1-1 By: Moncrief, Ellis S.B. No. 789
1-2 (In the Senate - Filed February 20, 2001; February 21, 2001,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; April 10, 2001, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 7, Nays 0;
1-6 April 10, 2001, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 789 By: Moncrief
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the regulation and reimbursement of telemedicine
1-11 medical services and telehealth services.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 531.0216, Government Code, is amended to
1-14 read as follows:
1-15 Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
1-16 TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The
1-17 commission by rule shall develop and implement a system to
1-18 reimburse providers of services under the state Medicaid program
1-19 for services performed using telemedicine medical services.
1-20 (b) In developing the system, the commission by rule shall:
1-21 (1) review programs and pilot projects in other states
1-22 to determine the most effective method for reimbursement;
1-23 (2) establish billing codes and a fee schedule for
1-24 services; [and]
1-25 (3) provide for an approval process before a provider
1-26 can receive reimbursement for services;
1-27 (4) establish a separate provider identifier for
1-28 telemedicine medical services providers; and
1-29 (5) consult with the Texas Department of Health and
1-30 the telemedicine advisory committee to establish procedures to:
1-31 (A) identify clinical evidence supporting
1-32 delivery of health care services using a telecommunications system;
1-33 (B) establish pilot studies for telemedicine
1-34 medical service delivery; and
1-35 (C) annually review health care services,
1-36 considering new clinical findings, to determine whether
1-37 reimbursement for particular services should be denied or
1-38 authorized.
1-39 (c) The commission shall establish pilot programs in
1-40 designated areas of this state under which the commission, in
1-41 administering government-funded health programs, may reimburse a
1-42 health professional participating in the pilot program for
1-43 telehealth services authorized under the licensing law applicable
1-44 to the health professional.
1-45 (d) The commission shall encourage physicians, teaching
1-46 hospitals, small rural hospitals, federally qualified health
1-47 centers, and state-owned health care facilities to participate as
1-48 telemedicine medical services [service] providers in the health
1-49 care delivery system. The commission may not require that a
1-50 service be provided to a patient through telemedicine medical
1-51 services when the service can reasonably be provided by a physician
1-52 through a face-to-face consultation with the patient in the
1-53 community in which the patient resides or works. This subsection
1-54 does not prohibit the authorization of the provision of any service
1-55 to a patient through telemedicine medical services at the patient's
1-56 request.
1-57 (e) Not later than December 1 of each even-numbered year,
1-58 the commission shall report to the speaker of the house of
1-59 representatives and the lieutenant governor on the effects of
1-60 telemedicine medical services on the Medicaid program in the state,
1-61 including the number of physicians and health professionals using
1-62 telemedicine medical services, the geographic and demographic
1-63 disposition of the physicians and health professionals, the number
1-64 of patients receiving telemedicine medical services, the types of
2-1 services being provided, and the cost of utilization of
2-2 telemedicine medical services to the program.
2-3 (f) [(d)] Subject to Section 153.004, Occupations Code
2-4 [5.11, Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-5 Statutes)], the commission may adopt rules as necessary to
2-6 implement this section.
2-7 (g) [(e)] In this section:
2-8 (1) "Telehealth service" has the meaning assigned by
2-9 Section 57.042, Utilities Code; and
2-10 (2) "Telemedicine medical service"[, "telemedicine"]
2-11 has the meaning assigned by Section 57.042, Utilities Code.
2-12 SECTION 2. Section 531.0217, Government Code, is amended to
2-13 read as follows:
2-14 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
2-15 CONSULTATIONS. (a) In this section:
2-16 (1) "Health professional" means:
2-17 (A) a physician;
2-18 (B) an individual who is licensed or certified
2-19 in this state to perform health care services and who is authorized
2-20 to assist a physician in providing telemedicine medical services
2-21 that are delegated and supervised by the physician; or
2-22 (C) a licensed or certified health professional
2-23 acting within the scope of the license or certification who does
2-24 not perform a telemedicine medical service [an advanced nurse
2-25 practitioner, an allied health professional, a mental health
2-26 professional, a physician, or a physician assistant who is licensed
2-27 in this state].
