77R15190 MCK-D                          
         By Moncrief, et al.                                    S.B. No. 789
         Substitute the following for S.B. No. 789:
         By Maxey                                           C.S.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.
 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 develop a procedure to deny
1-21     reimbursement for a medical service that, based on credible
1-22     clinical evidence, is shown to be medically inappropriate;
1-23                 (5)  establish pilot programs in designated areas of
1-24     this state under which the commission, in administering
 2-1     government-funded health programs, may reimburse a health
 2-2     professional participating in the pilot program for telehealth
 2-3     services authorized under the licensing law applicable to the
 2-4     health professional; and
 2-5                 (6)  establish a separate provider identifier for
 2-6     telemedicine medical services providers.
 2-7           (c)  The commission shall encourage physicians, teaching
 2-8     hospitals, small rural hospitals, federally qualified health
 2-9     centers, and state-owned health care facilities to participate as
2-10     telemedicine medical service providers in the health care delivery
2-11     system.  The commission may not require that a service be provided
2-12     to a patient through telemedicine medical services when the service
2-13     can reasonably be provided by a physician through a face-to-face
2-14     consultation with the patient in the community in which the patient
2-15     resides or works.  This subsection does not prohibit the
2-16     authorization of the provision of any service to a patient through
2-17     telemedicine medical services at the patient's request.
2-18           (d)  Subject to Section 153.004, Occupations Code [5.11,
2-19     Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-20     Statutes)], the commission may adopt rules as necessary to
2-21     implement this section.
2-22           (e)  The commission may not reimburse a health care facility
2-23     for telemedicine medical services provided to a Medicaid recipient
2-24     unless the facility complies with the minimum standards adopted
2-25     under Section 531.02161.
2-26           (f)  Not later than December 1 of each even-numbered year,
2-27     the commission shall report to the speaker of the house of
 3-1     representatives and the lieutenant governor on the effects of
 3-2     telemedicine medical services on the Medicaid program in the state,
 3-3     including the number of physicians and health professionals using
 3-4     telemedicine medical services, the geographic and demographic
 3-5     disposition of the physicians and health professionals, the number
 3-6     of patients receiving telemedicine medical services, the types of
 3-7     services being provided, and the cost of utilization of
 3-8     telemedicine medical services to the program.
 3-9           (g)  In this section:
3-10                 (1)  "Telehealth service" has the meaning assigned by
3-11     Section 57.042, Utilities Code.
3-12                 (2)  "Telemedicine medical service"[, "telemedicine"]
3-13     has the meaning assigned by Section 57.042, Utilities Code.
3-14           SECTION 2. Subchapter B, Chapter 531, Government Code, is
3-15     amended by adding Section 531.02161 to read as follows:
3-16           Sec. 531.02161.  TELEMEDICINE TECHNOLOGY STANDARDS. (a)  In
3-17     this section, "telemedicine medical service" has the meaning
3-18     assigned by Section 57.042, Utilities Code.
3-19           (b)  The commission and the Telecommunications Infrastructure
3-20     Fund Board by joint rule shall establish and adopt minimum
3-21     standards for an operating system used in the provision of
3-22     telemedicine medical services by a health care facility
3-23     participating in the state Medicaid program, including standards
3-24     for electronic transmission, software, and hardware.
3-25           (c)  In developing standards under this section, the
3-26     commission and the Telecommunications Infrastructure Fund Board
3-27     shall address:
 4-1                 (1)  authentication and authorization of users;
 4-2                 (2)  authentication of the origin of information;
 4-3                 (3)  the prevention of unauthorized access to the
 4-4     system or information;
 4-5                 (4)  system security, including the integrity of
 4-6     information that is collected, program integrity, and system
 4-7     integrity;
 4-8                 (5)  maintenance of  documentation about system and
 4-9     information usage;
4-10                 (6)  information storage, maintenance, and
4-11     transmission; and
4-12                 (7)  synchronization and verification of patient
4-13     profile data.
4-14           SECTION 3. Section 531.0217, Government Code, is amended to
4-15     read as follows:
4-16           Sec. 531.0217.  REIMBURSEMENT FOR CERTAIN MEDICAL
4-17     CONSULTATIONS. (a)  In this section:
4-18                 (1)  "Health professional" means:
4-19                       (A)  a physician;
4-20                       (B)  an individual who is:
4-21                             (i)  licensed or certified in this state to
4-22     perform health care services; and
4-23                             (ii)  authorized to assist a physician in
4-24     providing telemedicine medical services that are delegated and
4-25     supervised by the physician; or
4-26                       (C)  a licensed or certified health professional
4-27     acting within the scope of the license or certification who does
 5-1     not perform a telemedicine medical service [an advanced nurse
 5-2     practitioner, an allied health professional, a mental health
 5-3     professional, a physician, or a physician assistant who is licensed
 5-4     in this state].
 5-5                 (2)  "Physician" means a person licensed to practice
 5-6     medicine in this state under Subtitle B, Title 3, Occupations Code.
 5-7     ["Rural county" means a county that:]
 5-8                       [(A)  has a population of 50,000 or less; or]
 5-9                       [(B)  contains an area that was not designated as
5-10     an urban area by the United States Bureau of the Census according
5-11     to the 1990 federal census and does not have within the boundaries
5-12     of the county a hospital that:]
5-13                             [(i)  is licensed under Chapter 241, Health
5-14     and Safety Code; and]
5-15                             [(ii)  has more than 100 beds.]
5-16                 (3)  "Telehealth service" has the meaning assigned by
5-17     Section 57.042, Utilities Code.
