By Moncrief S.B. No. 789
77R7347 MCK-D
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 SERVICE PROVIDERS UNDER MEDICAID. (a) The commission
1-9 by rule shall develop and implement a system to reimburse providers
1-10 of services under the state Medicaid program for services performed
1-11 using telemedicine medical services.
1-12 (b) In developing the system, the commission, by rule,
1-13 shall:
1-14 (1) review programs and pilot projects in other states
1-15 to determine the most effective method for reimbursement;
1-16 (2) establish billing codes and a fee schedule for
1-17 services; [and]
1-18 (3) provide for an approval process before a provider
1-19 can receive reimbursement for services; and
1-20 (4) consult with the Texas Department of Health, the
1-21 Medicaid clinical review committee, the telemedicine advisory
1-22 committee, and the physician payment advisory committee to
1-23 establish procedures to:
1-24 (A) deny reimbursement for a health care service
2-1 that, based upon credible clinical evidence, is shown to be
2-2 medically inappropriate for delivery using a telecommunications
2-3 system; and
2-4 (B) annually review health care services,
2-5 considering new clinical findings, to determine whether
2-6 reimbursement for particular services should be denied or
2-7 authorized.
2-8 (c) The commission shall encourage teaching hospitals, small
2-9 rural hospitals, federally qualified health centers, and
2-10 state-owned health care facilities to participate as telemedicine
2-11 medical services [service] providers in the health care delivery
2-12 system. The commission may not require that a service be provided
2-13 to a patient through telemedicine medical services when the service
2-14 can reasonably be provided by a physician through a face-to-face
2-15 consultation with the patient in the community in which the patient
2-16 resides or works. This subsection does not prohibit the
2-17 authorization of the provision of any service to a patient through
2-18 telemedicine medical services at the patient's request.
2-19 (d) Not later than December 1 of each even-numbered year,
2-20 the commission shall report to the speaker of the house of
2-21 representatives and the lieutenant governor on the effects of
2-22 telemedicine medical services on the Medicaid program in the state,
2-23 including the number of physicians and health professionals using
2-24 telemedicine medical services, the geographic and demographic
2-25 disposition of the physicians and health professionals, the number
2-26 of patients receiving telemedicine medical services, the types of
2-27 services being provided, and the cost and utilization of
3-1 telemedicine medical services on the program.
3-2 (e) [(d)] Subject to Section 153.004, Occupations Code
3-3 [5.11, Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-4 Statutes)], the commission may adopt rules as necessary to
3-5 implement this section.
3-6 (f) [(e)] In this section, "telemedicine medical service"
3-7 has the meaning assigned by Section 57.042, Utilities Code.
3-8 SECTION 2. Section 531.0217, Government Code, is amended to
3-9 read as follows:
3-10 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
3-11 CONSULTATIONS. (a) In this section:
3-12 (1) "Health professional" means a physician or an
3-13 individual licensed or certified in this state to perform health
3-14 care services that are delegated and supervised by a physician [an
3-15 advanced nurse practitioner, an allied health professional, a
3-16 mental health professional, a physician, or a physician assistant
3-17 who is licensed in this state].
3-18 (2) "Physician" means a person licensed to practice
3-19 medicine in this state under Subtitle B, Title 3, Occupations Code
3-20 ["Rural county" means a county that:]
3-21 [(A) has a population of 50,000 or less; or]
3-22 [(B) contains an area that was not designated as
3-23 an urban area by the United States Bureau of the Census according
3-24 to the 1990 federal census and does not have within the boundaries
3-25 of the county a hospital that:]
3-26 [(i) is licensed under Chapter 241, Health
3-27 and Safety Code; and]
4-1 [(ii) has more than 100 beds].
4-2 (3) "Telemedicine medical service" has the meaning
4-3 assigned by Section 57.042, Utilities Code ["Rural health facility"
4-4 means a health facility that is located in a rural county and at
4-5 least 30 miles from any accredited medical school or any teaching
4-6 hospital affiliated with an accredited medical school and that is:]
4-7 [(A) a licensed, nonprofit hospital;]
4-8 [(B) a health clinic that is affiliated with:]
4-9 [(i) an accredited medical school;]
4-10 [(ii) a teaching hospital that is
4-11 affiliated with an accredited medical school;]
4-12 [(iii) a hospital described by Paragraph
4-13 (C); or]
4-14 [(iv) a federally qualified health center,
4-15 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
4-16 [(C) a hospital that:]
4-17 [(i) is licensed under Chapter 241, Health
4-18 and Safety Code;]
4-19 [(ii) is owned or operated by a
4-20 municipality, county, hospital district, or hospital authority; and]
4-21 [(iii) provides inpatient or outpatient
4-22 services.]