2-28 (2) "Physician" means a person licensed to practice
2-29 medicine in this state under Subtitle B, Title 3, Occupations Code
2-30 ["Rural county" means a county that:]
2-31 [(A) has a population of 50,000 or less; or]
2-32 [(B) contains an area that was not designated as
2-33 an urban area by the United States Bureau of the Census according
2-34 to the 1990 federal census and does not have within the boundaries
2-35 of the county a hospital that:]
2-36 [(i) is licensed under Chapter 241, Health
2-37 and Safety Code; and]
2-38 [(ii) has more than 100 beds].
2-39 (3) "Telehealth service" has the meaning assigned by
2-40 Section 57.042, Utilities Code.
2-41 (4) "Telemedicine medical service" has the meaning
2-42 assigned by Section 57.042, Utilities Code. ["Rural health
2-43 facility" means a health facility that is located in a rural county
2-44 and at least 30 miles from any accredited medical school or any
2-45 teaching hospital affiliated with an accredited medical school and
2-46 that is:]
2-47 [(A) a licensed, nonprofit hospital;]
2-48 [(B) a health clinic that is affiliated with:]
2-49 [(i) an accredited medical school;]
2-50 [(ii) a teaching hospital that is
2-51 affiliated with an accredited medical school;]
2-52 [(iii) a hospital described by Paragraph
2-53 (C); or]
2-54 [(iv) a federally qualified health center,
2-55 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
2-56 [(C) a hospital that:]
2-57 [(i) is licensed under Chapter 241, Health
2-58 and Safety Code;]
2-59 [(ii) is owned or operated by a
2-60 municipality, county, hospital district, or hospital authority; and]
2-61 [(iii) provides inpatient or outpatient
2-62 services.]
2-63 [(4) "Telemedical consultation" means a medical
2-64 consultation for purposes of patient diagnosis or treatment that
2-65 requires the use of advanced telecommunications technology,
2-66 including:]
2-67 [(A) compressed digital interactive video,
2-68 audio, or data transmission;]
2-69 [(B) clinical data transmission via computer
3-1 imaging for teleradiology or telepathology; and]
3-2 [(C) other technology that facilitates access in
3-3 rural counties to health care services or medical specialty
3-4 expertise.]
3-5 (b) The commission by rule shall require each health and
3-6 human services agency that administers a part of the Medicaid
3-7 program to provide Medicaid reimbursement for a telemedicine
3-8 medical service initiated or [telemedical consultation] provided by
3-9 a physician [licensed in this state who practices in:]
3-10 [(1) a rural health facility;]
3-11 [(2) an accredited medical school; or]
3-12 [(3) a teaching hospital that is affiliated with an
3-13 accredited medical school].
3-14 (c) The commission shall ensure that reimbursement is
3-15 provided only for a telemedicine medical service initiated or
3-16 [consultation] provided by a physician [described in Subsection (b)
3-17 to a health professional who practices in a rural county].
3-18 (d) The commission shall require reimbursement for a
3-19 telemedicine medical service [telemedical consultation] at the same
3-20 rate as the Medicaid program reimburses for a comparable in-person
3-21 medical service [consultation]. A request for reimbursement may
3-22 not be denied solely because an in-person medical service
3-23 [consultation] between a physician and a patient did not occur.
3-24 (e) A health care facility that receives reimbursement under
3-25 this section for a telemedicine medical service [consultations]
3-26 provided by a physician [physicians] who practices [practice] in
3-27 that facility or [and] a health professional who participates in a
3-28 telemedicine medical service [obtains consultations] under this
3-29 section shall establish quality of care protocols and patient
3-30 confidentiality guidelines to ensure that the telemedicine medical
3-31 service meets [telemedical consultations meet] legal requirements
3-32 and acceptable patient care standards.
3-33 (f) The commission may not require a telemedicine medical
3-34 service [telemedical consultation] if an in-person consultation
3-35 with a physician is reasonably available where the patient resides
3-36 or works. The commission shall require facilities and providers of
3-37 telemedicine medical services to make a good faith effort to
3-38 identify and coordinate with existing providers to preserve and
3-39 protect existing health care systems and medical relationships in
3-40 an area.