5-18                 (4)  "Telemedicine medical service" has the meaning
5-19     assigned by Section 57.042, Utilities Code. ["Rural health
5-20     facility" means a health facility that is located in a rural county
5-21     and at least 30 miles from any accredited medical school or any
5-22     teaching hospital affiliated with an accredited medical school and
5-23     that is:]
5-24                       [(A)  a licensed, nonprofit hospital;]
5-25                       [(B)  a health clinic that is affiliated with:]
5-26                             [(i)  an accredited medical school;]
5-27                             [(ii)  a teaching hospital that is
 6-1     affiliated with an accredited medical school;]
 6-2                             [(iii)  a hospital described by Paragraph
 6-3     (C); or]
 6-4                             [(iv)  a federally qualified health center,
 6-5     as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
 6-6                       [(C)  a hospital that:]
 6-7                             [(i)  is licensed under Chapter 241, Health
 6-8     and Safety Code;]
 6-9                             [(ii)  is owned or operated by a
6-10     municipality, county, hospital district, or hospital authority; and]
6-11                             [(iii)  provides inpatient or outpatient
6-12     services.]
6-13                 [(4)  "Telemedical consultation" means a medical
6-14     consultation for purposes of patient diagnosis or treatment that
6-15     requires the use of advanced telecommunications technology,
6-16     including:]
6-17                       [(A)  compressed digital interactive video,
6-18     audio, or data transmission;]
6-19                       [(B)  clinical data transmission via computer
6-20     imaging for teleradiology or telepathology; and]
6-21                       [(C)  other technology that facilitates access in
6-22     rural counties to health care services or medical specialty
6-23     expertise.]
6-24           (b)  The commission by rule shall require each health and
6-25     human services agency that administers a part of the Medicaid
6-26     program to provide Medicaid reimbursement for a telemedicine
6-27     medical service initiated or [telemedical consultation] provided by
 7-1     a physician [licensed in this state who practices in:]
 7-2                 [(1)  a rural health facility;]
 7-3                 [(2)  an accredited medical school; or]
 7-4                 [(3)  a teaching hospital that is affiliated with an
 7-5     accredited medical school].
 7-6           (c)  The commission shall ensure that reimbursement is
 7-7     provided only for a telemedicine medical service initiated or
 7-8     [consultation] provided by a physician [described in Subsection (b)
 7-9     to a health professional who practices in a rural county].
7-10           (d)  The commission shall require reimbursement for a
7-11     telemedicine medical service [telemedical consultation] at the same
7-12     rate as the Medicaid program reimburses for a comparable in-person
7-13     medical service [consultation].  A request for reimbursement may
7-14     not be denied solely because an in-person medical service
7-15     [consultation] between a physician and a patient did not occur.
7-16           (e)  A health care facility that receives reimbursement under
7-17     this section for a telemedicine medical service [consultations]
7-18     provided by a physician [physicians] who practices [practice] in
7-19     that facility or [and] a health professional who participates in a
7-20     telemedicine medical service [obtains consultations] under this
7-21     section shall establish quality of care protocols and patient
7-22     confidentiality guidelines to ensure that the telemedicine medical
7-23     service meets [telemedical consultations meet] legal requirements
7-24     and acceptable patient care standards.
7-25           (f)  The commission may not require a telemedicine medical
7-26     service [telemedical consultation] if an in-person consultation
7-27     with a physician is reasonably available where the patient resides
 8-1     or works.  The commission shall require facilities and providers of
 8-2     telemedicine medical services to make a good faith effort to
 8-3     identify and coordinate with existing providers to preserve and
 8-4     protect existing health care systems and medical relationships in
 8-5     an area.
 8-6           (g)  If a patient receiving a telemedicine medical service
 8-7     has a primary care physician or provider and consents to the
 8-8     notification, the commission shall require that the primary care
 8-9     physician or provider be notified of the telemedicine medical
8-10     service for the purpose of sharing medical information.
8-11           (h)  The commission in consultation with the Texas State
8-12     Board of Medical Examiners shall monitor and regulate the use of
8-13     telemedicine medical services to ensure compliance with this
8-14     section.  In addition to any other method of enforcement, the
8-15     commission may use a corrective action plan to ensure compliance
8-16     with this section.
8-17           (i) [(g)]  The Texas State Board of Medical Examiners, in
8-18     consultation with the commission, as appropriate, may adopt rules
8-19     as necessary to:
8-20                 (1)  ensure that appropriate care, including quality of
8-21     care, is provided to patients who receive telemedicine medical
8-22     services [that are provided through a telemedical consultation];
8-23     [and]
8-24                 (2)  prevent abuse and fraud through the use of
8-25     telemedicine medical services [telemedical consultations],
8-26     including rules relating to filing of claims and records required
8-27     to be maintained in connection with telemedicine;
 9-1                 (3)  establish supervisory requirements for a service
 9-2     delegated to and performed by an individual who is not a physician;
 9-3     and
 9-4                 (4)  define those situations when a face-to-face
 9-5     consultation with a physician is required after a telemedicine
 9-6     medical service.
 9-7           (j) [(h)]  The commissioner shall establish an advisory
 9-8     committee to coordinate state telemedicine efforts and assist the
 9-9     commission in:
9-10                 (1)  evaluating [developing] policies for telemedicine
9-11     medical services under Section 531.0216 and this section;
9-12                 (2)  monitoring the types of programs receiving
9-13     reimbursement under this section; and
9-14                 (3)  coordinating the activities of state agencies
9-15     interested in the use of telemedicine medical services [telemedical
9-16     consultations under this section].
