By: Price H.B. No. 4
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to telemedicine, telehealth, and technology-related
  health care services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.0216, Government Code, is amended by
  amending Subsection (i) and adding Subsections (k) and (l) to read
  as follows:
         (i)  The executive commissioner by rule shall ensure that a
  federally qualified health center as defined by 42 U.S.C. Section
  1396d(l)(2)(B) or a rural health clinic as defined by 42 U.S.C.
  Section 1396d(l)(1) may be reimbursed for the originating site
  facility fee or the distant site practitioner fee or both, as
  appropriate, for a covered telemedicine medical service or
  telehealth service delivered by a health care provider to a
  Medicaid recipient. The commission is required to implement this
  subsection only if the legislature appropriates money specifically
  for that purpose. If the legislature does not appropriate money
  specifically for that purpose, the commission may, but is not
  required to, implement this subsection using other money available
  to the commission for that purpose.
         (k)  No later than January 1, 2022, the commission shall
  implement reimbursement for telemedicine medical services and
  telehealth services in the following programs, services and
  benefits:
               (1)  Children with Special Health Care Needs program,
               (2)  Early Childhood Intervention,
               (3)  School and Health Related Services,
               (4)  physical therapy, occupational therapy and speech
  therapy,
               (5)  targeted case management,
               (6)  nutritional counseling services,
               (7)  Texas Health Steps checkups,
               (8)  Medicaid 1915(c)waiver programs, including the
  Community Living and Support Services waiver, and
               (9)  any other program, benefit, or service under the
  commission's jurisdiction that the commissioner determines to be
  cost effective and clinically effective.
         (l)  The commission shall implement audio-only benefits for
  behavioral health services, and may implement audio-only benefits
  in any program under the commission's jurisdiction, in accordance
  with federal and state law and shall consider other factors,
  including whether reimbursement is cost-effective and whether the
  provision of the service is clinically effective, in making the
  determination.
         SECTION 2.  Section 531.02164, Government Code, is amended
  by adding Subsection (f) to read as follows:
         (f)  In complying with state and federal requirements to
  provide access to medically necessary services under the Medicaid
  managed care program, a Medicaid managed care organization may
  reimburse providers for home telemonitoring services not
  specifically defined in this section and shall consider other
  factors, including whether reimbursement is cost-effective and
  whether the provision of the service is clinically effective, in
  making the determination.
         SECTION 3.  Section 533, Government Code, is amended by
  adding Section 533.00252 to read as follows:
         533.00252 DELIVERY OF TELECOMMUNICATION SERVICES. (a)  The
  commission shall implement policies and procedures to improve
  access to care through telemedicine, telehealth, tele-monitoring,
  and other telecommunication or information technology solutions.
         (b)  To the extent authorized by federal law, the commission
  shall establish policies and procedures that allow managed care
  organizations to conduct assessment and service coordination
  activities for members receiving home and community-based services
  through telecommunication or information technology in the
  following circumstances:
               (1)  when the managed care organization determines it
  appropriate;
               (2)  the member requests activities occur through
  telecommunication or information technology;
               (3)  when in-person activities are not feasible due to
  a natural disaster, pandemic, public health emergency; or
               (4)  in other circumstances identified by the
  commission.
         (c)  If assessment or service coordination activities are
  conducted through telecommunication or information technology, the
  managed care organization must:
               (1)  monitor health care services provided to the
  member for fraud, waste, and abuse; and
               (2)  determine the need for additional social services
  and supports.
         (d)  Except as provided by Subsection (b)(3), a managed care
  organization must conduct the following activities for members
  receiving home and community-based services:
               (1)  at least one in-person visit for the population
  that requires face to face visits as determined by HHSC; or
               (2)  additional in-person visits as determined
  necessary by the managed care organization.
         (e)  To the extent authorized by federal law, the commission
  must allow managed care members receiving assessments or service
  coordination through telecommunication or information technology
  to provide verbal authorizations in lieu of written signatures on
  all required forms.
         SECTION 4.  Section 533.0061 (b), Government Code, is
  amended by adding Subsection (b)(3) to read as follows:
         (b)  To the extent it is feasible, the provider access
  standards established under this section must:
               (1)  distinguish between access to providers in urban
  and rural settings; and
               (2)  consider the number and geographic distribution of
  Medicaid-enrolled providers in a particular service delivery area,
  and
               (3)  consider and include the availability of
  telemedicine and telehealth services within the provider network of
  a managed care organization.
         SECTION 5.  Chapter 533, Government Code, is amended by
  adding Subsection 533.088(c)to read as follows:
         Sec. 533.008.  MARKETING GUIDELINES.  (a)  The commission
  shall establish marketing guidelines for managed care
  organizations that contract with the commission to provide health
  care services to recipients, including guidelines that prohibit:
               (1)  door-to-door marketing to recipients by managed
  care organizations or agents of those organizations;
               (2)  the use of marketing materials with inaccurate or
  misleading information;
               (3)  misrepresentations to recipients or providers;
               (4)  offering recipients material or financial
  incentives to choose a managed care plan other than nominal gifts or
  free health screenings approved by the commission that the managed
  care organization offers to all recipients regardless of whether
  the recipients enroll in the managed care plan;
               (5)  the use of marketing agents who are paid solely by
  commission; and
               (6)  face-to-face marketing at public assistance
  offices by managed care organizations or agents of those
  organizations.
         (b)  This section does not prohibit:
               (1)  the distribution of approved marketing materials
  at public assistance offices; or
               (2)  the provision of information directly to
  recipients under marketing guidelines established by the
  commission.
         (c)  The executive commissioner shall adopt and publish
  guidance that allows managed care plans that contract with the
  commission to communicate with their enrolled recipients via text
  message in accordance with this section.  Such guidance shall
  include the development and implementation of standardized consent
  language to be used by managed care plans in obtaining patient
  consent to receive text messages. The guidance must be published no
  later than January 1, 2022.
         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, 2021.