4-23 [(4) "Telemedical consultation" means a medical
4-24 consultation for purposes of patient diagnosis or treatment that
4-25 requires the use of advanced telecommunications technology,
4-26 including:]
4-27 [(A) compressed digital interactive video,
5-1 audio, or data transmission;]
5-2 [(B) clinical data transmission via computer
5-3 imaging for teleradiology or telepathology; and]
5-4 [(C) other technology that facilitates access in
5-5 rural counties to health care services or medical specialty
5-6 expertise].
5-7 (b) The commission by rule shall require each health and
5-8 human services agency that administers a part of the Medicaid
5-9 program to provide Medicaid reimbursement for a telemedicine
5-10 medical service initiated or [telemedical consultation] provided by
5-11 a physician [licensed in this state who practices in:]
5-12 [(1) a rural health facility;]
5-13 [(2) an accredited medical school; or]
5-14 [(3) a teaching hospital that is affiliated with an
5-15 accredited medical school].
5-16 (c) The commission shall ensure that reimbursement is
5-17 provided only for a telemedicine medical service initiated or
5-18 [consultation] provided by a physician [described in Subsection (b)
5-19 to a health professional who practices in a rural county].
5-20 (d) The commission shall require reimbursement for a
5-21 telemedicine medical service [telemedical consultation] at the same
5-22 rate as the Medicaid program reimburses for a comparable in-person
5-23 medical service [consultation]. A request for reimbursement may
5-24 not be denied solely because an in-person medical service
5-25 [consultation] between a physician or another health professional
5-26 who provides the telemedicine medical service and a patient did not
5-27 occur.
6-1 (e) A health care facility that receives reimbursement under
6-2 this section for a telemedicine medical service [consultations]
6-3 provided by a physician [physicians] who practices [practice] in
6-4 that facility or [and] a health professional who participates in a
6-5 telemedicine medical service [obtains consultations] under this
6-6 section shall establish quality of care protocols and patient
6-7 confidentiality guidelines to ensure that the telemedicine medical
6-8 service meets [telemedical consultations meet] legal requirements
6-9 and acceptable patient care standards.
6-10 (f) The commission may not require a telemedicine medical
6-11 service [telemedical consultation] if an in-person consultation
6-12 with a physician is reasonably available where the patient resides
6-13 or works. The commission shall make a good faith effort to
6-14 identify and coordinate with existing providers to preserve and
6-15 protect existing health care systems and medical relationships in
6-16 an area.
6-17 (g) If a patient receiving a telemedicine medical service
6-18 has a primary care physician, the commission shall require that the
6-19 primary care physician be notified of the telemedicine medical
6-20 service for the purpose of sharing medical information.
6-21 (h) The commission in consultation with the Texas State
6-22 Board of Medical Examiners shall monitor and regulate the use of
6-23 telemedicine medical services to ensure compliance with this
6-24 section. In addition to any other method of enforcement, the
6-25 commission may use a corrective action plan to ensure compliance
6-26 with this section.
6-27 (i) [(g)] The Texas State Board of Medical Examiners, in
7-1 consultation with the commission, as appropriate, may adopt rules
7-2 as necessary to:
7-3 (1) ensure that appropriate care, including quality of
7-4 care, is provided to patients who receive telemedicine medical
7-5 services [that are provided through a telemedical consultation];
7-6 [and]
7-7 (2) prevent abuse and fraud through the use of
7-8 telemedicine medical services [telemedical consultations],
7-9 including rules relating to filing of claims and records required
7-10 to be maintained in connection with telemedicine;
7-11 (3) establish supervisory requirements for a service
7-12 delegated to and performed by an individual who is not a physician;
7-13 and
7-14 (4) require a face-to-face consultation with a
7-15 physician within a certain number of days following a telemedicine
7-16 medical service.
7-17 (j) [(h)] The commissioner shall establish an advisory
7-18 committee to assist the commission in coordinating state
7-19 telemedicine efforts [developing policies for telemedical
7-20 consultations under this section].
