By: Watson, Nelson S.B. No. 293
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to telemedicine medical services, 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 or a hospital, as those terms are defined by
  Section 531.02164(a).
               (7)  "Telehealth service" means a health service, other
  than a telemedicine medical service, that is 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 and that requires the use of
  advanced telecommunications technology, other than telephone or
  facsimile technology, 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 that is initiated by a physician or provided by a health
  professional acting under physician delegation and supervision,
  that is provided for purposes of patient assessment by a health
  professional, diagnosis or consultation by a physician, or
  treatment, or for the transfer of medical data, and that requires
  the use of advanced telecommunications technology, other than
  telephone or facsimile technology, 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.  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.  (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 providers [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
                     (C)  annually review health care services,
  considering new clinical findings, to determine whether
  reimbursement for particular services should be denied or
  authorized;
               (4) [(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;] and
               (5) [(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.
         (d)  Subject to Section 153.004, Occupations Code, the
  commission may adopt rules as necessary to implement this
  section.  In the rules adopted under this section, the commission
  shall:
               (1)  refer to the site where the patient is physically
  located as the patient site; and
               (2)  refer to the site where the physician or health
  professional providing the telemedicine medical service or
  telehealth service is physically located as the distant site.
         (e)  The commission may not reimburse a health care facility
  for telemedicine medical services or telehealth services provided
  to a Medicaid recipient unless the facility complies with the
  minimum standards adopted under Section 531.02161.
         (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
  telemonitoring 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, and 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.
         [(g)  In this section:
               [(1)     "Telehealth service"   has the meaning assigned by
  Section 57.042, Utilities Code.
               [(2)     "Telemedicine medical service"   has the meaning
  assigned by Section 57.042, Utilities Code.]
         SECTION 3.  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:
               (1)  "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.
               (2)  "Hospital" means a hospital licensed under Chapter
  241, Health and Safety Code, that provides 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 who are diagnosed with one or more
  conditions described by Section 531.02171(c)(4) 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 or hospital 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 4.  Subsection (c), Section 531.02171, Government
  Code, as added by Chapter 661 (H.B. 2700), 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
  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;
                     (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 provision of traditional medical
  services within the area served by the pilot program.
         SECTION 5.  The following provisions of the Government Code
  are repealed:
               (1)  Subsection (a), Section 531.02161;
               (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)  Section 531.02171, as added by Chapter 959 (S.B.
  1536), Acts of the 77th Legislature, Regular Session, 2001.
         SECTION 6.  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 7.  This Act takes effect September 1, 2011.