3-41 (g) If a patient receiving a telemedicine medical service
3-42 has a primary care physician, the commission shall require that the
3-43 primary care physician be notified of the telemedicine medical
3-44 service for the purpose of sharing medical information.
3-45 (h) The commission in consultation with the Texas State
3-46 Board of Medical Examiners shall monitor and regulate the use of
3-47 telemedicine medical services to ensure compliance with this
3-48 section. In addition to any other method of enforcement, the
3-49 commission may use a corrective action plan to ensure compliance
3-50 with this section.
3-51 (i) [(g)] The Texas State Board of Medical Examiners, in
3-52 consultation with the commission, as appropriate, may adopt rules
3-53 as necessary to:
3-54 (1) ensure that appropriate care, including quality of
3-55 care, is provided to patients who receive telemedicine medical
3-56 services [that are provided through a telemedical consultation];
3-57 [and]
3-58 (2) prevent abuse and fraud through the use of
3-59 telemedicine medical services [telemedical consultations],
3-60 including rules relating to filing of claims and records required
3-61 to be maintained in connection with telemedicine;
3-62 (3) establish supervisory requirements for a service
3-63 delegated to and performed by an individual who is not a physician;
3-64 and
3-65 (4) define those situations when a face-to-face
3-66 consultation with a physician is required after a telemedicine
3-67 medical service.
3-68 (j) [(h)] The commissioner shall establish an advisory
3-69 committee to assist the commission in coordinating state
4-1 telemedicine efforts [developing policies for telemedical
4-2 consultations under this section].
4-3 (k) This section does not affect any requirement relating
4-4 to:
4-5 (1) a rural health clinic or federally qualified
4-6 health center; or
4-7 (2) physician delegation of the authority to carry out
4-8 or sign prescription drug orders to an advanced practice nurse or
4-9 physician assistant.
4-10 SECTION 3. Section 1, Article 21.53F, Insurance Code, as
4-11 added by Section 1, Chapter 880, Acts of the 75th Legislature,
4-12 Regular Session, 1997, is amended to read as follows:
4-13 Sec. 1. DEFINITIONS. In this article:
4-14 (1) "Health benefit plan" means a plan described by
4-15 Section 2 of this article.
4-16 (2) "Health professional" means:
4-17 (A) a physician;
4-18 (B) an individual who is licensed or certified
4-19 in this state to perform health care services that are delegated
4-20 and supervised by the physician; or
4-21 (C) a licensed or certified health professional
4-22 acting within the scope of the license or certification who does
4-23 not perform a telemedicine medical service.
4-24 (3) "Physician" means a person licensed to practice
4-25 medicine in this state under Subtitle B, Title 3, Occupations Code.
4-26 (4) "Telehealth service" has the meaning assigned by
4-27 Section 57.042, Utilities Code.
4-28 (5) "Telemedicine medical service" has the meaning
4-29 assigned by Section 57.042, Utilities Code. ["Telemedicine" means
4-30 the use of interactive audio, video, or other electronic media to
4-31 deliver health care. The term includes the use of electronic media
4-32 for diagnosis, consultation, treatment, transfer of medical data,
4-33 and medical education. The term does not include services
4-34 performed using a telephone or facsimile machine.]
4-35 SECTION 4. Section 3, Article 21.53F, Insurance Code, as
4-36 added by Section 1, Chapter 880, Acts of the 75th Legislature,
4-37 Regular Session, 1997, is amended to read as follows:
4-38 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND
4-39 TELEHEALTH SERVICES. (a) A health benefit plan may not exclude a
4-40 telemedicine medical service or a telehealth service from coverage
4-41 under the plan solely because the service is [provided through
4-42 telemedicine and] not provided through a face-to-face consultation.
4-43 (b) Benefits [for a service provided through telemedicine]
4-44 required under this article may be made subject to a deductible,
4-45 copayment, or coinsurance requirement. A deductible, copayment, or
4-46 coinsurance applicable to a particular service provided through
4-47 telemedicine medical services or telehealth services may not exceed
4-48 the deductible, copayment, or coinsurance required by the health
4-49 benefit plan for a comparable [the same] service provided through a
4-50 face-to-face consultation.
