79R9619 CLG-D
By: Madla S.B. No. 1340
A BILL TO BE ENTITLED
AN ACT
relating to the regulation and reimbursement of health care
services provided through telemedicine or telepsychiatry under the
state Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.0216(b), Government Code, is amended
to read as follows:
(b) In developing the system, the executive commissioner
[commission] by rule shall:
(1) review programs and pilot projects in other states
to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for
services;
(3) provide for an approval process before a provider
can receive reimbursement for services;
(4) consult with the [Texas] Department of State
Health Services and the telemedicine advisory committee to
establish procedures to:
(A) identify clinical evidence supporting
delivery of health care services using a telecommunications system
[by January 1, 2001];
(B) establish pilot studies for telemedicine
medical service delivery; and
(C) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
(5) establish pilot programs in designated areas of
this state under which the commission, in administering
government-funded health programs, may reimburse a health
professional participating in the pilot program for telehealth
services authorized under the licensing law applicable to the
health professional; [and]
(6) establish a separate provider identifier for
telemedicine medical services providers; and
(7) establish a separate identifier for telemedicine
medical services eligible for reimbursement.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02163 to read as follows:
Sec. 531.02163. TELEPRESENTERS. (a) In this section,
"health professional" means an individual who is licensed or
certified in this state to perform health care services.
(b) The executive commissioner by rule shall establish and
adopt minimum standards to permit the use of trained health
professionals other than physicians, including professionals who
are not registered nurses, advanced practice nurses, or physician
assistants, in presenting patients who are Medicaid recipients for
telemedicine medical services consultations to be conducted by
physicians at distant sites. The health professionals may initiate
the consultation but must act under physician delegation and
supervision throughout the consultation.
(c) Notwithstanding Section 531.0217, the commission may
provide reimbursement under the state Medicaid program for a
telemedicine medical service initiated by a trained health
professional who complies with the minimum standards adopted under
this section.
SECTION 3. Section 531.0217, Government Code, is amended by
amending Subsection (i) and adding Subsection (i-1) to read as
follows:
(i) The Texas State Board of Medical Examiners, in
consultation with the commission, as appropriate, may adopt rules
as necessary to:
(1) ensure that appropriate care, including quality of
care, is provided to patients who receive telemedicine medical
services;
(2) prevent abuse and fraud through the use of
telemedicine medical services, including rules relating to filing
of claims and records required to be maintained in connection with
telemedicine; and
(3) [establish supervisory requirements for a service
delegated to and performed by an individual who is not a physician;
and
[(4)] define those situations when a face-to-face
consultation with a physician is required after a telemedicine
medical service.
(i-1) The Texas State Board of Medical Examiners, in
consultation with the commission, as appropriate, shall adopt rules
to establish supervisory requirements for a service delegated to
and performed by an individual who is not a physician, including a
health professional who is authorized to be a telepresenter under
Section 531.02163.
SECTION 4. Section 531.02172(a), Government Code, is
amended to read as follows:
(a) The commissioner shall establish an advisory committee
to assist the commission in:
(1) evaluating policies for telemedical consultations
under Sections 531.02163 and [Section] 531.0217;
(2) evaluating policies for telemedicine medical
services or telehealth services pilot programs established under
Section 531.02171;
(3) ensuring the efficient and consistent development
and use of telecommunication technology for telemedical
consultations and telemedicine medical services or telehealth
services reimbursed under government-funded health programs;
(4) monitoring the type of programs receiving
reimbursement under Sections 531.0217 and 531.02171; and
(5) coordinating the activities of state agencies
concerned with the use of telemedical consultations and
telemedicine medical services or telehealth services.
SECTION 5. (a) In this section, "telepsychiatry" means the
use of live interactive two-way audio-video communication in the
field of psychiatry.
(b) The executive commissioner of the Health and Human
Services Commission by rule shall develop and the Department of
State Health Services shall implement a pilot program under which
Medicaid recipients in need of mental health services are provided
those services through telepsychiatry.
(c) The executive commissioner shall design the pilot
program in a manner that:
(1) enhances the delivery of mental health services to
recipients;
(2) ensures adequate supervision of social workers,
psychologists, and other professionals who are not psychiatrists
and who provide telepsychiatry; and
(3) enables the state to determine whether extension
of the use of telepsychiatry would improve the delivery of mental
health services.
(d) The executive commissioner may not require mental
health services to be provided through telepsychiatry under the
pilot program if an in-person consultation with a psychiatrist is
reasonably available where the recipient resides or works.
(e) The commission may reimburse a provider participating
in the pilot program for services provided through telepsychiatry.
(f) The commission may apply for and receive a grant to fund
the pilot program under the federal New Freedom Initiative on
Mental Health plan or from the Office of the National Coordinator
for Health Information Technology. The commission shall seek the
assistance of the Office of State-Federal Relations in identifying
and applying for federal grants for the pilot program.
(g) Not later than December 1, 2006, the commission shall
submit a report to the legislature regarding the results of the
pilot program. The report must include:
(1) the number of Medicaid recipients receiving
services through telepsychiatry;
(2) an analysis of:
(A) the pilot program's cost-effectiveness;
(B) the pilot program's effect on the quality of
care received by program participants; and
(C) the satisfaction of pilot program
participants with mental health services provided through
telepsychiatry; and
(3) recommendations regarding elimination,
continuation, or expansion of the pilot program.
(h) This section expires September 1, 2007.
SECTION 6. (a) The Health and Human Services Commission
shall conduct a study to:
(1) identify any program or policy changes necessary
to facilitate the development of a network of providers of
telemedicine medical services under the state Medicaid program,
including:
(A) the establishment of new billing codes;
(B) the establishment of new provider
identifiers; and
(C) a description of telemedicine medical
services eligible for reimbursement;
(2) investigate the current use of digital medical
imaging in the provision of telemedicine medical services to
Medicaid recipients;
(3) investigate the feasibility, including the fiscal
impact, of expanding the use of digital medical imaging in the
provision of telemedicine medical services to Medicaid recipients;
(4) investigate the feasibility of reimbursing health
care providers under the state Medicaid program for telemedicine
medical services appropriately performed using digital medical
imaging; and
(5) investigate the feasibility of developing a system
to reimburse physicians for services performed through
telemedicine by health care providers acting under physician
delegation and supervision, regardless of whether the health care
service was initiated by the physician.
(b) Not later than January 1, 2006, the commission shall
submit a report regarding the results of the study to the presiding
officers of each house and senate standing committee having
jurisdiction over the state Medicaid program. The report must:
(1) identify any significant barriers, in addition to
cost, to expanding the use of digital medical imaging in the
provision of telemedicine medical services to Medicaid recipients;
and
(2) include the fiscal impact to this state of each of
the proposed initiatives.
(c) This section expires September 1, 2007.
SECTION 7. As soon as practicable after the effective date
of this Act:
(1) the Texas State Board of Medical Examiners shall
adopt rules as required by Section 531.0217(i-1), Government Code,
as added by this Act; and
(2) the executive commissioner of the Health and Human
Services Commission shall adopt rules as required by Section
531.02163, Government Code, as added by this Act.
SECTION 8. If before implementing any provision of this Act
a state agency determines that a waiver or other authorization from
a federal agency is necessary for implementation, the agency
affected by the provision shall request the waiver or authorization
and may delay implementing that provision until the waiver or
authorization is granted.
SECTION 9. This Act takes effect September 1, 2005.