9-17           (k)  This section does not affect any requirement relating
9-18     to:
9-19                 (1)  a federally qualified health center;
9-20                 (2)  a rural health clinic; or
9-21                 (3)  physician delegation of the authority to carry out
9-22     or sign prescription drug orders to an advanced practice nurse or
9-23     physician assistant.
9-24           SECTION 4. Subchapter D, Chapter 62, Health and Safety Code,
9-25     is amended by adding Section 62.157 to read as follows:
9-26           Sec. 62.157.  TELEMEDICINE MEDICAL SERVICES. (a)  In
9-27     providing covered benefits to a child, a health plan provider must
 10-1    permit benefits to be provided through telemedicine medical
 10-2    services in accordance with policies developed by the commission.
 10-3          (b)  The policies must provide for:
 10-4                (1)  the availability of covered benefits appropriately
 10-5    provided through telemedicine medical services that are comparable
 10-6    to the same types of covered benefits provided without the use of
 10-7    telemedicine medical services; and
 10-8                (2)  the availability of covered benefits for different
 10-9    services performed by multiple health care providers during a
10-10    single session of telemedicine medical services, if the commission
10-11    determines that delivery of the covered benefits in that manner is
10-12    cost-effective in comparison to the costs that would be involved in
10-13    obtaining the services from providers without the use of
10-14    telemedicine medical services, including the costs of
10-15    transportation and lodging and other direct costs.
10-16          (c)  In developing the policies required by Subsection (a),
10-17    the commission shall consult with the telemedicine advisory
10-18    committee.
10-19          (d)  In this section, "telemedicine medical service" has the
10-20    meaning assigned by Section 57.042, Utilities Code.
10-21          SECTION 5. Section 1, Article 21.53F, Insurance Code, as
10-22    added by Section 1, Chapter 880, Acts of the 75th Legislature,
10-23    Regular Session, 1997,  is amended to read as follows:
10-24          Sec. 1.  DEFINITIONS. In this article:
10-25                (1)  "Health benefit plan" means a plan described by
10-26    Section 2 of this article.
10-27                (2)  "Health professional" means:
 11-1                      (A)  a physician;
 11-2                      (B)  an individual who is:
 11-3                            (i)  licensed or certified in this state to
 11-4    perform health care services; and
 11-5                            (ii)  authorized to assist a physician in
 11-6    providing telemedicine medical services that are delegated and
 11-7    supervised by the physician; or
 11-8                      (C)  a licensed or certified health professional
 11-9    acting within the scope of the license or certification who does
11-10    not perform a telemedicine medical service.
11-11                (3)  "Physician" means a person licensed to practice
11-12    medicine in this state under Subtitle B, Title 3, Occupations Code.
11-13                (4)  "Telehealth service" has the meaning assigned by
11-14    Section 57.042, Utilities Code.
11-15                (5)  "Telemedicine medical service" has the meaning
11-16    assigned by Section 57.042, Utilities Code. ["Telemedicine" means
11-17    the use of interactive audio, video, or other electronic media to
11-18    deliver health care.  The term includes the use of electronic media
11-19    for diagnosis, consultation, treatment, transfer of medical data,
11-20    and medical education.  The term does not include services
11-21    performed using a telephone or facsimile machine.]
11-22          SECTION 6. Section 3, Article 21.53F, Insurance Code, as
11-23    added by Section 1, Chapter 880, Acts of the 75th Legislature,
11-24    Regular Session, 1997, is amended to read as follows:
11-25          Sec. 3.  COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND
11-26    TELEHEALTH SERVICES. (a)  A health benefit plan may not exclude a
11-27    telemedicine medical service or a telehealth service from coverage
 12-1    under the plan solely because the service is [provided through
 12-2    telemedicine and] not provided through a face-to-face consultation.
 12-3          (b)  Benefits [for a service provided through telemedicine]
 12-4    required under this article may be made subject to a deductible,
 12-5    copayment, or coinsurance requirement.  A deductible, copayment, or
 12-6    coinsurance applicable to a particular service provided through
 12-7    telemedicine medical services or telehealth services may not exceed
 12-8    the deductible, copayment, or coinsurance required by the health
 12-9    benefit plan for a comparable medical [the same] service provided
12-10    through a face-to-face consultation.
12-11          SECTION 7. Section 4, 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. 4.  INFORMED CONSENT. A treating physician or [other]
12-15    health professional [care provider] who provides or facilitates the
12-16    use of telemedicine medical services or telehealth services shall
12-17    ensure that the informed consent of the patient, or another
12-18    appropriate person with authority to make health care treatment
12-19    decisions for the patient, is obtained before telemedicine medical
12-20    services or telehealth services are provided [through
12-21    telemedicine].
12-22          SECTION 8. Section 5, Article 21.53F, Insurance Code, as
12-23    added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-24    Regular Session, 1997, is amended to read as follows:
12-25          Sec. 5.  CONFIDENTIALITY. A treating physician or [other]
12-26    health professional [care provider] who provides or facilitates the
12-27    use of telemedicine medical services or telehealth services shall
 13-1    ensure that the confidentiality of the patient's medical
 13-2    information is maintained as required by Chapter 159, Occupations
 13-3    Code [Section 5.08, Medical Practice Act (Article 4495b, Vernon's
 13-4    Texas Civil Statutes)], or other applicable law.
