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.