1-1 AN ACT
1-2 relating to the application of technology in providing certain
1-3 health services, including certain telemedicine and telehealth
1-4 services.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter B, Chapter 531, Government Code, is
1-7 amended by adding Section 531.055 to read as follows:
1-8 Sec. 531.055. PILOT PROJECTS RELATING TO TECHNOLOGY
1-9 APPLICATIONS. (a) Notwithstanding any other law, the commission
1-10 may establish one or more pilot projects through which
1-11 reimbursement under the medical assistance program under Chapter
1-12 32, Human Resources Code, is made to demonstrate the applications
1-13 of technology in providing services under that program.
1-14 (b) A pilot project established under this section may
1-15 relate to providing rehabilitation services, services for the aging
1-16 or disabled, or long-term care services, including community care
1-17 services and support.
1-18 (c) Notwithstanding an eligibility requirement prescribed by
1-19 any other law or rule, the commission may establish requirements
1-20 for a person to receive services provided through a pilot project
1-21 under this section.
1-22 (d) Receipt of services provided through a pilot project
1-23 under this section does not entitle the recipient to other services
1-24 under a government-funded health program.
1-25 (e) The commission may set a maximum enrollment limit for a
2-1 pilot project established under this section.
2-2 SECTION 2. Subchapter B, Chapter 531, Government Code, is
2-3 amended by adding Section 531.02161 to read as follows:
2-4 Sec. 531.02161. MEDICAID SERVICES PROVIDED THROUGH
2-5 TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES TO CHILDREN
2-6 WITH SPECIAL HEALTH CARE NEEDS. (a) In this section, "child with
2-7 special health care needs" has the meaning assigned by Section
2-8 35.0022, Health and Safety Code.
2-9 (b) The commission by rule shall establish policies that
2-10 permit reimbursement under the state Medicaid and children's health
2-11 insurance program for services provided through telemedicine
2-12 medical services and telehealth services to children with special
2-13 health care needs.
2-14 (c) The policies required under this section must:
2-15 (1) be designed to:
2-16 (A) prevent unnecessary travel and encourage
2-17 efficient use of telemedicine medical services and telehealth
2-18 services for children with special health care needs in all
2-19 suitable circumstances; and
2-20 (B) ensure in a cost-effective manner the
2-21 availability to a child with special health care needs of services
2-22 appropriately performed using telemedicine medical services and
2-23 telehealth services that are comparable to the same types of
2-24 services available to that child without the use of telemedicine
2-25 medical services and telehealth services; and
2-26 (2) provide for reimbursement of multiple providers of
3-1 different services who participate in a single telemedicine medical
3-2 services and telehealth services session for a child with special
3-3 health care needs, if the commission determines that reimbursing
3-4 each provider for the session is cost-effective in comparison to
3-5 the costs that would be involved in obtaining the services from
3-6 providers without the use of telemedicine medical services and
3-7 telehealth services, including the costs of transportation and
3-8 lodging and other direct costs.
3-9 SECTION 3. Subchapter B, Chapter 531, Government Code, is
3-10 amended by adding Sections 531.02171 and 531.02172 to read as
3-11 follows:
3-12 Sec. 531.02171. TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
3-13 SERVICES PILOT PROGRAMS. (a) In this section:
3-14 (1) "Health professional" means:
3-15 (A) a physician;
3-16 (B) an individual who is licensed or certified
3-17 in this state to perform health care services and who is authorized
3-18 to assist a physician in providing telemedicine medical services
3-19 that are delegated and supervised by the physician; or
3-20 (C) a licensed or certified health professional
3-21 acting within the scope of the license or certification who does
3-22 not perform a telemedicine medical service.
3-23 (2) "Physician" means a person licensed to practice
3-24 medicine in this state under Subtitle B, Title 3, Occupations Code.
3-25 (3) "Telehealth service" has the meaning assigned by
3-26 Section 57.042, Utilities Code.
4-1 (4) "Telemedicine medical service" has the meaning
4-2 assigned by Section 57.042, Utilities Code.
4-3 (b) The commission shall establish pilot programs in
4-4 designated areas of this state under which the commission, in
4-5 administering government-funded health programs, may reimburse a
4-6 health professional participating in the pilot program for
4-7 telemedicine medical services or telehealth services authorized
4-8 under the licensing law applicable to the health professional.
4-9 Each pilot program established before January 1, 2003, must provide
4-10 services in areas of this state that are not more than 150 miles
4-11 from the border between this state and the United Mexican States.