 13-5          SECTION 9. Section 6(b), Article 21.53F, Insurance Code, as
 13-6    added by Section 1, Chapter 880, Acts of the 75th Legislature,
 13-7    Regular Session, 1997, is amended to read as follows:
 13-8          (b)  The Texas State Board of Medical Examiners, in
 13-9    consultation with the commissioner, as appropriate, may adopt rules
13-10    as necessary to:
13-11                (1)  ensure that appropriate care, including quality of
13-12    care, is provided to patients who receive telemedicine medical
13-13    services [that are provided through telemedicine]; [and]
13-14                (2)  prevent abuse and fraud through use of
13-15    telemedicine medical services, including rules relating to filing
13-16    of claims and records required to be maintained in connection with
13-17    telemedicine medical services;
13-18                (3)  ensure adequate supervision of health
13-19    professionals who are not physicians and who provide telemedicine
13-20    medical services;
13-21                (4)  establish the maximum  number of health
13-22    professionals who are not physicians that a physician may supervise
13-23    through a telemedicine medical service; and
13-24                (5)  require a face-to-face consultation between a
13-25    patient and a physician providing a telemedicine medical service
13-26    within a certain number of days following an initial telemedicine
13-27    medical service only if the physician has never seen the patient.
 14-1          SECTION 10. Section 153.004, Occupations Code, is amended to
 14-2    read as follows:
 14-3          Sec. 153.004.  RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
 14-4    (a)  In consultation with the Health and Human Services Commission
 14-5    and the commissioner of insurance, the board may adopt rules as
 14-6    necessary to:
 14-7                (1)  ensure that appropriate care is provided to
 14-8    Medicaid and Medicare patients who receive telemedicine medical
 14-9    services [that are provided through telemedicine]; and
14-10                (2)  prevent abuse and fraud in the use of telemedicine
14-11    medical services for Medicaid and Medicare patients.
14-12          (b)  The rules adopted under Subsection [Section] (a)(2) may
14-13    include rules relating to filing of claims and records required to
14-14    be maintained in relation to telemedicine medical services.
14-15          SECTION 11.  Section 57.042, Utilities Code, is amended by
14-16    amending Subdivision (11) and adding Subdivision (12) to read as
14-17    follows:
14-18                (11)  "Telehealth service" means a health service,
14-19    other than a telemedicine medical service, delivered by a licensed
14-20    or certified health professional acting within the scope of the
14-21    health professional's license or certification who does not perform
14-22    a telemedicine medical service that requires the use of advanced
14-23    telecommunications technology, other than by telephone or
14-24    facsimile, including:
14-25                      (A)  compressed digital interactive video, audio,
14-26    or data transmission;
14-27                      (B)  clinical data transmission using computer
 15-1    imaging by way of still-image capture and store and forward; and
 15-2                      (C)  other technology that facilitates access to
 15-3    health care services or medical specialty expertise.
 15-4                (12)  "Telemedicine medical service" means a health
 15-5    care service initiated by a physician or provided by a health
 15-6    professional acting under physician delegation and supervision for
 15-7    purposes of patient assessment by a health professional, diagnosis
 15-8    or consultation by a physician, treatment, or the transfer of
 15-9    medical data, that requires the use of advanced telecommunications
15-10    technology, other than by telephone or facsimile, including:
15-11                      (A)  compressed digital interactive video, audio,
15-12    or data transmission;
15-13                      (B)  clinical data transmission using computer
15-14    imaging by way of still-image capture; and
15-15                      (C)  other technology that facilitates access to
15-16    health care services or medical specialty expertise[:]
15-17                      [(A)  means medical services delivered by
15-18    telecommunications technologies to rural or underserved public
15-19    not-for-profit health care facilities or primary health care
15-20    facilities in collaboration with an academic health center and an
15-21    associated teaching hospital or tertiary center or with another
15-22    public not-for-profit health care facility; and]
15-23                      [(B)  includes consultive services, diagnostic
15-24    services, interactive video consultation, teleradiology,
15-25    telepathology, and distance education for working health care
15-26    professionals].
15-27          SECTION 12. Section 57.045, Utilities Code, is amended by
 16-1    adding Subsection (e) to read as follows:
 16-2          (e)  The board shall establish an assistance program to
 16-3    provide education concerning the telecommunications infrastructure
 16-4    fund and to facilitate access to funds and programs under this
 16-5    subchapter by health care facilities and by physicians licensed to
 16-6    practice medicine in this state.  The assistance program must
 16-7    include a toll-free telephone number and provide access to
 16-8    information through the Internet.
 16-9          SECTION 13.  Section 57.046(b), Utilities Code, is amended to
16-10    read as follows:
16-11          (b)  The board shall use money in the qualifying entities
16-12    account for any purpose authorized by this subchapter, including:
16-13                (1)  equipment;
16-14                (2)  wiring;
16-15                (3)  material;
16-16                (4)  program development;
16-17                (5)  training;
16-18                (6)  installation costs; [and]
16-19                (7)  a statewide telecommunications network; and
16-20                (8)  funding an automated system to integrate client
16-21    services and eligibility requirements for health and human services
16-22    across agencies.
16-23          SECTION 14. Sections 57.047(a) and (b), Utilities Code, are
16-24    amended to read as follows:
16-25          (a)  The board may award a grant to a project or proposal
16-26    that:
16-27                (1)  provides equipment and infrastructure necessary
 17-1    for:
 17-2                      (A)  distance learning;
 17-3                      (B)  an information sharing program of a library;
 17-4    [or]
 17-5                      (C)  telemedicine medical services; or
 17-6                      (D)  telehealth services;
 17-7                (2)  develops and implements the initial or
 17-8    prototypical delivery of a course or other distance learning
 17-9    material;
17-10                (3)  trains teachers, faculty, librarians, or
17-11    technicians in the use of distance learning or information sharing
17-12    materials and equipment;
17-13                (4)  develops a curriculum or instructional material
17-14    specially suited for telecommunications delivery;
17-15                (5)  provides electronic information; or
17-16                (6)  establishes or carries out an information sharing
17-17    program.