4-51 SECTION 5. Section 4, Article 21.53F, Insurance Code, as
4-52 added by Section 1, Chapter 880, Acts of the 75th Legislature,
4-53 Regular Session, 1997, is amended to read as follows:
4-54 Sec. 4. INFORMED CONSENT. A treating physician or [other]
4-55 health professional [care provider] who provides or facilitates the
4-56 use of telemedicine medical services or telehealth services shall
4-57 ensure that the informed consent of the patient, or another
4-58 appropriate person with authority to make health care treatment
4-59 decisions for the patient, is obtained before telemedicine medical
4-60 services or telehealth services are provided [through
4-61 telemedicine].
4-62 SECTION 6. Section 5, Article 21.53F, Insurance Code, as
4-63 added by Section 1, Chapter 880, Acts of the 75th Legislature,
4-64 Regular Session, 1997, is amended to read as follows:
4-65 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
4-66 health professional [care provider] who provides or facilitates the
4-67 use of telemedicine medical services or telehealth services shall
4-68 ensure that the confidentiality of the patient's medical
4-69 information is maintained as required by Chapter 159, Occupations
5-1 Code [Section 5.08, Medical Practice Act (Article 4495b, Vernon's
5-2 Texas Civil Statutes)], or other applicable law.
5-3 SECTION 7. Section 6, Article 21.53F, Insurance Code, as
5-4 added by Section 1, Chapter 880, Acts of the 75th Legislature,
5-5 Regular Session, 1997, is amended by amending Subsection (b) and
5-6 adding Subsection (c) to read as follows:
5-7 (b) The Texas State Board of Medical Examiners, in
5-8 consultation with the commissioner, as appropriate, may adopt rules
5-9 as necessary to:
5-10 (1) ensure that appropriate care, including quality of
5-11 care, is provided to patients who receive telemedicine medical
5-12 services [that are provided through telemedicine]; and
5-13 (2) prevent abuse and fraud through use of
5-14 telemedicine medical services, including rules relating to filing
5-15 of claims and records required to be maintained in connection with
5-16 telemedicine medical services.
5-17 (c) The appropriate licensing agency for a person providing
5-18 telehealth services, in consultation with the commissioner, as
5-19 appropriate, may adopt rules as necessary to:
5-20 (1) ensure that appropriate care, including quality of
5-21 care, is provided to patients who receive telehealth services; and
5-22 (2) prevent abuse and fraud through use of telehealth
5-23 services, including rules relating to filing of claims and records
5-24 required to be maintained in connection with telehealth services.
5-25 SECTION 8. Section 153.004, Occupations Code, is amended to
5-26 read as follows:
5-27 Sec. 153.004. RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
5-28 (a) In consultation with the Health and Human Services Commission
5-29 and the commissioner of insurance, the board may adopt rules as
5-30 necessary to:
5-31 (1) ensure that appropriate care is provided to
5-32 Medicaid and Medicare patients who receive telemedicine medical
5-33 services [that are provided through telemedicine]; and
5-34 (2) prevent abuse and fraud in the use of telemedicine
5-35 medical services for Medicaid and Medicare patients.
5-36 (b) The rules adopted under Subsection [Section] (a)(2) may
5-37 include rules relating to filing of claims and records required to
5-38 be maintained in relation to telemedicine medical services.
5-39 SECTION 9. Section 57.042, Utilities Code, is amended by
5-40 amending Subdivision (11) and adding Subdivision (12) to read as
5-41 follows:
5-42 (11) "Telehealth service" means a health service,
5-43 other than a telemedicine medical service, delivered by a licensed
5-44 or certified health professional acting within the scope of the
5-45 health professional's license or certification who does not perform
5-46 a telemedicine medical service that requires the use of advanced
5-47 telecommunications technology, other than by telephone or
5-48 facsimile, including:
5-49 (A) compressed digital interactive video, audio,
5-50 or data transmission;
5-51 (B) clinical data transmission using computer
5-52 imaging by way of still-image capture and store and forward; and
5-53 (C) other technology that facilitates access to
5-54 health care services or medical specialty expertise.
