By: Ellis S.B. No. 1041 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to services provided through telemedicine for children 1-3 with special health care needs. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Chapter 35, Health and Safety Code, is amended by 1-6 adding Section 35.0041 to read as follows: 1-7 Sec. 35.0041. PARTICIPATION AND REIMBURSEMENT OF 1-8 TELEMEDICINE SERVICE PROVIDERS. (a) In this section, 1-9 "telemedicine" means the use of interactive audio, video, or other 1-10 electronic media to deliver health care services. The term 1-11 includes the use of electronic media for diagnosis, consultation, 1-12 treatment, and transfer of medical data. The term does not include 1-13 services performed by using a telephone or facsimile machine. 1-14 (b) The department by rule shall develop and implement 1-15 policies permitting reimbursement of a provider for services under 1-16 the program performed using telemedicine. 1-17 (c) The policies must provide for reimbursement of: 1-18 (1) providers using telemedicine in a cost-effective 1-19 manner that ensures the availability to a child with special health 1-20 care needs of services appropriately performed using telemedicine 1-21 that are comparable to the same types of services available to that 1-22 child without use of telemedicine; 1-23 (2) a provider for a service performed using 1-24 telemedicine at an amount equal to the amount paid to a provider 1-25 for performing the same service without using telemedicine; and 2-1 (3) multiple providers of different services who 2-2 participate in a single telemedicine session for a child with 2-3 special health care needs, if the department determines that 2-4 reimbursing each provider for the session is cost-effective in 2-5 comparison to the costs that would be involved in obtaining the 2-6 services from providers without the use of telemedicine, including 2-7 the costs of transportation and lodging and other direct costs. 2-8 (d) In developing and implementing the policies required by 2-9 this section, the department shall consult with: 2-10 (1) The University of Texas Medical Branch at 2-11 Galveston; 2-12 (2) Texas Tech University Health Sciences Center; 2-13 (3) the Health and Human Services Commission, 2-14 including the state Medicaid office; 2-15 (4) providers of telemedicine hub sites in this state; 2-16 (5) providers of services to children with special 2-17 health care needs; and 2-18 (6) representatives of consumer or disability groups 2-19 affected by changes to services for children with special health 2-20 care needs. 2-21 (e) This section applies to services for which coverage is 2-22 provided under the health benefits plan established under Section 2-23 35.0031. 2-24 SECTION 2. Subchapter D, Chapter 62, Health and Safety Code, 2-25 is amended by adding Section 62.157 to read as follows: 2-26 Sec. 62.157. TELEMEDICINE FOR CHILDREN WITH SPECIAL HEALTH 3-1 CARE NEEDS. (a) In providing covered benefits to a child with 3-2 special health care needs, a health plan provider must permit 3-3 benefits to be provided through telemedicine in accordance with 3-4 policies developed by the commission. 3-5 (b) The policies must provide for: 3-6 (1) the availability of covered benefits appropriately 3-7 provided through telemedicine that are comparable to the same types 3-8 of covered benefits provided without the use of telemedicine; and 3-9 (2) the availability of covered benefits for different 3-10 services performed by multiple health care providers during a 3-11 single telemedicine session, if the commission determines that 3-12 delivery of the covered benefits in that manner is cost-effective 3-13 in comparison to the costs that would be involved in obtaining the 3-14 services from providers without the use of telemedicine, including 3-15 the costs of transportation and lodging and other direct costs. 3-16 (c) In developing the policies required by Subsection (a), 3-17 the commission shall consult with: 3-18 (1) The University of Texas Medical Branch at 3-19 Galveston; 3-20 (2) Texas Tech University Health Sciences Center; 3-21 (3) the Texas Department of Health; 3-22 (4) providers of telemedicine hub sites in this state; 3-23 (5) providers of services to children with special 3-24 health care needs; and 3-25 (6) representatives of consumer or disability groups 3-26 affected by changes to services for children with special health 4-1 care needs. 4-2 (d) In this section, "telemedicine" has the meaning assigned 4-3 by Section 35.0041. 4-4 SECTION 3. Subchapter B, Chapter 531, Government Code, is 4-5 amended by adding Section 531.02161 to read as follows: 4-6 Sec. 531.02161. MEDICAID SERVICES PROVIDED THROUGH 4-7 TELEMEDICINE TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a) In 4-8 this section: 4-9 (1) "Child with special health care needs" has the 4-10 meaning assigned by Section 35.0022, Health and Safety Code. 4-11 (2) "Telemedicine" has the meaning assigned by Section 4-12 35.0041, Health and Safety Code. 4-13 (b) The commission by rule shall establish policies that 4-14 permit reimbursement under the state Medicaid program for services 4-15 provided through telemedicine to children with special health care 4-16 needs. 4-17 (c) The policies required under this section must: 4-18 (1) be designed to: 4-19 (A) prevent unnecessary travel and encourage 4-20 efficient use of telemedicine for children with special health care 4-21 needs in all suitable circumstances; and 4-22 (B) ensure in a cost-effective manner the 4-23 availability to a child with special health care needs of services 4-24 appropriately performed using telemedicine that are comparable to 4-25 the same types of services available to that child without the use 4-26 of telemedicine; and 5-1 (2) provide for reimbursement of multiple providers of 5-2 different services who participate in a single telemedicine session 5-3 for a child with special health care needs, if the commission 5-4 determines that reimbursing each provider for the session is 5-5 cost-effective in comparison to the costs that would be involved in 5-6 obtaining the services from providers without the use of 5-7 telemedicine, including the costs of transportation and lodging and 5-8 other direct costs. 5-9 SECTION 4. The Health and Human Services Commission and the 5-10 Texas Department of Health shall develop and implement policies 5-11 required by this Act not later than December 31, 2001. 5-12 SECTION 5. If before implementing any provision of this Act 5-13 a state agency determines that a waiver or authorization from a 5-14 federal agency is necessary for implementation of that provision, 5-15 the agency affected by the provision shall request the waiver or 5-16 authorization and may delay implementing that provision until the 5-17 waiver or authorization is granted. 5-18 SECTION 6. This Act takes effect September 1, 2001.