17-18          (b)  The board may award a loan to a project or proposal to
17-19    acquire equipment needed for distance learning and telemedicine
17-20    medical service projects.
17-21          SECTION 15. Subchapter C, Chapter 57, Utilities Code, is
17-22    amended by adding Section 57.0475 to read as follows:
17-23          Sec. 57.0475.  ELIGIBILITY FOR GRANTS TO HEALTH CARE
17-24    FACILITIES. (a)  The board may award a grant under Section
17-25    57.047(a)(1)(C) only to a health care facility that:
17-26                (1)  is a hospital or other entity, including a health
17-27    clinic, that:
 18-1                      (A)  is supported by local or regional tax
 18-2    revenue;
 18-3                      (B)  is a certified nonprofit health corporation
 18-4    under federal law; or
 18-5                      (C)  is an ambulatory health care center; or
 18-6                (2)  meets the criteria adopted by the board and the
 18-7    Health and Human Services Commission under Subsection (b).
 18-8          (b)  The board and the Health and Human Services Commission
 18-9    shall jointly adopt rules prescribing the criteria a health care
18-10    facility not described by Subsection (a)(1) must meet to be
18-11    eligible to receive a grant under Section 57.047(a)(1)(C).  In
18-12    determining the criteria, the board and commission shall prioritize
18-13    health care facilities based on:
18-14                (1)  the amount of charity care provided by each
18-15    facility during the year preceding the year in which the facility
18-16    applies for a grant; and
18-17                (2)  the number of Medicaid patients and patients
18-18    enrolled in the state child health plan treated by each facility
18-19    during the year preceding the year in which the facility applies
18-20    for a grant.
18-21          (c)  The criteria adopted under Subsection (b) must provide
18-22    that a health care facility is not eligible to receive a grant
18-23    under Section 57.047(a)(1)(C) if the health care facility did not
18-24    provide any charity care or treat any patients described by
18-25    Subsection (b)(2) during the year preceding the year in which the
18-26    facility applies for a grant.
18-27          SECTION 16.  Section 58.253(a), Utilities Code, is amended to
 19-1    read as follows:
 19-2          (a)  On customer request, an electing company shall provide
 19-3    private network services to:
 19-4                (1)  an educational institution;
 19-5                (2)  a library;
 19-6                (3)  a nonprofit telemedicine center;
 19-7                (4)  a public or not-for-profit hospital;
 19-8                (5)  a project that would have been eligible to be
 19-9    funded by the telecommunications infrastructure fund under
19-10    Subchapter C, Chapter 57, as that subchapter existed on January 1,
19-11    2001; or
19-12                (6)  a legally constituted consortium or group of
19-13    entities listed in this subsection.
19-14          SECTION 17. Subchapter B, Chapter 32, Human Resources Code,
19-15    is amended by adding Section 32.053 to read as follows:
19-16          Sec. 32.053.  HOME TELEMEDICINE PILOT PROGRAM. (a)  The
19-17    Health and Human Services Commission shall establish a pilot
19-18    program under which certain recipients of medical assistance
19-19    receive, in addition to other home health care services for which
19-20    the recipients are eligible, home health care services through home
19-21    telemonitoring systems located in the recipients' homes.
19-22          (b)  The commission shall implement the program in each of
19-23    the following areas:
19-24                (1)  a rural area;
19-25                (2)  an urban area;
19-26                (3)  a medically underserved area; and
19-27                (4)  an area that adjoins this state's international
 20-1    border.
 20-2          (c)  The commission may reimburse a home and community
 20-3    support services agency participating in the program for services
 20-4    provided by the agency through home telemonitoring systems in an
 20-5    amount not to exceed $300 a month for each home at which services
 20-6    are provided.
 20-7          (d)  The commission shall adopt eligibility criteria for the
 20-8    program.  The criteria must:
 20-9                (1)  require that a program participant:
20-10                      (A)  be:
20-11                            (i)  diagnosed with a chronic illness,
20-12    including hypertension, congestive heart failure, diabetes
20-13    mellitus, chronic obstructive pulmonary disease, or a chronic
20-14    wound;
20-15                            (ii)  diagnosed with depression, if it is
20-16    secondary to a chronic illness; or
20-17                            (iii)  in need of post-hospitalization care
20-18    or care related to receipt of an organ transplant, regardless of
20-19    whether the care is needed before or after the transplant;
20-20                      (B)  be able to use home telemonitoring system
20-21    equipment or be assisted by a regular caregiver who is willing and
20-22    able to use that equipment;
20-23                      (C)  provide written consent to receipt of home
20-24    health care services through a home telemonitoring system; and
20-25                      (D)  be under the care of a physician who
20-26    consents to the participant's receipt of home health care services
20-27    through a home telemonitoring system; and
 21-1                (2)  prohibit a recipient of medical assistance from
 21-2    participating in the program if the recipient:
 21-3                      (A)  is diagnosed with a terminal condition and
 21-4    expected to live for less than six months; or
 21-5                      (B)  requires daily, in-person, home health care
 21-6    visits or invasive procedures.
