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A BILL TO BE ENTITLED
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AN ACT
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relating to telemedicine medical services, telehealth services, |
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and home telemonitoring services provided to certain Medicaid |
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recipients. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.001, Government Code, is amended by |
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adding Subdivisions (4-a), (7), and (8) to read as follows: |
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(4-a) "Home telemonitoring service" means a health |
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service that requires scheduled remote monitoring of data related |
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to a patient's health and transmission of the data to a licensed |
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home health agency as defined by Section 531.02164(a). |
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(7) "Telehealth service" means a health service, other |
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than a telemedicine medical service, that is delivered by a |
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licensed or certified health professional acting within the scope |
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of the health professional's license or certification who does not |
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perform a telemedicine medical service and that requires the use of |
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advanced telecommunications technology, other than telephone or |
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facsimile technology, including: |
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(A) compressed digital interactive video, audio, |
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or data transmission; |
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(B) clinical data transmission using computer |
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imaging by way of still-image capture and store and forward; and |
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(C) other technology that facilitates access to |
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health care services or medical specialty expertise. |
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(8) "Telemedicine medical service" means a health care |
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service that is initiated by a physician or provided by a health |
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professional acting under physician delegation and supervision, |
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that is provided for purposes of patient assessment by a health |
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professional, diagnosis or consultation by a physician, or |
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treatment, or for the transfer of medical data, and that requires |
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the use of advanced telecommunications technology, other than |
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telephone or facsimile technology, including: |
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(A) compressed digital interactive video, audio, |
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or data transmission; |
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(B) clinical data transmission using computer |
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imaging by way of still-image capture and store and forward; and |
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(C) other technology that facilitates access to |
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health care services or medical specialty expertise. |
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SECTION 2. Section 531.0216, Government Code, is amended to |
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read as follows: |
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Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF |
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TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE |
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PROVIDERS UNDER MEDICAID. (a) The commission by rule shall |
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develop and implement a system to reimburse providers of services |
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under the state Medicaid program for services performed using |
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telemedicine medical services or telehealth services. |
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(b) In developing the system, the executive commissioner by |
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rule shall: |
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(1) review programs and pilot projects in other states |
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to determine the most effective method for reimbursement; |
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(2) establish billing codes and a fee schedule for |
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services; |
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(3) [provide for an approval process before a provider
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can receive reimbursement for services;
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[(4)] consult with the Department of State Health |
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Services and providers [the telemedicine advisory committee] to |
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establish procedures to: |
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(A) identify clinical evidence supporting |
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delivery of health care services using a telecommunications system; |
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(B) establish pilot studies for telemedicine |
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medical service delivery; and |
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(C) annually review health care services, |
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considering new clinical findings, to determine whether |
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reimbursement for particular services should be denied or |
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authorized; |
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(4) [(5)] establish pilot programs in designated |
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areas of this state under which the commission, in administering |
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government-funded health programs, may reimburse a health |
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professional participating in the pilot program for telehealth |
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services authorized under the licensing law applicable to the |
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health professional; |
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[(6)
establish a separate provider identifier for
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telemedicine medical services providers;] and |
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(5) [(7)] establish a separate modifier for |
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telemedicine medical services, telehealth services, and home |
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telemonitoring services eligible for reimbursement. |
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(c) The commission shall encourage health care providers |
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and health care facilities to participate as telemedicine medical |
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service providers or telehealth service providers in the health |
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care delivery system. The commission may not require that a |
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service be provided to a patient through telemedicine medical |
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services or telehealth services when the service can reasonably be |
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provided by a physician through a face-to-face consultation with |
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the patient in the community in which the patient resides or |
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works. This subsection does not prohibit the authorization of the |
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provision of any service to a patient through telemedicine medical |
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services or telehealth services at the patient's request. |
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(d) Subject to Section 153.004, Occupations Code, the |
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commission may adopt rules as necessary to implement this |
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section. In the rules adopted under this section, the commission |
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shall: |
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(1) refer to the site where the patient is physically |
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located as the patient site; and |
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(2) refer to the site where the physician or health |
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professional providing the telemedicine medical service or |
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telehealth service is physically located as the distant site. |
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(e) The commission may not reimburse a health care facility |
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for telemedicine medical services or telehealth services provided |
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to a Medicaid recipient unless the facility complies with the |
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minimum standards adopted under Section 531.02161. |
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(f) Not later than December 1 of each even-numbered year, |
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the commission shall report to the speaker of the house of |
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representatives and the lieutenant governor on the effects of |
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telemedicine medical services, telehealth services, and home |
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telemonitoring services on the Medicaid program in the state, |
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including the number of physicians, [and] health professionals, and |
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licensed health care facilities using telemedicine medical |
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services, telehealth services, or home telemonitoring services, |
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the geographic and demographic disposition of the physicians and |
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health professionals, the number of patients receiving |
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telemedicine medical services, telehealth services, and home |
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telemonitoring services, the types of services being provided, and |
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the cost of utilization of telemedicine medical services, |
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telehealth services, and home telemonitoring services to the |
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program. |
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[(g) In this section:
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[(1)
"Telehealth service"
has the meaning assigned by
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Section 57.042, Utilities Code.
