BILL ANALYSIS

 

 

 

H.B. 3234

By: Davis, John

Public Health

Committee Report (Unamended)

 

 

 

BACKGROUND AND PURPOSE

 

Home telemonitoring holds great potential for helping chronic disease patients avoid unnecessary hospitalizations.  Such technology can transmit data on a scheduled, real-time basis and prevent hospitalizations by identifying symptoms early and prompting adjustments in care before a crisis occurs.  The types of data captured by home telemonitoring devices include weight, vital signs, pulse oximetry for blood oxygen saturation, and blood sugar, which are then transmitted to a home health agency.  Nurses review the data to determine whether a patient's health data is outside prescribed norms and work in coordination with a physician to determine whether any change is necessary to achieve compliance with a patient's treatment plan.

 

H.B. 3234 provides for telehealth services and home telemonitoring services to be provided for certain Medicaid recipients.

RULEMAKING AUTHORITY

 

It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of HHSC in SECTIONS 3 and 5, and jointly to the executive commissioner of HHSC and the Telecommunications Infrastructure Fund Board in SECTION 4 of this bill.

ANALYSIS

 

Section 531.0055, Government Code, as amended by Chapter 198 (H.B. 2292), Acts of the 78th Legislature, Regular Session, 2003, expressly grants to the executive commissioner of the Health and Human Services Commission all rulemaking authority for the operation of and provision of services by the health and human services agencies. Similarly, Sections 1.16-1.29, Chapter 198 (H.B. 2292), Acts of the 78th Legislature, Regular Session, 2003, provide for the transfer of a power, duty, function, program, or activity from a health and human services agency abolished by that act to the corresponding legacy agency. To the extent practicable, this bill analysis is written to reflect any transfer of rulemaking authority and to update references as necessary to an agency's authority with respect to a particular health and human services program.

 

H.B. 3234 amends the Government Code to add reimbursement of telehealth services providers to the Health and Human Services Commission's (HHSC) rulemaking authority relating to the development and implementation of a system for reimbursing providers of services under the state Medicaid program.  The bill expands the HHSC executive commissioner's rulemaking authority to encompass telehealth services delivery, telehealth services and telemonitoring services, and providers of those services by including those services and service providers in the provisions setting forth the commissioner's duties in the development of the reimbursement system described above.  The bill requires HHSC, within that reimbursement system, to encourage health care providers and health care facilities to participate either as telemedicine medical service providers or telehealth service providers in the health care delivery system; prohibits HHSC from requiring that a service be provided to a patient either through telemedicine medical services or telehealth services when the service can reasonably be provided through a face-to-face consultation with the patient, but permits an authorization for provision of any service to a patient through telemedicine medical services or telehealth services at the patient's request; and requires the inclusion of matters relating to telehealth services and home telemonitoring services in HHSC's biennial report to the speaker of the house and lieutenant governor on the effects of telemedicine medical services, telehealth services, and home telemonitoring services on the Medicaid program in Texas.

 

H.B. 3234 adds telehealth services or home telemonitoring services to the joint rulemaking authority of HHSC and the Telecommunications Infrastructure Fund Board relating to the establishment of minimum standards for an operating system used in the delivery of telemedicine medical services by health care facilities participating in the state Medicaid program. 

 

H.B. 3234 requires the HHSC executive commissioner to by rule establish a statewide program that permits reimbursement under the state Medicaid program for home telemonitoring services.  The bill requires such a program to ensure that clinical information gathered by a home health agency while providing home telemonitoring services is shared with the patient’s physician; ensure that the program does not duplicate Department of State Health Services disease management program services; and provide that home telemonitoring services are available only to persons diagnosed with one or more specified conditions, and who exhibit two or more of the following factors: two or more hospitalizations in the preceding 12-month period, frequent or recurrent emergency room admissions, a documented history of poor adherence to ordered medication regimens, a documented history of falls in the preceding six-month period, limited or absent informal support systems, living alone or being home alone for extended periods of time, and a documented history of care access challenges. 

 

H.B. 3234 adds a focus on enhancing health outcomes in a pilot program's service area through increased access to monitoring of chronic conditions and consideration of condition-specific applications of telemedicine medical services or telehealth services for chronic obstructive pulmonary disease, hypertension, and congestive heart failure to the requirements for HHSC's telemedicine medical services and telehealth services pilot programs.  The bill adds representatives of state agencies concerned with the use of telehealth consultations and home telemonitoring services in the Medicaid and state child health plan program and representatives of providers of telemedicine medical services, telehealth services, and home telemonitoring services to those representatives who must be included on the telemedicine and telehealth advisory committee.  The bill extends a temporary provision previously set to expire September 1, 2009, but now set to expire September 1, 2011, to set a new deadline of September 1, 2010, for HHSC to submit a report to the legislature regarding the results of the pilot program for mental health, telehealth, or telemedicine consultations for certain Medicaid recipients.

 

H.B. 3234 defines "home telemonitoring service" as a health service that requires scheduled remote monitoring of data related to a patient's health and transmission of the data to a licensed home health agency.  The bill defines "telehealth service" as a health service, other than a telemedicine medical service, delivered by a licensed or certified health professional acting within the scope of the health professional’s license or certification who does not perform a telemedicine medical service, that requires the use of advanced telecommunications technology, other than by telephone or facsimile, including compressed digital interactive video, audio, or data transmission; clinical data transmission using computer imaging by way of still-image capture and store and forward; and other technology that facilitates access to health care services or medical specialty expertise.  The bill defines "telemedicine medical service" as a health care service, initiated by a physician or provided by a health professional acting under physician delegation and supervision, for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, treatment, or the transfer of medical data, that requires the use of advanced telecommunications technology as described above. The bill defines "home health agency" as a facility licensed to provide home health services.

 

 

H.B. 3234 requires a state agency that is affected by a provision of the bill to request a federal waiver or authorization if the agency determines that a waiver or authorization is necessary for the implementation of the provision, and it authorizes the agency to delay implementation until the federal waiver or authorization is obtained.

 

H.B. 3234 repeals the following provisions of the Government Code relating to definitions of "telehealth service," and "telemedicine medical service":

 

·         Section 531.0216(g)

·         Section 531.0217(a)(3) and (4)

·         Section 531.02171(a)(3) and (4), as added by Chapter 661 (H.B. 2700), Acts of the 77th Legislature, Regular Session, 2001

·         Section 531.02171(a)(3) and (4), as added by Chapter 959 (S.B. 1536), Acts of the 77th Legislature, Regular Session, 2001

EFFECTIVE DATE

 

September 1, 2009.