 21-7          (e)  The commission shall determine home health care services
 21-8    to be provided to program participants through a home
 21-9    telemonitoring system.  Home health care services provided through
21-10    the system may include:
21-11                (1)  educating a program participant regarding
21-12    self-care and preventive health;
21-13                (2)  monitoring a program participant's compliance with
21-14    medication requirements;
21-15                (3)  monitoring a program participant's vital signs;
21-16                (4)  providing a program participant with counseling
21-17    and social support; and
21-18                (5)  any other service the commission determines is
21-19    appropriate.
21-20          (f)  In designing and implementing the program, the
21-21    commission shall ensure that:
21-22                (1)  a program participant receives, for the duration
21-23    of services, at no cost to the participant, home telemonitoring
21-24    system equipment other than a telephone line and telephone that is
21-25    necessary for receipt of home health care services through the
21-26    system;
21-27                (2)  a program participant or the participant's regular
 22-1    caregiver receives personal training and written instructions in
 22-2    the use and maintenance of the home telemonitoring system
 22-3    equipment;
 22-4                (3)  a program participant's satisfaction with home
 22-5    health care services provided through a home telemonitoring system
 22-6    is frequently monitored and evaluated by the commission; and
 22-7                (4)  the quality of home health care services provided
 22-8    through a home telemonitoring system to a program participant is
 22-9    frequently monitored and evaluated by the commission.
22-10          (g)  The commission shall adopt all rules necessary for
22-11    implementation of the program.
22-12          (h)  Not later than December 1, 2004, the commission shall
22-13    submit a report to the legislature regarding the program that
22-14    includes:
22-15                (1)  an analysis of:
22-16                      (A)  the program's cost-effectiveness;
22-17                      (B)  the program's effect on the quality of
22-18    health care received by program participants; and
22-19                      (C)  the satisfaction of program participants
22-20    with home health care services provided through home telemonitoring
22-21    systems; and
22-22                (2)  recommendations regarding elimination,
22-23    continuation, or expansion of the program.
22-24          (i)  This section expires September 1, 2005.
22-25          SECTION 18. Chapter 533, Health and Safety Code, is amended
22-26    by adding Subchapter E to read as follows:
22-27                   SUBCHAPTER E.  JAIL DIVERSION PROGRAM
 23-1          Sec. 533.101.  JAIL DIVERSION PILOT PROGRAM. (a)  The board
 23-2    and department shall develop and implement a pilot program in one
 23-3    rural area and one urban area designed to incorporate audiovisual
 23-4    telecommunications systems to:
 23-5                (1)  divert persons with mental illness from the
 23-6    criminal justice system, when appropriate treatment services are
 23-7    available;
 23-8                (2)  provide access to appropriate mental health
 23-9    services to persons who have entered the criminal justice system;
23-10    and
23-11                (3)  increase the awareness of law enforcement officers
23-12    and officials to mental health issues that may bring persons with
23-13    mental illness into the criminal justice system.
23-14          (b)  In designing the program, the commission shall employ to
23-15    the greatest extent practicable available electronic information
23-16    systems for the program, including:
23-17                (1)  systems to enable the transmission of booking
23-18    information;
23-19                (2)  computer and software systems to match client data
23-20    to booking information;
23-21                (3)  electronic messaging and notification systems; and
23-22                (4)  audiovisual teleconferencing or other
23-23    teleconferencing or telecommunications systems.
23-24          (c)  The department and participating local mental health
23-25    authorities, prosecutorial agencies, law enforcement agencies, jail
23-26    facilities, courts, county or municipal governments, and providers
23-27    of psychiatric services shall enter into an agreement regarding the
 24-1    procedures to follow in implementing the program and the duties of
 24-2    each participating entity. The participating county shall be
 24-3    responsible for establishing the diversion team as prescribed by
 24-4    the department.
 24-5          Sec. 533.102.  PREBOOKING DIVERSION. (a)  The pilot program
 24-6    shall incorporate a system for diverting a person with mental
 24-7    illness from the criminal justice system before the person's
 24-8    contact with a law enforcement officer results in:
 24-9                (1)  charges being brought against the person; or
24-10                (2)  the person being detained in a jail.
24-11          (b)  The prebooking diversion system shall provide for a law
24-12    enforcement officer or booking center staff member to request a
24-13    mental health or crisis stabilization evaluation of a person by a
24-14    local mental health authority crisis counselor or the equivalent
24-15    through an audiovisual teleconference.  The board by rule shall
24-16    establish procedures for evaluations performed under the system.
24-17          Sec. 533.103.  POSTBOOKING DIVERSION BY COURT. The pilot
24-18    program shall incorporate a system for diverting a person with
24-19    mental illness from the criminal justice system by a court at the
24-20    person's arraignment or a court hearing.  A court participating in
24-21    the pilot program may order:
24-22                (1)  the assessment of a person before the court by the
24-23    local mental health authority to assess appropriate community
24-24    mental health treatment options as alternatives to prosecution; and
24-25                (2)  a person before the court to undertake appropriate
24-26    psychiatric treatment as a condition of the dismissal of criminal
24-27    charges, deferral of prosecution, bail, or probation.
 25-1          Sec. 533.104.  POSTBOOKING DIVERSION FOR PERSON IN JAIL. (a)
 25-2    The pilot program shall incorporate a system to provide routine
 25-3    mental health treatment to a person in jail by the local mental
 25-4    health authority through an audiovisual teleconferencing system.