4-12 (c) In developing and operating a pilot program under this
4-13 section, the commission shall:
4-14 (1) solicit and obtain support for the program from
4-15 local officials and the medical community;
4-16 (2) focus on enhancing health outcomes in the area
4-17 served by the pilot program through increased access to medical or
4-18 health care services, including:
4-19 (A) health screenings;
4-20 (B) prenatal care;
4-21 (C) medical or surgical follow-up visits;
4-22 (D) periodic consultation with specialists
4-23 regarding chronic disorders;
4-24 (E) triage and pretransfer arrangements; and
4-25 (F) transmission of diagnostic images or data;
4-26 (3) establish quantifiable measures and expected
5-1 health outcomes for each authorized telemedicine medical service or
5-2 telehealth service;
5-3 (4) consider condition-specific applications of
5-4 telemedicine medical services or telehealth services, including
5-5 applications for:
5-6 (A) pregnancy;
5-7 (B) diabetes;
5-8 (C) heart disease; and
5-9 (D) cancer; and
5-10 (5) demonstrate that the provision of services
5-11 authorized as telemedicine medical services or telehealth services
5-12 will not adversely affect the delivery of traditional medical
5-13 services or other health care services within the area served by
5-14 the pilot program.
5-15 Sec. 531.02172. TELEMEDICINE ADVISORY COMMITTEE. (a) The
5-16 commissioner shall establish an advisory committee to assist the
5-17 commission in:
5-18 (1) evaluating policies for telemedical consultations
5-19 under Section 531.0217;
5-20 (2) evaluating policies for telemedicine medical
5-21 service or telehealth service pilot programs established under
5-22 Section 531.02171;
5-23 (3) ensuring the efficient and consistent development
5-24 and use of telecommunication technology for telemedical
5-25 consultations and telemedicine medical services or telehealth
5-26 services reimbursed under government-funded health programs;
6-1 (4) monitoring the types of programs receiving
6-2 reimbursement under Sections 531.0217 and 531.02171; and
6-3 (5) coordinating the activities of state agencies
6-4 concerned with the use of telemedical consultations and
6-5 telemedicine medical services or telehealth services.
6-6 (b) The advisory committee must include:
6-7 (1) representatives of health and human services
6-8 agencies and other state agencies concerned with the use of
6-9 telemedical consultations in the Medicaid program and the state
6-10 child health plan program, including representatives of:
6-11 (A) the commission;
6-12 (B) the Texas Department of Health;
6-13 (C) the Center for Rural Health Initiatives;
6-14 (D) the Telecommunications Infrastructure Fund
6-15 Board;
6-16 (E) the Texas Department of Insurance;
6-17 (F) the Texas State Board of Medical Examiners;
6-18 (G) the Board of Nurse Examiners; and
6-19 (H) the Texas State Board of Pharmacy;
6-20 (2) representatives of health science centers in this
6-21 state;
6-22 (3) experts on telemedicine, telemedical consultation,
6-23 and telemedicine medical services; and
6-24 (4) representatives of consumers of health services
6-25 provided through telemedical consultations and telemedicine medical
6-26 services.
7-1 (c) A member of the advisory committee serves at the will of
7-2 the commissioner.
7-3 SECTION 4. Chapter 35, Health and Safety Code, is amended by
7-4 adding Section 35.0041 to read as follows:
7-5 Sec. 35.0041. PARTICIPATION AND REIMBURSEMENT OF
7-6 TELEMEDICINE MEDICAL SERVICE PROVIDERS. (a) The department by
7-7 rule shall develop and implement policies permitting reimbursement
7-8 of a provider for services under the program performed using
7-9 telemedicine medical services.
7-10 (b) The policies must provide for reimbursement of:
7-11 (1) providers using telemedicine medical services and
7-12 telehealth services in a cost-effective manner that ensures the
7-13 availability to a child with special health care needs of services
7-14 appropriately performed using telemedicine medical services and
7-15 telehealth services that are comparable to the same types of
7-16 services available to that child without use of telemedicine
7-17 medical services and telehealth services;
7-18 (2) a provider for a service performed using
7-19 telemedicine medical services and telehealth services at an amount
7-20 equal to the amount paid to a provider for performing the same
7-21 service without using telemedicine medical services and telehealth
7-22 services;
7-23 (3) multiple providers of different services who
7-24 participate in a single telemedicine medical services or telehealth
7-25 services session for a child with special health care needs, if the
7-26 department determines that reimbursing each provider for the
8-1 session is cost-effective in comparison to the costs that would be
8-2 involved in obtaining the services from providers without the use
8-3 of telemedicine medical services and telehealth services, including
8-4 the costs of transportation and lodging and other direct costs; and
8-5 (4) providers using telemedicine medical services and
8-6 telehealth services included in the school health and related
8-7 services program.