7-21 (k) This section does not affect any requirement relating
7-22 to:
7-23 (1) a rural health clinic; or
7-24 (2) physician delegation of the authority to carry out
7-25 or sign prescription drug orders to an advanced practice nurse or
7-26 physician assistant.
7-27 (l) The commission shall create and maintain a telemedicine
8-1 medical services registry that is available to licensing and
8-2 regulatory agencies.
8-3 SECTION 3. Section 1, Article 21.53F, Insurance Code, as
8-4 added by Section 1, Chapter 880, Acts of the 75th Legislature,
8-5 Regular Session, 1997, is amended to read as follows:
8-6 Sec. 1. DEFINITIONS. In this article:
8-7 (1) "Health benefit plan" means a plan described by
8-8 Section 2 of this article.
8-9 (2) "Health professional" means a physician or an
8-10 individual licensed or certified in this state to perform health
8-11 care services that are delegated and supervised by a physician.
8-12 (3) "Physician" means a person licensed to practice
8-13 medicine in this state under Subtitle B, Title 3, Occupations Code.
8-14 (4) "Telemedicine medical service" has the meaning
8-15 assigned by Section 57.042, Utilities Code ["Telemedicine" means
8-16 the use of interactive audio, video, or other electronic media to
8-17 deliver health care. The term includes the use of electronic media
8-18 for diagnosis, consultation, treatment, transfer of medical data,
8-19 and medical education. The term does not include services
8-20 performed using a telephone or facsimile machine].
8-21 SECTION 4. Section 3, Article 21.53F, Insurance Code, as
8-22 added by Section 1, Chapter 880, Acts of the 75th Legislature,
8-23 Regular Session, 1997, is amended to read as follows:
8-24 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES. (a) A
8-25 health benefit plan may not exclude a telemedicine medical service
8-26 from coverage under the plan solely because the service is
8-27 [provided through telemedicine and] not provided through a
9-1 face-to-face consultation.
9-2 (b) Benefits [for a service provided through telemedicine]
9-3 required under this article may be made subject to a deductible,
9-4 copayment, or coinsurance requirement. A deductible, copayment, or
9-5 coinsurance applicable to a particular service provided through
9-6 telemedicine medical services may not exceed the deductible,
9-7 copayment, or coinsurance required by the health benefit plan for a
9-8 comparable [the same] service provided through a face-to-face
9-9 consultation.
9-10 SECTION 5. Section 4, Article 21.53F, Insurance Code, as
9-11 added by Section 1, Chapter 880, Acts of the 75th Legislature,
9-12 Regular Session, 1997, is amended to read as follows:
9-13 Sec. 4. INFORMED CONSENT. A treating physician or [other]
9-14 health professional [care provider] who provides or facilitates the
9-15 use of telemedicine medical services shall ensure that the informed
9-16 consent of the patient, or another appropriate person with
9-17 authority to make health care treatment decisions for the patient,
9-18 is obtained before telemedicine medical services are provided
9-19 [through telemedicine].
9-20 SECTION 6. Section 5, Article 21.53F, Insurance Code, as
9-21 added by Section 1, Chapter 880, Acts of the 75th Legislature,
9-22 Regular Session, 1997, is amended to read as follows:
9-23 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
9-24 health professional [care provider] who provides or facilitates the
9-25 use of telemedicine medical services shall ensure that the
9-26 confidentiality of the patient's medical information is maintained
9-27 as required by Chapter 159, Occupations Code [Section 5.08, Medical
10-1 Practice Act (Article 4495b, Vernon's Texas Civil Statutes)], or
10-2 other applicable law.
10-3 SECTION 7. Section 6(b), Article 21.53F, Insurance Code, as
10-4 added by Section 1, Chapter 880, Acts of the 75th Legislature,
10-5 Regular Session, 1997, is amended to read as follows:
10-6 (b) The Texas State Board of Medical Examiners, in
10-7 consultation with the commissioner, as appropriate, may adopt rules
10-8 as necessary to:
10-9 (1) ensure that appropriate care, including quality of
10-10 care, is provided to patients who receive telemedicine medical
10-11 services [that are provided through telemedicine]; and
10-12 (2) prevent abuse and fraud through use of
10-13 telemedicine medical services, including rules relating to filing
10-14 of claims and records required to be maintained in connection with
10-15 telemedicine medical services.