5-55 (12) "Telemedicine medical service" means a health
5-56 care service initiated by a physician or provided by a health
5-57 professional acting under physician delegation and supervision for
5-58 purposes of patient assessment by a health professional, diagnosis
5-59 or consultation by a physician, treatment, or the transfer of
5-60 medical data, that requires the use of advanced telecommunications
5-61 technology, other than by telephone or facsimile, including:
5-62 (A) compressed digital interactive video, audio,
5-63 or data transmission;
5-64 (B) clinical data transmission using computer
5-65 imaging by way of still-image capture and store and forward; and
5-66 (C) other technology that facilitates access to
5-67 health care services or medical specialty expertise[:]
5-68 [(A) means medical services delivered by
5-69 telecommunications technologies to rural or underserved public
6-1 not-for-profit health care facilities or primary health care
6-2 facilities in collaboration with an academic health center and an
6-3 associated teaching hospital or tertiary center or with another
6-4 public not-for-profit health care facility; and]
6-5 [(B) includes consultive services, diagnostic
6-6 services, interactive video consultation, teleradiology,
6-7 telepathology, and distance education for working health care
6-8 professionals].
6-9 SECTION 10. Section 57.045, Utilities Code, is amended by
6-10 adding Subsection (e) to read as follows:
6-11 (e) The board shall establish an assistance program to
6-12 provide education concerning the telecommunications infrastructure
6-13 fund and to facilitate access to funds and programs under this
6-14 subchapter by health care facilities and by physicians licensed to
6-15 practice medicine in this state. The assistance program must
6-16 include a toll-free telephone number and provide access to
6-17 information through the Internet.
6-18 SECTION 11. Subsections (a) and (b), Section 57.047,
6-19 Utilities Code, are amended to read as follows:
6-20 (a) The board may award a grant to a project or proposal
6-21 that:
6-22 (1) provides equipment and infrastructure necessary
6-23 for:
6-24 (A) distance learning;
6-25 (B) an information sharing program of a library;
6-26 [or]
6-27 (C) telemedicine medical services; or
6-28 (D) telehealth services;
6-29 (2) develops and implements the initial or
6-30 prototypical delivery of a course or other distance learning
6-31 material;
6-32 (3) trains teachers, faculty, librarians, or
6-33 technicians in the use of distance learning or information sharing
6-34 materials and equipment;
6-35 (4) develops a curriculum or instructional material
6-36 specially suited for telecommunications delivery;
6-37 (5) provides electronic information; or
6-38 (6) establishes or carries out an information sharing
6-39 program.
6-40 (b) The board may award a loan to a project or proposal to
6-41 acquire equipment needed for distance learning and telemedicine
6-42 medical service projects.
6-43 SECTION 12. Subsection (a), Section 58.253, Utilities Code,
6-44 is amended to read as follows:
6-45 (a) On customer request, an electing company shall provide
6-46 private network services to:
6-47 (1) an educational institution;
6-48 (2) a library;
6-49 (3) a nonprofit telemedicine center;
6-50 (4) a public or not-for-profit hospital;
6-51 (5) a project funded by the telecommunications
6-52 infrastructure fund under Subchapter C, Chapter 57, except to the
6-53 extent the project benefits a health care facility that:
6-54 (A) is not supported by local or regional tax
6-55 revenue;
6-56 (B) is not a certified nonprofit health
6-57 corporation under federal law; or
6-58 (C) is not an ambulatory health care center; or
6-59 (6) a legally constituted consortium or group of
6-60 entities listed in this subsection.
6-61 SECTION 13. Not later than January 1, 2002, the Health and
6-62 Human Services Commission shall adopt rules required by Section
6-63 531.0217, Government Code, as amended by this Act.
6-64 SECTION 14. If before implementing any provision of this Act
6-65 a state agency determines that a waiver or authorization from a
6-66 federal agency is necessary for implementation of that provision,
6-67 the agency affected by the provision shall request the waiver or
6-68 authorization and may delay implementing that provision until the
6-69 waiver or authorization is granted.
7-1 SECTION 15. This Act takes effect immediately if it receives
7-2 a vote of two-thirds of all the members elected to each house, as
7-3 provided by Section 39, Article III, Texas Constitution. If this
7-4 Act does not receive the vote necessary for immediate effect, this
7-5 Act takes effect September 1, 2001.
7-6 * * * * *