1-1 By: Ellis S.B. No. 1041 1-2 (In the Senate - Filed March 1, 2001; March 5, 2001, read 1-3 first time and referred to Committee on Health and Human Services; 1-4 April 11, 2001, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 6, Nays 0; April 11, 2001, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1041 By: Moncrief 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to services provided through telemedicine for children 1-11 with special health care needs. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Chapter 35, Health and Safety Code, is amended by 1-14 adding Section 35.0041 to read as follows: 1-15 Sec. 35.0041. PARTICIPATION AND REIMBURSEMENT OF 1-16 TELEMEDICINE SERVICE PROVIDERS. (a) In this section, 1-17 "telemedicine" means the use of interactive audio, video, or other 1-18 electronic media to deliver health care services. The term 1-19 includes the use of electronic media for diagnosis, consultation, 1-20 treatment, and transfer of medical data. The term does not include 1-21 services performed by using a telephone or facsimile machine. 1-22 (b) The department by rule shall develop and implement 1-23 policies permitting reimbursement of a provider for services under 1-24 the program performed using telemedicine. 1-25 (c) The policies must provide for reimbursement of: 1-26 (1) providers using telemedicine in a cost-effective 1-27 manner that ensures the availability to a child with special health 1-28 care needs of services appropriately performed using telemedicine 1-29 that are comparable to the same types of services available to that 1-30 child without use of telemedicine; 1-31 (2) a provider for a service performed using 1-32 telemedicine at an amount equal to the amount paid to a provider 1-33 for performing the same service without using telemedicine; and 1-34 (3) multiple providers of different services who 1-35 participate in a single telemedicine session for a child with 1-36 special health care needs, if the department determines that 1-37 reimbursing each provider for the session is cost-effective in 1-38 comparison to the costs that would be involved in obtaining the 1-39 services from providers without the use of telemedicine, including 1-40 the costs of transportation and lodging and other direct costs. 1-41 (d) In developing and implementing the policies required by 1-42 this section, the department shall consult with: 1-43 (1) The University of Texas Medical Branch at 1-44 Galveston; 1-45 (2) Texas Tech University Health Sciences Center; 1-46 (3) the Health and Human Services Commission, 1-47 including the state Medicaid office; 1-48 (4) providers of telemedicine hub sites in this state; 1-49 (5) providers of services to children with special 1-50 health care needs; and 1-51 (6) representatives of consumer or disability groups 1-52 affected by changes to services for children with special health 1-53 care needs. 1-54 (e) This section applies to services for which coverage is 1-55 provided under the health benefits plan established under Section 1-56 35.0031. 1-57 SECTION 2. Subchapter D, Chapter 62, Health and Safety Code, 1-58 is amended by adding Section 62.157 to read as follows: 1-59 Sec. 62.157. TELEMEDICINE FOR CHILDREN WITH SPECIAL HEALTH 1-60 CARE NEEDS. (a) In providing covered benefits to a child with 1-61 special health care needs, a health plan provider must permit 1-62 benefits to be provided through telemedicine in accordance with 1-63 policies developed by the commission. 1-64 (b) The policies must provide for: 2-1 (1) the availability of covered benefits appropriately 2-2 provided through telemedicine that are comparable to the same types 2-3 of covered benefits provided without the use of telemedicine; and 2-4 (2) the availability of covered benefits for different 2-5 services performed by multiple health care providers during a 2-6 single telemedicine session, if the commission determines that 2-7 delivery of the covered benefits in that manner is cost-effective 2-8 in comparison to the costs that would be involved in obtaining the 2-9 services from providers without the use of telemedicine, including 2-10 the costs of transportation and lodging and other direct costs. 2-11 (c) In developing the policies required by Subsection (a), 2-12 the commission shall consult with: 2-13 (1) The University of Texas Medical Branch at 2-14 Galveston; 2-15 (2) Texas Tech University Health Sciences Center; 2-16 (3) the Texas Department of Health; 2-17 (4) providers of telemedicine hub sites in this state; 2-18 (5) providers of services to children with special 2-19 health care needs; and 2-20 (6) representatives of consumer or disability groups 2-21 affected by changes to services for children with special health 2-22 care needs. 2-23 (d) In this section, "telemedicine" has the meaning assigned 2-24 by Section 35.0041. 2-25 SECTION 3. Subchapter B, Chapter 531, Government Code, is 2-26 amended by adding Section 531.02161 to read as follows: 2-27 Sec. 531.02161. MEDICAID SERVICES PROVIDED THROUGH 2-28 TELEMEDICINE TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a) In 2-29 this section: 2-30 (1) "Child with special health care needs" has the 2-31 meaning assigned by Section 35.0022, Health and Safety Code. 2-32 (2) "Telemedicine" has the meaning assigned by Section 2-33 35.0041, Health and Safety Code. 2-34 (b) The commission by rule shall establish policies that 2-35 permit reimbursement under the state Medicaid program for services 2-36 provided through telemedicine to children with special health care 2-37 needs. 2-38 (c) The policies required under this section must: 2-39 (1) be designed to: 2-40 (A) prevent unnecessary travel and encourage 2-41 efficient use of telemedicine for children with special health care 2-42 needs in all suitable circumstances; and 2-43 (B) ensure in a cost-effective manner the 2-44 availability to a child with special health care needs of services 2-45 appropriately performed using telemedicine that are comparable to 2-46 the same types of services available to that child without the use 2-47 of telemedicine; and 2-48 (2) provide for reimbursement of multiple providers of 2-49 different services who participate in a single telemedicine session 2-50 for a child with special health care needs, if the commission 2-51 determines that reimbursing each provider for the session is 2-52 cost-effective in comparison to the costs that would be involved in 2-53 obtaining the services from providers without the use of 2-54 telemedicine, including the costs of transportation and lodging and 2-55 other direct costs. 2-56 SECTION 4. The Health and Human Services Commission and the 2-57 Texas Department of Health shall develop and implement policies 2-58 required by this Act not later than December 31, 2001. 2-59 SECTION 5. If before implementing any provision of this Act 2-60 a state agency determines that a waiver or authorization from a 2-61 federal agency is necessary for implementation of that provision, 2-62 the agency affected by the provision shall request the waiver or 2-63 authorization and may delay implementing that provision until the 2-64 waiver or authorization is granted. 2-65 SECTION 6. This Act takes effect September 1, 2001. 2-66 * * * * *