10-16 SECTION 8. Section 153.004, Occupations Code, is amended to
10-17 read as follows:
10-18 Sec. 153.004. RULES REGARDING TELEMEDICINE SERVICES. (a) In
10-19 consultation with the Health and Human Services Commission and the
10-20 commissioner of insurance, the board may adopt rules as necessary
10-21 to:
10-22 (1) ensure that appropriate care is provided to
10-23 Medicaid and Medicare patients who receive telemedicine medical
10-24 services [that are provided through telemedicine]; and
10-25 (2) prevent abuse and fraud in the use of telemedicine
10-26 medical services for Medicaid and Medicare patients.
10-27 (b) The rules adopted under Section (a)(2) may include rules
11-1 relating to filing of claims and records required to be maintained
11-2 in relation to telemedicine medical services.
11-3 SECTION 9. Section 57.042(11), Utilities Code, is amended to
11-4 read as follows:
11-5 (11) "Telemedicine medical service" means a health
11-6 care service initiated by a physician or provided by a health
11-7 professional acting under physician delegation and supervision for
11-8 purposes of patient assessment by a health professional, diagnosis
11-9 or consultation by a physician, treatment, or the transfer of
11-10 medical data, that requires the use of advanced telecommunications
11-11 technology, other than by telephone or facsimile, including:
11-12 (A) compressed digital interactive video, audio,
11-13 or data transmission;
11-14 (B) clinical data transmission using computer
11-15 imaging by way of still-image capture and store and forward; and
11-16 (C) other technology that facilitates access to
11-17 health care services or medical specialty expertise[:]
11-18 [(A) means medical services delivered by
11-19 telecommunications technologies to rural or underserved public
11-20 not-for-profit health care facilities or primary health care
11-21 facilities in collaboration with an academic health center and an
11-22 associated teaching hospital or tertiary center or with another
11-23 public not-for-profit health care facility; and]
11-24 [(B) includes consultive services, diagnostic
11-25 services, interactive video consultation, teleradiology,
11-26 telepathology, and distance education for working health care
11-27 professionals].
12-1 SECTION 10. Section 57.045, Utilities Code, is amended by
12-2 adding Subsection (e) to read as follows:
12-3 (e) The board shall establish an assistance program to
12-4 provide education concerning the telecommunications infrastructure
12-5 fund and to facilitate access to funds and programs under this
12-6 subchapter by health care facilities and by physicians licensed to
12-7 practice medicine in this state. The assistance program must
12-8 include a toll-free telephone number and provide access to
12-9 information through the Internet.
12-10 SECTION 11. Sections 57.047(a) and (b), Utilities Code, are
12-11 amended to read as follows:
12-12 (a) The board may award a grant to a project or proposal
12-13 that:
12-14 (1) provides equipment and infrastructure necessary
12-15 for:
12-16 (A) distance learning;
12-17 (B) an information sharing program of a library;
12-18 or
12-19 (C) telemedicine medical services;
12-20 (2) develops and implements the initial or
12-21 prototypical delivery of a course or other distance learning
12-22 material;
12-23 (3) trains teachers, faculty, librarians, or
12-24 technicians in the use of distance learning or information sharing
12-25 materials and equipment;
12-26 (4) develops a curriculum or instructional material
12-27 specially suited for telecommunications delivery;
13-1 (5) provides electronic information; or
13-2 (6) establishes or carries out an information sharing
13-3 program.
13-4 (b) The board may award a loan to a project or proposal to
13-5 acquire equipment needed for distance learning and telemedicine
13-6 medical service projects.
13-7 SECTION 12. Not later than January 1, 2002, the Health and
13-8 Human Services Commission shall adopt rules required by Section
13-9 531.0217, Government Code, as amended by this Act.
13-10 SECTION 13. If before implementing any provision of this Act
13-11 a state agency determines that a waiver or authorization from a
13-12 federal agency is necessary for implementation of that provision,
13-13 the agency affected by the provision shall request the waiver or
13-14 authorization and may delay implementing that provision until the
13-15 waiver or authorization is granted.
13-16 SECTION 14. This Act takes effect immediately if it receives
13-17 a vote of two-thirds of all the members elected to each house, as
13-18 provided by Section 39, Article III, Texas Constitution. If this
13-19 Act does not receive the vote necessary for immediate effect, this
13-20 Act takes effect September 1, 2001.