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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision and reimbursement of home telemonitoring |
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services, telemedicine medical services, and telehealth services |
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under the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 531.02164(a) and (c), Government Code, |
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are amended to read as follows: |
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(a) In this section: |
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(1) "Elderly individual" means an individual 60 years |
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of age or older. |
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(2) "Home health agency" means a facility licensed |
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under Chapter 142, Health and Safety Code, to provide home health |
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services as defined by Section 142.001, Health and Safety Code. |
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(3) [(2)] "Hospital" means a hospital licensed under |
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Chapter 241, Health and Safety Code. |
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(4) "Individual with special health care needs" means |
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an individual who has: |
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(A) a chronic physical or developmental |
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condition; or |
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(B) a terminal illness. |
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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 a person [persons] who is: |
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(A) an elderly individual; |
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(B) an individual with special health care needs; |
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or |
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(C) an individual who: |
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(i) is [are] diagnosed with one or more of |
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the following conditions: |
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(a) [(i)] pregnancy; |
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(b) [(ii)] diabetes; |
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(c) [(iii)] heart disease; |
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(d) [(iv)] cancer; |
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(e) [(v)] chronic obstructive |
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pulmonary disease; |
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(f) [(vi)] hypertension; |
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(g) [(vii)] congestive heart failure; |
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(h) [(viii)] mental illness or |
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serious emotional disturbance; |
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(i) [(ix)] asthma; |
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(j) [(x)] myocardial infarction; or |
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(k) [(xi)] stroke; and |
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(ii) exhibits [(B) exhibit] two or more of |
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the following risk factors: |
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(a) [(i)] two or more |
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hospitalizations in the prior 12-month period; |
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(b) [(ii)] frequent or recurrent |
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emergency room admissions; |
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(c) [(iii)] a documented history of |
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poor adherence to ordered medication regimens; |
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(d) [(iv)] a documented history of |
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falls in the prior six-month period; |
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(e) [(v)] limited or absent informal |
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support systems; |
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(f) [(vi)] living alone or being home |
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alone for extended periods of time; and |
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(g) [(vii)] a documented history of |
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care access challenges; |
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(2) ensure that clinical information gathered by a |
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home health agency or hospital while providing home telemonitoring |
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services is 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 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02165 to read as follows: |
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Sec. 531.02165. PROVISION OF TELEMEDICINE MEDICAL SERVICES |
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AND TELEHEALTH SERVICES TO RECIPIENTS AT RESIDENCE. (a) In this |
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section, "residence" means a place where a person resides and |
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includes a home, a nursing home, a convalescent home, or a |
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residential unit. |
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(b) The executive commissioner shall develop and implement |
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a pilot project under the state Medicaid program that provides for |
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the reimbursement of telemedicine medical services and telehealth |
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services provided to a recipient while the recipient is at the |
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recipient's residence. |
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(c) Based on the results of the pilot project established |
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under Subsection (b), if the executive commissioner determines that |
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it would be cost-effective and feasible to develop and implement a |
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statewide program under the state Medicaid program that provides |
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for the reimbursement of telemedicine medical services and |
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telehealth services provided to a recipient while the recipient is |
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at the recipient's residence, the executive commissioner shall |
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establish the statewide program by rule. |
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(d) Not later than December 1, 2016, the executive |
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commissioner shall submit a report to the legislature on the |
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results of the pilot project established under Subsection (b) and, |
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if applicable, the progress on the implementation of the statewide |
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program established under Subsection (c). The report must include: |
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(1) an evaluation of the pilot project's success and, |
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if applicable, the statewide program's success in increasing health |
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care access for Medicaid recipients; |
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(2) an evaluation of the cost savings to the state and |
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Medicaid recipients attributable to the pilot project and, if |
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applicable, the statewide program; and |
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(3) a recommendation regarding the continuation, |
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expansion, or termination of the statewide program, if applicable. |
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(e) Subsection (d) and this subsection expire September 1, |
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2017. |
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SECTION 3. Section 531.0217, Government Code, is amended by |
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adding Subsections (d-1) and (d-2) to read as follows: |
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(d-1) The commission shall require that requests for |
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reimbursement for telemedicine medical services be approved at a |
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similar frequency as requests for reimbursement for comparable |
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in-person medical services. A request for reimbursement for a |
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telemedicine medical service may not be denied if the service is |
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medically necessary. |
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(d-2) Not later than December 1 of each even-numbered year, |
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the commission shall prepare and submit a report on telemedicine |
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medical services billing procedures to the legislative committees |
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having jurisdiction over the Medicaid program. The report required |
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by this subsection may be made in conjunction with any other report |
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the commission is required to submit to the legislature if the |
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commission determines it appropriate. |
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SECTION 4. Section 531.02176, Government Code, is repealed. |
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SECTION 5. Section 531.02164, Government Code, as amended |
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by this Act, applies only to an insurance claim filed, an insurance |
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policy entered into, or a legal cause arising on or after the |
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effective date of this Act. An insurance claim filed, an insurance |
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policy entered into, or a legal cause that arose before the |
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effective date of this Act is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 6. (a) Not later than January 1, 2016, the |
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executive commissioner of the Health and Human Services Commission |
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shall adopt the rules necessary to implement Section 531.02165, |
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Government Code, as added by this Act, and Section 531.0217, |
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Government Code, as amended by this Act. |
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(b) Not later than March 1, 2016, the executive commissioner |
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of the Health and Human Services Commission shall adopt the rules |
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necessary to implement Section 531.02164, Government Code, as |
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amended by this Act. |
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SECTION 7. 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 8. This Act takes effect September 1, 2015. |