 25-5          (b)  The program must include a jail diversion liaison
 25-6    employed by the local mental health authority who shall:
 25-7                (1)  determine whether certain jailed individuals are
 25-8    eligible for diversion treatment programs; and
 25-9                (2)  facilitate the interaction of jail staff and court
25-10    officials to further the program.
25-11          (c)  The local mental health authority must employ a jail
25-12    diversion team to select candidates for diversion into mental
25-13    health treatment based on:
25-14                (1)  the nature of the offense for which the person is
25-15    jailed;
25-16                (2)  the person's history of incarceration;
25-17                (3)  the person's mental status;
25-18                (4)  the availability of community mental health
25-19    resources appropriate for the person;
25-20                (5)  public safety factors;
25-21                (6)  the person's previous performance in and
25-22    compliance with treatment settings; and
25-23                (7)  other appropriate factors.
25-24          Sec. 533.105.  INFORMATION SYSTEM TO SUPPORT POSTBOOKING
25-25    DIVERSION. (a)  To support the postbooking jail diversion program,
25-26    the pilot program must provide for implementation of an information
25-27    system designed to quickly identify a person with a serious mental
 26-1    illness who has entered the local jail system.
 26-2          (b)  The pilot program must provide for electronic
 26-3    transmission of information concerning all admissions to jails
 26-4    participating in the program to an information system at the local
 26-5    mental health authority.
 26-6          (c)  The local mental health authority shall ensure that the
 26-7    authority's information system automatically:
 26-8                (1)  identifies whether persons admitted to jail are
 26-9    current or former clients of the authority using the person's name,
26-10    date of birth, social security number, sex, or other identifying
26-11    information; and
26-12                (2)  notifies a jail diversion team and case manager at
26-13    the authority when a client or former client of the authority is
26-14    identified as having been admitted to jail.
26-15          Sec. 533.106.  REPORTS TO LEGISLATURE. The board shall
26-16    evaluate the pilot program under this subchapter and publish a
26-17    report on the performance of the program in providing needed
26-18    treatment and in saving or increasing costs to the jail and mental
26-19    health systems.  The board shall deliver the report to the
26-20    governor, lieutenant governor, and speaker of the house of
26-21    representatives not later than November 1 of each even-numbered
26-22    year.
26-23          Sec. 533.107.  EXPIRATION. This subchapter expires September
26-24    1, 2005.
26-25          SECTION 19. (a)  For purposes of this section, a licensed
26-26    dentist may delegate orally, in writing, or through advanced audio
26-27    and video telecommunications services a service, task, or procedure
 27-1    to a dental hygienist who is under the supervision and
 27-2    responsibility of the dentist, if:
 27-3                (1)  the dental hygienist is licensed to perform the
 27-4    service, task, or procedure;
 27-5                (2)  the supervising dentist examines the patient
 27-6    either in person or through advanced audio and video
 27-7    telecommunications services:
 27-8                      (A)  at the time the service, task, or procedure
 27-9    is performed by the dental hygienist; or
27-10                      (B)  during the 12 calendar months preceding the
27-11    date of performance of the service, task, or procedure by the
27-12    dental hygienist; and
27-13                (3)  the dental hygienist does not:
27-14                      (A)  diagnose a dental disease or ailment;
27-15                      (B)  prescribe a treatment or a regimen;
27-16                      (C)  prescribe, order, or dispense medication; or
27-17                      (D)  perform any procedure that is irreversible
27-18    or involves the intentional cutting of soft or hard tissue by any
27-19    means.
27-20          (b)  In this section:
27-21                (1)  "Dental professional" means:
27-22                      (A)  a dentist licensed under Subtitle D, Title
27-23    3, Occupations Code; or
27-24                      (B)  a dental hygienist licensed under Chapter
27-25    262, Occupations Code, practicing under the supervision of a
27-26    dentist.
27-27                (2)  "Student" means a person who is under 19 years of
 28-1    age, is enrolled in a public school, and receives dental services
 28-2    under Chapter 32, Human Resources Code.
 28-3                (3)  "Teledentistry dental services" means a dental
 28-4    service that utilizes, in whole or in part, advanced
 28-5    telecommunications technology including:
 28-6                      (A)  compressed digital interactive video, audio,
 28-7    or data transmission;
 28-8                      (B)  clinical data transmission via computer
 28-9    imaging for teleradiology or telepathology; and
28-10                      (C)  other technology that facilitates access in
28-11    rural and underserved counties to dental services or dental
28-12    specialty expertise.
28-13          (c)  The commissioner of human services shall appoint a
28-14    program administrator to administer a pilot program that uses
28-15    teledentistry and other methods of delivering dental services to
28-16    provide dental services to students in one public school district
28-17    in the state.
28-18          (d)  The program administrator shall establish an advisory
28-19    committee to assist the program administrator in developing and
28-20    implementing the pilot program.
28-21          (e)  In developing the pilot program, the program
28-22    administrator shall design the program in a manner that:
28-23                (1)  increases access to dental services and enhances
28-24    the delivery of dental services to students;
28-25                (2)  ensures the provision of oral health education
28-26    services;
28-27                (3)  provides for effective and appropriate supervision
 29-1    by a dentist of other dental professionals providing care under the
 29-2    program; and
 29-3                (4)  enables the state to determine whether extension
 29-4    of the use of teledentistry would improve the delivery of dental
 29-5    services.