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[(2)
"Telemedicine medical service"
has the meaning
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assigned by Section 57.042, Utilities Code.] |
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SECTION 3. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02164 to read as follows: |
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Sec. 531.02164. MEDICAID SERVICES PROVIDED THROUGH HOME |
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TELEMONITORING SERVICES. (a) In this section, "home health |
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agency" means a facility licensed under Chapter 142, Health and |
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Safety Code, to provide home health services as defined by Section |
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142.001, Health and Safety Code. |
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(b) The executive commissioner by rule shall establish a |
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statewide program that permits reimbursement under the state |
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Medicaid program for home telemonitoring services as provided under |
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this section. |
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(c) The program required under this section must: |
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(1) provide that home telemonitoring services are |
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available only to persons who are diagnosed with one or more |
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conditions described by Section 531.02171(c)(4) and who exhibit two |
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or more of the following risk factors: |
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(A) two or more hospitalizations in the prior |
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12-month period; |
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(B) frequent or recurrent emergency room |
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admissions; |
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(C) a documented history of poor adherence to |
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ordered medication regimens; |
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(D) a documented history of falls in the prior |
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six-month period; |
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(E) limited or absent informal support systems; |
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(F) living alone or being home alone for extended |
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periods of time; and |
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(G) a documented history of care access |
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challenges; |
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(2) ensure that clinical information gathered by a |
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home health agency while providing home telemonitoring services is |
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shared with the patient's physician; and |
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(3) ensure that the program does not duplicate disease |
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management program services provided under Section 32.057, Human |
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Resources Code. |
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SECTION 4. Subsection (c), Section 531.02171, Government |
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Code, as added by Chapter 661 (H.B. 2700), Acts of the 77th |
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Legislature, Regular Session, 2001, is amended to read as follows: |
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(c) In developing and operating a pilot program under this |
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section, the commission shall: |
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(1) solicit and obtain support for the program from |
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local officials and the medical community; |
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(2) focus on enhancing health outcomes in the area |
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served by the pilot program through increased access to medical |
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services, including: |
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(A) health screenings; |
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(B) prenatal care; |
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(C) medical or surgical follow-up visits; |
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(D) periodic consultation with specialists |
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regarding chronic disorders; |
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(E) triage and pretransfer arrangements; [and] |
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(F) transmission of diagnostic images or data; |
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and |
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(G) monitoring of chronic conditions; |
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(3) establish quantifiable measures and expected |
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health outcomes for each authorized telemedicine medical service or |
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telehealth service; |
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(4) consider condition-specific applications of |
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telemedicine medical services or telehealth services, including |
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applications for: |
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(A) pregnancy; |
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(B) diabetes; |
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(C) heart disease; [and] |
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(D) cancer; |
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(E) chronic obstructive pulmonary disease; |
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(F) hypertension; and |
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(G) congestive heart failure; and |
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(5) demonstrate that the provision of services |
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authorized as telemedicine medical services or telehealth services |
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will not adversely affect the provision of traditional medical |
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services within the area served by the pilot program. |
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SECTION 5. The following provisions of the Government Code |
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are repealed: |
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(1) Subsection (a), Section 531.02161; |
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(2) Subdivisions (3) and (4), Subsection (a), Section |
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531.0217; |
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(3) Subdivisions (3) and (4), Subsection (a), Section |
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531.02171, as added by Chapter 661 (H.B. 2700), Acts of the 77th |
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Legislature, Regular Session, 2001; and |
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(4) Section 531.02171, as added by Chapter 959 (S.B. |
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1536), Acts of the 77th Legislature, Regular Session, 2001. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect September 1, 2011. |
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* * * * * |