-20 (j) [(h)] The commissioner shall establish an advisory
9-21 committee to coordinate state telemedicine efforts and assist the
9-22 commission in:
9-23 (1) evaluating [developing] policies for telemedicine
9-24 medical services under Section 531.0216 and this section;
9-25 (2) monitoring the types of programs receiving
9-26 reimbursement under this section; and
10-1 (3) coordinating the activities of state agencies
10-2 interested in the use of telemedicine medical services [telemedical
10-3 consultations under this section].
10-4 (k) This section does not affect any requirement relating
10-5 to:
10-6 (1) a federally qualified health center;
10-7 (2) a rural health clinic; or
10-8 (3) physician delegation of the authority to carry out
10-9 or sign prescription drug orders to an advanced practice nurse or
10-10 physician assistant.
10-11 SECTION 4. Subchapter D, Chapter 62, Health and Safety Code,
10-12 is amended by adding Section 62.157 to read as follows:
10-13 Sec. 62.157. TELEMEDICINE MEDICAL SERVICES. (a) In
10-14 providing covered benefits to a child, a health plan provider must
10-15 permit benefits to be provided through telemedicine medical
10-16 services in accordance with policies developed by the commission.
10-17 (b) The policies must provide for:
10-18 (1) the availability of covered benefits appropriately
10-19 provided through telemedicine medical services that are comparable
10-20 to the same types of covered benefits provided without the use of
10-21 telemedicine medical services; and
10-22 (2) the availability of covered benefits for different
10-23 services performed by multiple health care providers during a
10-24 single session of telemedicine medical services, if the commission
10-25 determines that delivery of the covered benefits in that manner is
10-26 cost-effective in comparison to the costs that would be involved in
11-1 obtaining the services from providers without the use of
11-2 telemedicine medical services, including the costs of
11-3 transportation and lodging and other direct costs.
11-4 (c) In developing the policies required by Subsection (a),
11-5 the commission shall consult with the telemedicine advisory
11-6 committee.
11-7 (d) In this section, "telemedicine medical service" has the
11-8 meaning assigned by Section 57.042, Utilities Code.
11-9 SECTION 5. Section 1, Article 21.53F, Insurance Code, as
11-10 added by Section 1, Chapter 880, Acts of the 75th Legislature,
11-11 Regular Session, 1997, is amended to read as follows:
11-12 Sec. 1. DEFINITIONS. In this article:
11-13 (1) "Health benefit plan" means a plan described by
11-14 Section 2 of this article.
11-15 (2) "Health professional" means:
11-16 (A) a physician;
11-17 (B) an individual who is:
11-18 (i) licensed or certified in this state to
11-19 perform health care services; and
11-20 (ii) authorized to assist a physician in
11-21 providing telemedicine medical services that are delegated and
11-22 supervised by the physician; or
11-23 (C) a licensed or certified health professional
11-24 acting within the scope of the license or certification who does
11-25 not perform a telemedicine medical service.
11-26 (3) "Physician" means a person licensed to practice
12-1 medicine in this state under Subtitle B, Title 3, Occupations Code.
12-2 (4) "Telehealth service" has the meaning assigned by
12-3 Section 57.042, Utilities Code.
12-4 (5) "Telemedicine medical service" has the meaning
12-5 assigned by Section 57.042, Utilities Code. ["Telemedicine" means
12-6 the use of interactive audio, video, or other electronic media to
12-7 deliver health care. The term includes the use of electronic media
12-8 for diagnosis, consultation, treatment, transfer of medical data,
12-9 and medical education. The term does not include services
12-10 performed using a telephone or facsimile machine.]
12-11 SECTION 6. Section 3, Article 21.53F, Insurance Code, as
12-12 added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-13 Regular Session, 1997, is amended to read as follows:
12-14 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND
12-15 TELEHEALTH SERVICES. (a) A health benefit plan may not exclude a
12-16 telemedicine medical service or a telehealth service from coverage
12-17 under the plan solely because the service is [provided through
12-18 telemedicine and] not provided through a face-to-face consultation.