 29-6          (f)  The program administrator shall adopt procedures as
 29-7    necessary to:
 29-8                (1)  ensure that appropriate care, including quality of
 29-9    care, is provided to students who receive teledentistry dental
29-10    services;
29-11                (2)  ensure adequate supervision of dental
29-12    professionals who are not dentists and who provide teledentistry
29-13    dental services;
29-14                (3)  establish the maximum number of dental
29-15    professionals who are not dentists that a dentist may supervise;
29-16    and
29-17                (4)  require a face-to-face consultation with a dentist
29-18    within a certain number of days following a teledentistry dental
29-19    service.
29-20          (g)  Only a teledentistry dental service initiated or
29-21    provided by a licensed dentist in this state may be reimbursed
29-22    under the Medicaid program.  Medicaid reimbursement for a
29-23    teledentistry dental service shall be at the same rate as the
29-24    Medicaid program reimburses for a comparable in-person dental
29-25    service.  A request for reimbursement may not be denied solely
29-26    because an in-person consultation between a dentist or other dental
29-27    professional and a patient did not occur.  Reimbursement for a
 30-1    dental hygienist for service shall be made through the supervising
 30-2    dentist.
 30-3          (h)  A dental hygienist must act under the remote supervision
 30-4    of a local dentist.  Both the dentist and the hygienist must be
 30-5    located within the boundaries of the school district served by the
 30-6    pilot program.
 30-7          (i)  Images and assessment information shall be sent by the
 30-8    dental hygienist to a supervising dentist either live or by means
 30-9    of store and forward technology.  After a dentist has reviewed the
30-10    required information, the dentist may authorize the provision of
30-11    preventive services by the dental hygienist located at the school.
30-12          (j)  A dental hygienist participating in the pilot program
30-13    may initiate screening and assessment services and, under the
30-14    supervision of a dentist, may perform any procedure the hygienist
30-15    is authorized to perform under law.
30-16          (k)  A teledentistry dental service may not be provided if an
30-17    in-person consultation with a dentist is reasonably available to a
30-18    student.  Dentists and other dental professionals participating in
30-19    the pilot program shall make a good faith effort to identify and
30-20    coordinate with existing providers to preserve and protect existing
30-21    dental care systems and dental relationships.
30-22          (l)  The program administrator shall establish a control
30-23    group not to exceed 1,000 students to provide a benchmark for
30-24    measuring the performance of the pilot program.  Each student in
30-25    the control group shall be examined by a dentist, in person, at the
30-26    end of the program to evaluate the effectiveness of teledentistry
30-27    dental services provided during the program.  The examining dentist
 31-1    must practice in a dental office located outside the boundaries of
 31-2    the school district served by the pilot program.
 31-3          (m)  The program administrator shall use the results of the
 31-4    pilot program to:
 31-5                (1)  determine the efficacy of teledentistry; and
 31-6                (2)  determine the effectiveness of teledentistry in
 31-7    increasing access to dental services and improving oral health of
 31-8    students.
 31-9          (n)  A dental professional who provides teledentistry dental
31-10    services shall ensure that the informed consent of the student or a
31-11    person authorized to provide consent for the student is obtained
31-12    before teledentistry dental services are provided.
31-13          (o)  Students participating in the pilot program must be
31-14    referred to local dentists for restorative care and monitored to
31-15    ensure that restorative services are provided.
31-16          (p)  Not later than December 31, 2002, the program
31-17    administrator shall submit a report to the legislature containing
31-18    the following:
31-19                (1)  the number of students who received teledentistry
31-20    dental services;
31-21                (2)  the types of teledentistry dental services
31-22    provided;
31-23                (3)  the cost and level of utilization of teledentistry
31-24    dental services;
31-25                (4)  the effect of the pilot program on school
31-26    absenteeism of students in the control group;
31-27                (5)  a description of improvements in the oral health
 32-1    of students in the pilot program; and
 32-2                (6)  recommendations for changes in or the expansion of
 32-3    the pilot program.
 32-4          (q)  This section expires and the advisory committee is
 32-5    abolished December 31, 2002.
 32-6          SECTION 20. Not later than October 1, 2001, the Health and
 32-7    Human Services Commission and the Telecommunications Infrastructure
 32-8    Fund Board shall adopt minimum standards for an operating system
 32-9    used by a health care facility in providing telemedicine medical
32-10    services to a Medicaid recipient as required by Section 531.02161,
32-11    Government Code, as added by this Act.
32-12          SECTION 21. Not later than January 1, 2002, the Health and
32-13    Human Services Commission shall adopt rules required by Section
32-14    531.0217, Government Code, as amended by this Act.
32-15          SECTION 22. (a)  The commissioner of human services shall
32-16    appoint a program administrator for the teledentistry pilot
32-17    program, as added by Section 19 of this Act, not later than the
32-18    30th day after the effective date of this Act.
32-19          (b)  The program administrator shall appoint an advisory
32-20    committee and shall begin implementing the teledentistry pilot
32-21    program not later than the 30th day after the date the program
32-22    administrator is appointed.
32-23          SECTION 23.  Section 57.046(b)(8), Utilities Code, as added
32-24    by this Act, expires September 1, 2003.
32-25          SECTION 24.  If before implementing any provision of this Act
32-26    a state agency determines that a waiver or authorization from a
32-27    federal agency is necessary for implementation of that provision,
 33-1    the agency affected by the provision shall request the waiver or
 33-2    authorization and may delay implementing that provision until the
 33-3    waiver or authorization is granted.
 33-4          SECTION 25.  This Act takes effect immediately if it receives
 33-5    a vote of two-thirds of all the members elected to each house, as
 33-6    provided by Section 39, Article III, Texas Constitution.  If this
 33-7    Act does not receive the vote necessary for immediate effect, this
 33-8    Act takes effect September 1, 2001.