82R1436 EES-F
 
  By: Watson 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 as 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 the telemedicine and telehealth 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.
         (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.  The heading to Section 531.02161, Government
  Code, is amended to read as follows:
         Sec. 531.02161.  TELEMEDICINE, TELEHEALTH, AND HOME
  TELEMONITORING TECHNOLOGY STANDARDS.
         SECTION 4.  Section 531.02161(b), Government Code, is
  amended to read as follows:
         (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.
         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 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 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.  The heading to 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:
         Sec. 531.02171.  TELEMEDICINE MEDICAL SERVICES AND
  TELEHEALTH SERVICES PILOT PROGRAMS.
         SECTION 7.  Section 531.02171(c), 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 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;
                     (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 or other health care services within the area served by the
  pilot program.
         SECTION 8.  The heading to Section 531.02172, Government
  Code, is amended to read as follows:
         Sec. 531.02172.  TELEMEDICINE AND TELEHEALTH ADVISORY
  COMMITTEE.
         SECTION 9.  Section 531.02172(b), 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 Texas Department of Rural 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 10.  Section 531.02173(c), 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 11.  The following provisions of the Government Code
  are repealed:
               (1)  Section 531.02161(a);
               (2)  Sections 531.0217(a)(3) and (4);
               (3)  Sections 531.02171(a)(3) and (4), 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 12.  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 13.  This Act takes effect September 1, 2011.