12-19 (b) Benefits [for a service provided through telemedicine]
12-20 required under this article may be made subject to a deductible,
12-21 copayment, or coinsurance requirement. A deductible, copayment, or
12-22 coinsurance applicable to a particular service provided through
12-23 telemedicine medical services or telehealth services may not exceed
12-24 the deductible, copayment, or coinsurance required by the health
12-25 benefit plan for a comparable medical [the same] service provided
12-26 through a face-to-face consultation.
13-1 SECTION 7. Section 4, Article 21.53F, Insurance Code, as
13-2 added by Section 1, Chapter 880, Acts of the 75th Legislature,
13-3 Regular Session, 1997, is amended to read as follows:
13-4 Sec. 4. INFORMED CONSENT. A treating physician or [other]
13-5 health professional [care provider] who provides or facilitates the
13-6 use of telemedicine medical services or telehealth services shall
13-7 ensure that the informed consent of the patient, or another
13-8 appropriate person with authority to make health care treatment
13-9 decisions for the patient, is obtained before telemedicine medical
13-10 services or telehealth services are provided [through
13-11 telemedicine].
13-12 SECTION 8. Section 5, Article 21.53F, Insurance Code, as
13-13 added by Section 1, Chapter 880, Acts of the 75th Legislature,
13-14 Regular Session, 1997, is amended to read as follows:
13-15 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
13-16 health professional [care provider] who provides or facilitates the
13-17 use of telemedicine medical services or telehealth services shall
13-18 ensure that the confidentiality of the patient's medical
13-19 information is maintained as required by Chapter 159, Occupations
13-20 Code [Section 5.08, Medical Practice Act (Article 4495b, Vernon's
13-21 Texas Civil Statutes)], or other applicable law.
13-22 SECTION 9. Subsection (b), Section 6, Article 21.53F,
13-23 Insurance Code, as added by Section 1, Chapter 880, Acts of the
13-24 75th Legislature, Regular Session, 1997, is amended to read as
13-25 follows:
13-26 (b) The Texas State Board of Medical Examiners, in
14-1 consultation with the commissioner, as appropriate, may adopt rules
14-2 as necessary to:
14-3 (1) ensure that appropriate care, including quality of
14-4 care, is provided to patients who receive telemedicine medical
14-5 services [that are provided through telemedicine]; [and]
14-6 (2) prevent abuse and fraud through use of
14-7 telemedicine medical services, including rules relating to filing
14-8 of claims and records required to be maintained in connection with
14-9 telemedicine medical services;
14-10 (3) ensure adequate supervision of health
14-11 professionals who are not physicians and who provide telemedicine
14-12 medical services;
14-13 (4) establish the maximum number of health
14-14 professionals who are not physicians that a physician may supervise
14-15 through a telemedicine medical service; and
14-16 (5) require a face-to-face consultation between a
14-17 patient and a physician providing a telemedicine medical service
14-18 within a certain number of days following an initial telemedicine
14-19 medical service only if the physician has never seen the patient.
14-20 SECTION 10. Section 153.004, Occupations Code, is amended to
14-21 read as follows:
14-22 Sec. 153.004. RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
14-23 (a) In consultation with the Health and Human Services Commission
14-24 and the commissioner of insurance, the board may adopt rules as
14-25 necessary to:
14-26 (1) ensure that appropriate care is provided to
15-1 Medicaid and Medicare patients who receive telemedicine medical
15-2 services [that are provided through telemedicine]; and
15-3 (2) prevent abuse and fraud in the use of telemedicine
15-4 medical services for Medicaid and Medicare patients.
15-5 (b) The rules adopted under Subsection [Section] (a)(2) may
15-6 include rules relating to filing of claims and records required to
15-7 be maintained in relation to telemedicine medical services.
15-8 SECTION 11. Section 57.042, Utilities Code, is amended by
15-9 amending Subdivision (11) and adding Subdivision (12) to read as
15-10 follows:
15-11 (11) "Telehealth service" means a health service,
15-12 other than a telemedicine medical service, delivered by a licensed
15-13 or certified health professional acting within the scope of the
15-14 health professional's license or certification who does not perform
15-15 a telemedicine medical service that requires the use of advanced
15-16 telecommunications technology, other than by telephone or
15-17 facsimile, including:
15-18 (A) compressed digital interactive video, audio,
15-19 or data transmission;
15-20 (B) clinical data transmission using computer
15-21 imaging by way of still-image capture and store and forward; and
15-22 (C) other technology that facilitates access to
15-23 health care services or medical specialty expertise.
15-24 (12) "Telemedicine medical service" means a health
15-25 care service initiated by a physician or provided by a health
15-26 professional acting under physician delegation and supervision for
16-1 purposes of patient assessment by a health professional, diagnosis
16-2 or consultation by a physician, treatment, or the transfer of
16-3 medical data, that requires the use of advanced telecommunications
16-4 technology, other than by telephone or facsimile, including:
16-5 (A) compressed digital interactive video, audio,
16-6 or data transmission;
16-7 (B) clinical data transmission using computer
16-8 imaging by way of still-image capture; and
16-9 (C) other technology that facilitates access to
16-10 health care services or medical specialty expertise[:]
16-11 [(A) means medical services delivered by
16-12 telecommunications technologies to rural or underserved public
16-13 not-for-profit health care facilities or primary health care
16-14 facilities in collaboration with an academic health center and an
16-15 associated teaching hospital or tertiary center or with another
16-16 public not-for-profit health care facility; and]
16-17 [(B) includes consultive services, diagnostic
16-18 services, interactive video consultation, teleradiology,
16-19 telepathology, and distance education for working health care
16-20 professionals].
16-21 SECTION 12. Section 57.045, Utilities Code, is amended by
16-22 adding Subsection (e) to read as follows:
16-23 (e) The board shall establish an assistance program to
16-24 provide education concerning the telecommunications infrastructure
16-25 fund and to facilitate access to funds and programs under this
16-26 subchapter by health care facilities and by physicians licensed to
17-1 practice medicine in this state. The assistance program must
17-2 include a toll-free telephone number and provide access to
17-3 information through the Internet.
17-4 SECTION 13. Subsection (b), Section 57.046, Utilities Code,
17-5 is amended to read as follows:
17-6 (b) The board shall use money in the qualifying entities
17-7 account for any purpose authorized by this subchapter, including:
17-8 (1) equipment;
17-9 (2) wiring;
17-10 (3) material;
17-11 (4) program development;
17-12 (5) training;
17-13 (6) installation costs; [and]
17-14 (7) a statewide telecommunications network; and
17-15 (8) funding an automated system to integrate client
17-16 services and eligibility requirements for health and human services
17-17 across agencies.
17-18 SECTION 14. Subsections (a) and (b), Section 57.047,
17-19 Utilities Code, are amended to read as follows:
17-20 (a) The board may award a grant to a project or proposal
17-21 that:
17-22 (1) provides equipment and infrastructure necessary
17-23 for:
17-24 (A) distance learning;
17-25 (B) an information sharing program of a library;
17-26 [or]
18-1 (C) telemedicine medical services; or
18-2 (D) telehealth services;
18-3 (2) develops and implements the initial or
18-4 prototypical delivery of a course or other distance learning
18-5 material;
18-6 (3) trains teachers, faculty, librarians, or
18-7 technicians in the use of distance learning or information sharing
18-8 materials and equipment;
18-9 (4) develops a curriculum or instructional material
18-10 specially suited for telecommunications delivery;
18-11 (5) provides electronic information; or
18-12 (6) establishes or carries out an information sharing
18-13 program.
18-14 (b) The board may award a loan to a project or proposal to
18-15 acquire equipment needed for distance learning and telemedicine
18-16 medical service projects.
18-17 SECTION 15. Subchapter C, Chapter 57, Utilities Code, is
18-18 amended by adding Section 57.0475 to read as follows:
18-19 Sec. 57.0475. ELIGIBILITY FOR GRANTS TO HEALTH CARE
18-20 FACILITIES. (a) The board may award a grant under Section
18-21 57.047(a)(1)(C) only to a health care facility that:
18-22 (1) is a hospital or other entity, including a health
18-23 clinic, that:
18-24 (A) is supported by local or regional tax
18-25 revenue;
18-26 (B) is a certified nonprofit health corporation
19-1 under federal law; or
19-2 (C) is an ambulatory health care center; or
19-3 (2) meets the criteria adopted by the board and the
19-4 Health and Human Services Commission under Subsection (b).
19-5 (b) The board and the Health and Human Services Commission
19-6 shall jointly adopt rules prescribing the criteria a health care
19-7 facility not described by Subsection (a)(1) must meet to be
19-8 eligible to receive a grant under Section 57.047(a)(1)(C). In
19-9 determining the criteria, the board and commission shall prioritize
19-10 health care facilities based on:
19-11 (1) the amount of charity care provided by each
19-12 facility during the year preceding the year in which the facility
19-13 applies for a grant; and
19-14 (2) the number of Medicaid patients and patients
19-15 enrolled in the state child health plan treated by each facility
19-16 during the year preceding the year in which the facility applies
19-17 for a grant.
19-18 (c) The criteria adopted under Subsection (b) must provide
19-19 that a health care facility is not eligible to receive a grant
19-20 under Section 57.047(a)(1)(C) if the health care facility did not
19-21 provide any charity care or treat any patients described by
19-22 Subsection (b)(2) during the year preceding the year in which the
19-23 facility applies for a grant.
19-24 SECTION 16. Subsection (a), Section 58.253, Utilities Code,
19-25 is amended to read as follows:
19-26 (a) On customer request, an electing company shall provide
20-1 private network services to:
20-2 (1) an educational institution;
20-3 (2) a library;
20-4 (3) a nonprofit telemedicine center;
20-5 (4) a public or not-for-profit hospital;
20-6 (5) a project that would have been eligible to be
20-7 funded by the telecommunications infrastructure fund under
20-8 Subchapter C, Chapter 57, as that subchapter existed on January 1,
20-9 2001; or
20-10 (6) a legally constituted consortium or group of
20-11 entities listed in this subsection.
20-12 SECTION 17. Subchapter B, Chapter 32, Human Resources Code,
20-13 is amended by adding Section 32.053 to read as follows:
20-14 Sec. 32.053. HOME TELEMEDICINE PILOT PROGRAM. (a) The
20-15 Health and Human Services Commission shall establish a pilot
20-16 program under which certain recipients of medical assistance
20-17 receive, in addition to other home health care services for which
20-18 the recipients are eligible, home health care services through home
20-19 telemonitoring systems located in the recipients' homes.
20-20 (b) The Health and Human Services Commission shall implement
20-21 the program in each of the following areas:
20-22 (1) a rural area;
20-23 (2) an urban area;
20-24 (3) a medically underserved area; and
20-25 (4) an area that adjoins this state's international
20-26 border.
21-1 (c) The Health and Human Services Commission may reimburse a
21-2 home and community support services agency participating in the
21-3 program for services provided by the agency through home
21-4 telemonitoring systems in an amount not to exceed $300 a month for
21-5 each home at which services are provided.
21-6 (d) The Health and Human Services Commission shall adopt
21-7 eligibility criteria for the program. The criteria must:
21-8 (1) require that a program participant:
21-9 (A) be:
21-10 (i) diagnosed with a chronic illness,
21-11 including hypertension, congestive heart failure, diabetes
21-12 mellitus, chronic obstructive pulmonary disease, or a chronic
21-13 wound;
21-14 (ii) diagnosed with depression, if it is
21-15 secondary to a chronic illness; or
21-16 (iii) in need of posthospitalization care
21-17 or care related to receipt of an organ transplant, regardless of
21-18 whether the care is needed before or after the transplant;
21-19 (B) be able to use home telemonitoring system
21-20 equipment or be assisted by a regular caregiver who is willing and
21-21 able to use that equipment;
21-22 (C) provide written consent to receipt of home
21-23 health care services through a home telemonitoring system; and
21-24 (D) be under the care of a physician who
21-25 consents to the participant's receipt of home health care services
21-26 through a home telemonitoring system; and
22-1 (2) prohibit a recipient of medical assistance from
22-2 participating in the program if the recipient:
22-3 (A) is diagnosed with a terminal condition and
22-4 expected to live for less than six months; or
22-5 (B) requires daily, in-person, home health care
22-6 visits or invasive procedures.
22-7 (e) The Health and Human Services Commission shall determine
22-8 home health care services to be provided to program participants
22-9 through a home telemonitoring system. Home health care services
22-10 provided through the system may include:
22-11 (1) educating a program participant regarding
22-12 self-care and preventive health;
22-13 (2) monitoring a program participant's compliance with
22-14 medication requirements;
22-15 (3) monitoring a program participant's vital signs;
22-16 (4) providing a program participant with counseling
22-17 and social support; and
22-18 (5) any other service the commission determines is
22-19 appropriate.
22-20 (f) In designing and implementing the program, the Health
22-21 and Human Services Commission shall ensure that:
22-22 (1) a program participant receives, for the duration
22-23 of services, at no cost to the participant, home telemonitoring
22-24 system equipment other than a telephone line and telephone that is
22-25 necessary for receipt of home health care services through the
22-26 system;
23-1 (2) a program participant or the participant's regular
23-2 caregiver receives personal training and written instructions in
23-3 the use and maintenance of the home telemonitoring system
23-4 equipment;
23-5 (3) a program participant's satisfaction with home
23-6 health care services provided through a home telemonitoring system
23-7 is frequently monitored and evaluated by the commission;
23-8 (4) the quality of home health care services provided
23-9 through a home telemonitoring system to a program participant is
23-10 frequently monitored and evaluated by the commission; and
23-11 (5) the home and community support services agency
23-12 that is providing services using home telemonitoring system
23-13 equipment pays for the equipment.
23-14 (g) The Health and Human Services Commission shall adopt all
23-15 rules necessary for implementation of the program.
23-16 (h) Not later than December 1, 2004, the Health and Human
23-17 Services Commission shall submit a report to the legislature
23-18 regarding the program that includes:
23-19 (1) an analysis of:
23-20 (A) the program's cost-effectiveness;
23-21 (B) the program's effect on the quality of
23-22 health care received by program participants; and
23-23 (C) the satisfaction of program participants
23-24 with home health care services provided through home telemonitoring
23-25 systems; and
23-26 (2) recommendations regarding elimination,
24-1 continuation, or expansion of the program.
24-2 (i) This section expires September 1, 2005.
24-3 SECTION 18. Chapter 533, Health and Safety Code, is amended
24-4 by adding Subchapter E to read as follows:
24-5 SUBCHAPTER E. JAIL DIVERSION PROGRAM
24-6 Sec. 533.101. JAIL DIVERSION PILOT PROGRAM. (a) The board
24-7 and department shall develop and implement a pilot program in one
24-8 rural area and one urban area designed to incorporate audiovisual
24-9 telecommunications systems to:
24-10 (1) divert persons with mental illness from the
24-11 criminal justice system, when appropriate treatment services are
24-12 available;
24-13 (2) provide access to appropriate mental health
24-14 services to persons who have entered the criminal justice system;
24-15 and
24-16 (3) increase the awareness of law enforcement officers
24-17 and officials to mental health issues that may bring persons with
24-18 mental illness into the criminal justice system.
24-19 (b) In designing the program, the commission shall employ to
24-20 the greatest extent practicable available electronic information
24-21 systems for the program, including:
24-22 (1) systems to enable the transmission of booking
24-23 information;
24-24 (2) computer and software systems to match client data
24-25 to booking information;
24-26 (3) electronic messaging and notification systems; and
25-1 (4) audiovisual teleconferencing or other
25-2 teleconferencing or telecommunications systems.
25-3 (c) The department and participating local mental health
25-4 authorities, prosecutorial agencies, law enforcement agencies, jail
25-5 facilities, courts, county or municipal governments, and providers
25-6 of psychiatric services shall enter into an agreement regarding the
25-7 procedures to follow in implementing the program and the duties of
25-8 each participating entity. The participating county shall be
25-9 responsible for establishing the diversion team as prescribed by
25-10 the department.
25-11 (d) If appropriate treatment services are not available, a
25-12 person with mental illness does not have to be diverted from the
25-13 criminal justice system.
25-14 Sec. 533.102. PREBOOKING DIVERSION. (a) The pilot program
25-15 shall incorporate a system for diverting a person with mental
25-16 illness from the criminal justice system before the person's
25-17 contact with a law enforcement officer results in:
25-18 (1) charges being brought against the person; or
25-19 (2) the person being detained in a jail.
25-20 (b) The prebooking diversion system shall provide for a law
25-21 enforcement officer or booking center staff member to request a
25-22 mental health or crisis stabilization evaluation of a person by a
25-23 local mental health authority crisis counselor or the equivalent
25-24 through an audiovisual teleconference. The board by rule shall
25-25 establish procedures for evaluations performed under the system.
25-26 Sec. 533.103. POSTBOOKING DIVERSION BY COURT. The pilot
26-1 program shall incorporate a system for diverting a person with
26-2 mental illness from the criminal justice system by a court at the
26-3 person's arraignment or a court hearing. A court participating in
26-4 the pilot program may order:
26-5 (1) the assessment of a person before the court by the
26-6 local mental health authority to assess appropriate community
26-7 mental health treatment options as alternatives to prosecution; and
26-8 (2) a person before the court to undertake appropriate
26-9 psychiatric treatment as a condition of the dismissal of criminal
26-10 charges, deferral of prosecution, bail, or probation.
26-11 Sec. 533.104. POSTBOOKING DIVERSION FOR PERSON IN JAIL.
26-12 (a) The pilot program shall incorporate a system to provide
26-13 routine mental health treatment to a person in jail by the local
26-14 mental health authority through an audiovisual teleconferencing
26-15 system.
26-16 (b) The program must include a jail diversion liaison
26-17 employed by the local mental health authority who shall:
26-18 (1) determine whether certain jailed individuals are
26-19 eligible for diversion treatment programs; and
26-20 (2) facilitate the interaction of jail staff and court
26-21 officials to further the program.
26-22 (c) The local mental health authority must employ a jail
26-23 diversion team to select candidates for diversion into mental
26-24 health treatment based on:
26-25 (1) the nature of the offense for which the person is
26-26 jailed;
27-1 (2) the person's history of incarceration;
27-2 (3) the person's mental status;
27-3 (4) the availability of community mental health
27-4 resources appropriate for the person;
27-5 (5) public safety factors;
27-6 (6) the person's previous performance in and
27-7 compliance with treatment settings; and
27-8 (7) other appropriate factors.
27-9 Sec. 533.105. INFORMATION SYSTEM TO SUPPORT POSTBOOKING
27-10 DIVERSION. (a) To support the postbooking jail diversion program,
27-11 the pilot program must provide for implementation of an information
27-12 system designed to quickly identify a person with a serious mental
27-13 illness who has entered the local jail system.
27-14 (b) The pilot program must provide for electronic
27-15 transmission of information concerning all admissions to jails
27-16 participating in the program to an information system at the local
27-17 mental health authority.
27-18 (c) The local mental health authority shall ensure that the
27-19 authority's information system automatically:
27-20 (1) identifies whether persons admitted to jail are
27-21 current or former clients of the authority using the person's name,
27-22 date of birth, social security number, sex, or other identifying
27-23 information; and
27-24 (2) notifies a jail diversion team and case manager at
27-25 the authority when a client or former client of the authority is
27-26 identified as having been admitted to jail.
28-1 Sec. 533.106. REPORTS TO LEGISLATURE. The board shall
28-2 evaluate the pilot program under this subchapter and publish a
28-3 report on the performance of the program in providing needed
28-4 treatment and in saving or increasing costs to the jail and mental
28-5 health systems. The board shall deliver the report to the
28-6 governor, lieutenant governor, and speaker of the house of
28-7 representatives not later than November 1 of each even-numbered
28-8 year.
28-9 Sec. 533.107. EXPIRATION. This subchapter expires September
28-10 1, 2005.
28-11 SECTION 19. (a) For purposes of this section, a licensed
28-12 dentist may delegate orally, in writing, or through advanced audio
28-13 and video telecommunications services a service, task, or procedure
28-14 to a dental hygienist who is under the supervision and
28-15 responsibility of the dentist, if:
28-16 (1) the dental hygienist is licensed to perform the
28-17 service, task, or procedure;
28-18 (2) the supervising dentist examines the patient
28-19 either in person or through advanced audio and video
28-20 telecommunications services:
28-21 (A) at the time the service, task, or procedure
28-22 is performed by the dental hygienist; or
28-23 (B) during the 12 calendar months preceding the
28-24 date of performance of the service, task, or procedure by the
28-25 dental hygienist; and
28-26 (3) the dental hygienist does not:
29-1 (A) diagnose a dental disease or ailment;
29-2 (B) prescribe a treatment or a regimen;
29-3 (C) prescribe, order, or dispense medication; or
29-4 (D) perform any procedure that is irreversible
29-5 or involves the intentional cutting of soft or hard tissue by any
29-6 means.
29-7 (b) In this section:
29-8 (1) "Dental professional" means:
29-9 (A) a dentist licensed under Subtitle D, Title
29-10 3, Occupations Code; or
29-11 (B) a dental hygienist licensed under Chapter
29-12 262, Occupations Code, practicing under the supervision of a
29-13 dentist.
29-14 (2) "Student" means a person who is under 19 years of
29-15 age, is enrolled in a public school, and receives dental services
29-16 under Chapter 32, Human Resources Code.
29-17 (3) "Teledentistry dental services" means a dental
29-18 service that utilizes, in whole or in part, advanced
29-19 telecommunications technology including:
29-20 (A) compressed digital interactive video, audio,
29-21 or data transmission;
29-22 (B) clinical data transmission via computer
29-23 imaging for teleradiology or telepathology; and
29-24 (C) other technology that facilitates access in
29-25 rural and underserved counties to dental services or dental
29-26 specialty expertise.
30-1 (c) The Commissioner of Human Services shall appoint a
30-2 program administrator to administer a pilot program that uses
30-3 teledentistry and other methods of delivering dental services to
30-4 provide dental services to students in one public school district
30-5 in the state.
30-6 (d) The program administrator shall establish an advisory
30-7 committee to assist the program administrator in developing and
30-8 implementing the pilot program.
30-9 (e) In developing the pilot program, the program
30-10 administrator shall design the program in a manner that:
30-11 (1) increases access to dental services and enhances
30-12 the delivery of dental services to students;
30-13 (2) ensures the provision of oral health education
30-14 services;
30-15 (3) provides for effective and appropriate supervision
30-16 by a dentist of other dental professionals providing care under the
30-17 program; and
30-18 (4) enables the state to determine whether extension
30-19 of the use of teledentistry would improve the delivery of dental
30-20 services.
30-21 (f) The program administrator shall adopt procedures as
30-22 necessary to:
30-23 (1) ensure that appropriate care, including quality of
30-24 care, is provided to students who receive teledentistry dental
30-25 services;
30-26 (2) ensure adequate supervision of dental
31-1 professionals who are not dentists and who provide teledentistry
31-2 dental services;
31-3 (3) establish the maximum number of dental
31-4 professionals who are not dentists that a dentist may supervise;
31-5 and
31-6 (4) require a face-to-face consultation with a dentist
31-7 within a certain number of days following a teledentistry dental
31-8 service.
31-9 (g) Only a teledentistry dental service initiated or
31-10 provided by a licensed dentist in this state may be reimbursed
31-11 under the Medicaid program. Medicaid reimbursement for a
31-12 teledentistry dental service shall be at the same rate as the
31-13 Medicaid program reimburses for a comparable in-person dental
31-14 service. A request for reimbursement may not be denied solely
31-15 because an in-person consultation between a dentist or other dental
31-16 professional and a patient did not occur. Reimbursement for a
31-17 dental hygienist for service shall be made through the supervising
31-18 dentist.
31-19 (h) A dental hygienist must act under the remote supervision
31-20 of a local dentist. Both the dentist and the hygienist must be
31-21 located within the boundaries of the school district served by the
31-22 pilot program.
31-23 (i) Images and assessment information shall be sent by the
31-24 dental hygienist to a supervising dentist either live or by means
31-25 of store and forward technology. After a dentist has reviewed the
31-26 required information, the dentist may authorize the provision of
32-1 preventive services by the dental hygienist located at the school.
32-2 (j) A dental hygienist participating in the pilot program
32-3 may initiate screening and assessment services and, under the
32-4 supervision of a dentist, may perform any procedure the hygienist
32-5 is authorized to perform under law.
32-6 (k) A teledentistry dental service may not be provided if an
32-7 in-person consultation with a dentist is reasonably available to a
32-8 student. Dentists and other dental professionals participating in
32-9 the pilot program shall make a good faith effort to identify and
32-10 coordinate with existing providers to preserve and protect existing
32-11 dental care systems and dental relationships.
32-12 (l) The program administrator shall establish a control
32-13 group not to exceed 1,000 students to provide a benchmark for
32-14 measuring the performance of the pilot program. Each student in
32-15 the control group shall be examined by a dentist, in person, at the
32-16 end of the program to evaluate the effectiveness of teledentistry
32-17 dental services provided during the program. The examining dentist
32-18 must practice in a dental office located outside the boundaries of
32-19 the school district served by the pilot program.
32-20 (m) The program administrator shall use the results of the
32-21 pilot program to:
32-22 (1) determine the efficacy of teledentistry; and
32-23 (2) determine the effectiveness of teledentistry in
32-24 increasing access to dental services and improving oral health of
32-25 students.
32-26 (n) A dental professional who provides teledentistry dental
33-1 services shall ensure that the informed consent of the student or a
33-2 person authorized to provide consent for the student is obtained
33-3 before teledentistry dental services are provided.
33-4 (o) Students participating in the pilot program must be
33-5 referred to local dentists for restorative care and monitored to
33-6 ensure that restorative services are provided.
33-7 (p) Not later than December 31, 2002, the program
33-8 administrator shall submit a report to the legislature containing
33-9 the following:
33-10 (1) the number of students who received teledentistry
33-11 dental services;
33-12 (2) the types of teledentistry dental services
33-13 provided;
33-14 (3) the cost and level of utilization of teledentistry
33-15 dental services;
33-16 (4) the effect of the pilot program on school
33-17 absenteeism of students in the control group;
33-18 (5) a description of improvements in the oral health
33-19 of students in the pilot program; and
33-20 (6) recommendations for changes in or the expansion of
33-21 the pilot program.
33-22 (q) This section expires and the advisory committee is
33-23 abolished December 31, 2002.
33-24 SECTION 20. Not later than October 1, 2001, the Health and
33-25 Human Services Commission and the Telecommunications Infrastructure
33-26 Fund Board shall adopt minimum standards for an operating system
34-1 used by a health care facility in providing telemedicine medical
34-2 services to a Medicaid recipient as required by Section 531.02161,
34-3 Government Code, as added by this Act.
34-4 SECTION 21. Not later than January 1, 2002, the Health and
34-5 Human Services Commission shall adopt rules required by Section
34-6 531.0217, Government Code, as amended by this Act.
34-7 SECTION 22. (a) The Commissioner of Human Services shall
34-8 appoint a program administrator for the teledentistry pilot
34-9 program, as added by Section 19 of this Act, not later than the
34-10 30th day after the effective date of this Act.
34-11 (b) The program administrator shall appoint an advisory
34-12 committee and shall begin implementing the teledentistry pilot
34-13 program not later than the 30th day after the date the program
34-14 administrator is appointed.
34-15 SECTION 23. Subdivision (8), Subsection (b), Section 57.046,
34-16 Utilities Code, as added by this Act, expires September 1, 2003.
34-17 SECTION 24. If before implementing any provision of this Act
34-18 a state agency determines that a waiver or authorization from a
34-19 federal agency is necessary for implementation of that provision,
34-20 the agency affected by the provision shall request the waiver or
34-21 authorization and may delay implementing that provision until the
34-22 waiver or authorization is granted.
34-23 SECTION 25. This Act takes effect immediately if it receives
34-24 a vote of two-thirds of all the members elected to each house, as
34-25 provided by Section 39, Article III, Texas Constitution. If this
34-26 Act does not receive the vote necessary for immediate effect, this
35-1 Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 789 passed the Senate on
April 18, 2001, by the following vote: Yeas 30, Nays 0, one
present, not voting; and that the Senate concurred in House
amendments on May 18, 2001, by the following vote: Yeas 30,
Nays 0, one present, not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 789 passed the House, with
amendments, on May 11, 2001, by the following vote: Yeas 133,
Nays 0, one present, not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor