2009S0614-1 03/09/09
 
  By: Davis of Harris H.B. No. 3234
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to telehealth services and home telemonitoring services
  provided to certain Medicaid recipients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.001, Government Code, is amended by
  adding Subdivisions (4-a), (7), and (8) to read as follows:
               (4-a)  "Home telemonitoring service" means 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 as defined by Section 531.02164(a).
               (7)  "Telehealth service" means 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:
                     (A)  compressed digital interactive video, audio,
  or data transmission;
                     (B)  clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     (C)  other technology that facilitates access to
  health care services or medical specialty expertise.
               (8)  "Telemedicine medical service" means 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, other than by telephone or
  facsimile, including:
                     (A)  compressed digital interactive video, audio,
  or data transmission;
                     (B)  clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     (C)  other technology that facilitates access to
  health care services or medical specialty expertise.
         SECTION 2.  The heading to Section 531.0216, Government
  Code, is amended to read as follows:
         Sec. 531.0216.  PARTICIPATION AND REIMBURSEMENT OF
  TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE
  PROVIDERS UNDER MEDICAID.
         SECTION 3.  Subsections (a), (b), (c), and (f), Section
  531.0216, Government Code, are amended to read as follows:
         (a)  The commission by rule shall develop and implement a
  system to reimburse providers of services under the state Medicaid
  program for services performed using telemedicine medical services
  or telehealth services.
         (b)  In developing the system, the executive commissioner 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 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;
                     (B)  establish pilot studies for telemedicine
  medical service delivery and telehealth 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;
               (6)  establish a separate provider identifier for
  telemedicine medical services providers, telehealth services
  providers, and home telemonitoring services providers; and
               (7)  establish a separate modifier for telemedicine
  medical services, telehealth services, and home telemonitoring
  services eligible for reimbursement.
         (c)  The commission shall encourage health care providers
  and health care facilities to participate as telemedicine medical
  service providers or telehealth service providers in the health
  care delivery system. The commission may not require that a service
  be provided to a patient through telemedicine medical services or
  telehealth services when the service can reasonably be provided by
  a physician through a face-to-face consultation with the patient in
  the community in which the patient resides or works. This
  subsection does not prohibit the authorization of the provision of
  any service to a patient through telemedicine medical services or
  telehealth services at the patient's request.
         (f)  Not later than December 1 of each even-numbered year,
  the commission shall report to the speaker of the house of
  representatives and the lieutenant governor on the effects of
  telemedicine medical services, telehealth services, and home
  telemonitorng services on the Medicaid program in the state,
  including the number of physicians, [and] health professionals, and
  licensed health care facilities using telemedicine medical
  services, telehealth services, or home telemonitoring services,
  the geographic and demographic disposition of the physicians and
  health professionals, the number of patients receiving
  telemedicine medical services, telehealth services, or home
  telemonitoring services, the types of services being provided, and
  the cost of utilization of telemedicine medical services,
  telehealth services, and home telemonitoring services to the
  program.
         SECTION 4.  Section 531.02161, Government Code, is amended
  to read as follows:
         Sec. 531.02161.  TELEMEDICINE, TELEHEALTH, AND HOME
  TELEMONITORING TECHNOLOGY STANDARDS. (a)  [In this section,
  "telemedicine medical service" has the meaning assigned by Section
  57.042, Utilities Code.
         [(b)]  The commission and the Telecommunications
  Infrastructure Fund Board by joint rule shall establish and adopt
  minimum standards for an operating system used in the provision of
  telemedicine medical services, telehealth services, or home
  telemonitoring services by a health care facility participating in
  the state Medicaid program, including standards for electronic
  transmission, software, and hardware.
         (b) [(c)]  In developing standards under this section, the
  commission and the Telecommunications Infrastructure Fund Board
  shall address:
               (1)  authentication and authorization of users;
               (2)  authentication of the origin of information;
               (3)  the prevention of unauthorized access to the
  system or information;
               (4)  system security, including the integrity of
  information that is collected, program integrity, and system
  integrity;
               (5)  maintenance of documentation about system and
  information usage;
               (6)  information storage, maintenance, and
  transmission; and
               (7)  synchronization and verification of patient
  profile data.
         SECTION 5.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02164 to read as follows:
         Sec. 531.02164.  MEDICAID SERVICES PROVIDED THROUGH HOME
  TELEMONITORING SERVICES. (a)  In this section, "home health
  agency" means a facility licensed under Chapter 142, Health and
  Safety Code, to provide home health services as defined by Section
  142.001, Health and Safety Code.
         (b)  The executive commissioner by rule shall establish a
  statewide program that permits reimbursement under the state
  Medicaid program for home telemonitoring services as provided under
  this section.
         (c)  The program required under this section must:
               (1)  provide that home telemonitoring services are
  available only to persons diagnosed with one or more conditions
  described by Section 531.02171(c)(4), as added by Chapter 959 (S.B.
  1536), Acts of the 77th Legislature, Regular Session, 2001, and who
  exhibit two or more of the following risk factors:
                     (A)  two or more hospitalizations in the prior 12-
  month period;
                     (B)  frequent or recurrent emergency room
  admissions;
                     (C)  a documented history of poor adherence to
  ordered medication regimens;
                     (D)  a documented history of falls in the prior
  six-month period;
                     (E)  limited or absent informal support systems;
                     (F)  living alone or being home alone for extended
  periods of time; and
                     (G)  a documented history of care access
  challenges;
               (2)  ensure that clinical information gathered by a
  home health agency while providing home telemonitoring services is
  shared with the patient's physician; and
               (3)  ensure that the program does not duplicate disease
  management program services provided under Section 32.057, Human
  Resources Code.
         SECTION 6.  Subsection (c), Section 531.02171, Government
  Code, as added by Chapter 959 (S.B. 1536), Acts of the 77th
  Legislature, Regular Session, 2001, is amended to read as follows:
         (c)  In developing and operating a pilot program under this
  section, the commission shall:
               (1)  solicit and obtain support for the program from
  local officials and the medical community;
               (2)  focus on enhancing health outcomes in the area
  served by the pilot program through increased access to medical or
  health care services, including:
                     (A)  health screenings;
                     (B)  prenatal care;
                     (C)  medical or surgical follow-up visits;
                     (D)  periodic consultation with specialists
  regarding chronic disorders;
                     (E)  triage and pretransfer arrangements; [and]
                     (F)  transmission of diagnostic images or data;
  and
                     (G)  monitoring of chronic conditions;
               (3)  establish quantifiable measures and expected
  health outcomes for each authorized telemedicine medical service or
  telehealth service;
               (4)  consider condition-specific applications of
  telemedicine medical services or telehealth services, including
  applications for:
                     (A)  pregnancy;
                     (B)  diabetes;
                     (C)  heart disease; [and]
                     (D)  cancer; [and]
                     (E)  chronic obstructive pulmonary disease;
                     (F)  hypertension; and
                     (G)  congestive heart failure; and
               (5)  demonstrate that the provision of services
  authorized as telemedicine medical services or telehealth services
  will not adversely affect the delivery of traditional medical
  services or other health care services within the area served by the
  pilot program.
         SECTION 7.  The heading to Section 531.02172, Government
  Code, is amended to read as follows:
         Sec. 531.02172.  TELEMEDICINE AND TELEHEALTH ADVISORY
  COMMITTEE.
         SECTION 8.  Subsection (b), Section 531.02172, Government
  Code, is amended to read as follows:
         (b)  The advisory committee must include:
               (1)  representatives of health and human services
  agencies and other state agencies concerned with the use of
  telemedical and telehealth consultations and home telemonitoring
  services in the Medicaid program and the state child health plan
  program, including representatives of:
                     (A)  the commission;
                     (B)  the Department of State Health Services;
                     (C)  the Office of Rural Community Affairs;
                     (D)  the Texas Department of Insurance;
                     (E)  the Texas Medical Board;
                     (F)  the Texas Board of Nursing; and
                     (G)  the Texas State Board of Pharmacy;
               (2)  representatives of health science centers in this
  state;
               (3)  experts on telemedicine, telemedical
  consultation, and telemedicine medical services or telehealth
  services; [and]
               (4)  representatives of consumers of health services
  provided through telemedical consultations and telemedicine
  medical services or telehealth services; and
               (5)  representatives of providers of telemedicine
  medical services, telehealth services, and home telemonitoring
  services.
         SECTION 9.  Subsection (c), Section 531.02173, Government
  Code, is amended to read as follows:
         (c)  The commission shall perform its duties under this
  section with assistance from the telemedicine and telehealth
  advisory committee established under Section 531.02172.
         SECTION 10.  The heading to Section 531.02175, Government
  Code, as added by Chapter 370 (S.B. 1340), Acts of the 79th
  Legislature, Regular Session, 2005, is amended to read as follows:
         Sec. 531.02175.  PILOT PROGRAM FOR MENTAL HEALTH TELEHEALTH
  OR TELEMEDICINE CONSULTATIONS FOR CERTAIN MEDICAID RECIPIENTS.
         SECTION 11.  Subsections (i) and (j), Section 531.02175,
  Government Code, as added by Chapter 370 (S.B. 1340), Acts of the
  79th Legislature, Regular Session, 2005, are amended to read as
  follows:
         (i)  Not later than September 1, 2010 [2008], the commission
  shall submit a report to the legislature regarding the results of
  the pilot program. The report must include recommendations
  regarding elimination, continuation, or expansion of the pilot
  program.
         (j)  This section expires September 1, 2011 [2009].
         SECTION 12.  The following provisions of the Government Code
  are repealed:
               (1)  Subsection (g), Section 531.0216;
               (2)  Subdivisions (3) and (4), Subsection (a), Section
  531.0217;
               (3)  Subdivisions (3) and (4), Subsection (a), Section
  531.02171, as added by Chapter 661 (H.B. 2700), Acts of the 77th
  Legislature, Regular Session, 2001; and
               (4)  Subdivisions (3) and (4), Subsection (a), Section
  531.02171, as added by Chapter 959 (S.B. 1536), Acts of the 77th
  Legislature, Regular Session, 2001.
         SECTION 13.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  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 14.  This Act takes effect September 1, 2009.