8-8 (c) In developing and implementing the policies required by
8-9 this section, the department shall consult with:
8-10 (1) The University of Texas Medical Branch at
8-11 Galveston;
8-12 (2) Texas Tech University Health Sciences Center;
8-13 (3) the Health and Human Services Commission,
8-14 including the state Medicaid office;
8-15 (4) providers of telemedicine medical services and
8-16 telehealth services hub sites in this state;
8-17 (5) providers of services to children with special
8-18 health care needs; and
8-19 (6) representatives of consumer or disability groups
8-20 affected by changes to services for children with special health
8-21 care needs.
8-22 (d) This section applies to services for which coverage is
8-23 provided under the health benefits plan established under Section
8-24 35.0031.
8-25 SECTION 5. Subchapter D, Chapter 62, Health and Safety Code,
8-26 is amended by adding Section 62.157 to read as follows:
9-1 Sec. 62.157. TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
9-2 SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a) In
9-3 providing covered benefits to a child with special health care
9-4 needs, a health plan provider must permit benefits to be provided
9-5 through telemedicine medical services and telehealth services in
9-6 accordance with policies developed by the commission.
9-7 (b) The policies must provide for:
9-8 (1) the availability of covered benefits appropriately
9-9 provided through telemedicine medical services and telehealth
9-10 services that are comparable to the same types of covered benefits
9-11 provided without the use of telemedicine medical services and
9-12 telehealth services; and
9-13 (2) the availability of covered benefits for different
9-14 services performed by multiple health care providers during a
9-15 single telemedicine medical services and telehealth services
9-16 session, if the commission determines that delivery of the covered
9-17 benefits in that manner is cost-effective in comparison to the
9-18 costs that would be involved in obtaining the services from
9-19 providers without the use of telemedicine medical services and
9-20 telehealth services, including the costs of transportation and
9-21 lodging and other direct costs.
9-22 (c) In developing the policies required by Subsection (a),
9-23 the commission shall consult with:
9-24 (1) The University of Texas Medical Branch at
9-25 Galveston;
9-26 (2) Texas Tech University Health Sciences Center;
10-1 (3) the Texas Department of Health;
10-2 (4) providers of telemedicine hub sites in this state;
10-3 (5) providers of services to children with special
10-4 health care needs; and
10-5 (6) representatives of consumer or disability groups
10-6 affected by changes to services for children with special health
10-7 care needs.
10-8 SECTION 6. Section 57.042, Utilities Code, is amended by
10-9 amending Subdivision (11) and adding Subdivision (12) to read as
10-10 follows:
10-11 (11) "Telehealth service" means a health service,
10-12 other than a telemedicine medical service, delivered by a licensed
10-13 or certified health professional acting within the scope of the
10-14 health professional's license or certification who does not perform
10-15 a telemedicine medical service that requires the use of advanced
10-16 telecommunications technology, other than by telephone or
10-17 facsimile, including:
10-18 (A) compressed digital interactive video, audio,
10-19 or data transmission;
10-20 (B) clinical data transmission using computer
10-21 imaging by way of still-image capture and store and forward; and
10-22 (C) other technology that facilitates access to
10-23 health care services or medical specialty expertise.
10-24 (12) "Telemedicine medical service" means a health
10-25 care service initiated by a physician or provided by a health
10-26 professional acting under physician delegation and supervision, for
11-1 purposes of patient assessment by a health professional, diagnosis
11-2 or consultation by a physician, treatment, or the transfer of
11-3 medical data, that requires the use of advanced telecommunications
11-4 technology, other than by telephone or facsimile, including:
11-5 (A) compressed digital interactive video, audio,
11-6 or data transmission;
11-7 (B) clinical data transmission using computer
11-8 imaging by way of still-image capture and store and forward; and
11-9 (C) other technology that facilitates access to
11-10 health care services or medical specialty expertise[:]
11-11 [(A) means medical services delivered by
11-12 telecommunications technologies to rural or underserved public
11-13 not-for-profit health care facilities or primary health care
11-14 facilities in collaboration with an academic health center and an
11-15 associated teaching hospital or tertiary center or with another
11-16 public not-for-profit health care facility; and]
11-17 [(B) includes consultive services, diagnostic
11-18 services, interactive video consultation, teleradiology,
11-19 telepathology, and distance education for working health care
11-20 professionals].
11-21 SECTION 7. Subsections (a) and (b), Section 57.047,
11-22 Utilities Code, are amended to read as follows:
11-23 (a) The board may award a grant to a project or proposal
11-24 that:
11-25 (1) provides equipment and infrastructure necessary
11-26 for:
12-1 (A) distance learning;
12-2 (B) an information sharing program of a library;
12-3 [or]
12-4 (C) telemedicine medical services; or
12-5 (D) telehealth services;
12-6 (2) develops and implements the initial or
12-7 prototypical delivery of a course or other distance learning
12-8 material;
12-9 (3) trains teachers, faculty, librarians, or
12-10 technicians in the use of distance learning or information sharing
12-11 materials and equipment;
12-12 (4) develops a curriculum or instructional material
12-13 specially suited for telecommunications delivery;
12-14 (5) provides electronic information; or
12-15 (6) establishes or carries out an information sharing
12-16 program.
12-17 (b) The board may award a loan to a project or proposal to
12-18 acquire equipment needed for distance learning and telemedicine
12-19 medical service projects.
12-20 SECTION 8. Subchapter C, Chapter 57, Utilities Code, is
12-21 amended by adding Section 57.0471 to read as follows:
12-22 Sec. 57.0471. GRANTS TO CERTAIN HEALTH CARE FACILITIES.
12-23 (a) A physician, health care professional, or health care facility
12-24 providing telemedicine medical services or telehealth services and
12-25 participating in a pilot program under Section 531.02171,
12-26 Government Code, is eligible to receive a grant under Section
13-1 57.047.
13-2 (b) The physician, health care professional, or health care
13-3 facility providing telemedicine medical services or telehealth
13-4 services and participating in a pilot program under Section
13-5 531.02171, Government Code, is not eligible to receive private
13-6 network services under Section 58.253(a), except with respect to a
13-7 project that would have been eligible to be funded by the
13-8 telecommunications infrastructure fund under this subchapter as it
13-9 existed on January 1, 2000.
13-10 SECTION 9. Subsection (a), Section 58.253, Utilities Code,
13-11 is amended to read as follows:
13-12 (a) On customer request, an electing company shall provide
13-13 private network services to:
13-14 (1) an educational institution;
13-15 (2) a library;
13-16 (3) a nonprofit telemedicine center;
13-17 (4) a public or not-for-profit hospital;
13-18 (5) a project that would have been eligible to be
13-19 funded by the telecommunications infrastructure fund under
13-20 Subchapter C, Chapter 57, as that subchapter existed on January 1,
13-21 2001; or
13-22 (6) a legally constituted consortium or group of
13-23 entities listed in this subsection.
13-24 SECTION 10. Subsection (h), Section 531.0217, Government
13-25 Code, is repealed.
13-26 SECTION 11. (a) Not later than December 31, 2001, the
14-1 commissioner of health and human services shall establish the
14-2 telemedicine advisory committee as required by Section 531.02172,
14-3 Government Code, as added by this Act.
14-4 (b) Not later than September 1, 2003, the telemedicine
14-5 advisory committee established under Section 531.02172, Government
14-6 Code, as added by this Act, shall prepare a report relating to the
14-7 implementation of the pilot programs established under Section
14-8 531.02171, Government Code, as added by this Act, and shall provide
14-9 the report to the governor, lieutenant governor, speaker of the
14-10 house of representatives, and appropriate standing committees of
14-11 the senate and house of representatives.
14-12 SECTION 12. The advisory committee established under
14-13 Subsection (h), Section 531.0217, Government Code, is abolished on
14-14 the effective date of this Act.
14-15 SECTION 13. The Health and Human Services Commission and the
14-16 Texas Department of Health shall develop and implement policies
14-17 required by Sections 35.0041 and 62.157, Health and Safety Code, as
14-18 added by this Act, not later than December 31, 2001.
14-19 SECTION 14. Not later than December 1 of each even-numbered
14-20 year, the Health and Human Services Commission shall report to the
14-21 speaker of the house of representatives, the lieutenant governor,
14-22 and the governor on the effects of telemedicine medical services on
14-23 the Medicaid and children's health insurance programs in the state,
14-24 including the number of physicians and health professionals using
14-25 telemedicine medical services, the geographic and demographic
14-26 dispositions of the physicians and health professionals, the number
15-1 of patients receiving telemedicine medical services, the types of
15-2 services being provided, and the cost of utilization of
15-3 telemedicine medical services to the program.
15-4 SECTION 15. If before implementing any provision of this Act
15-5 a state agency determines that a waiver or authorization from a
15-6 federal agency is necessary for implementation of that provision,
15-7 the agency affected by the provision shall request the waiver or
15-8 authorization and may delay implementing that provision until the
15-9 waiver or authorization is granted.
15-10 SECTION 16. This Act takes effect immediately if it receives
15-11 a vote of two-thirds of all the members elected to each house, as
15-12 provided by Section 39, Article III, Texas Constitution. If this
15-13 Act does not receive the vote necessary for immediate effect, this
15-14 Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1536 passed the Senate on
May 3, 2001, by the following vote: Yeas 30, Nays 0, one present
not voting; and that the Senate concurred in House amendments on
May 24, 2001, by the following vote: Yeas 30, Nays 0, one present
not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1536 passed the House, with
amendments, on May 18, 2001, by the following vote: Yeas 136,
Nays 0, two present not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor