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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision and delivery of certain health care |
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services in this state, including services under Medicaid and other |
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public benefits programs, using telecommunications or information |
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technology and to reimbursement for some of those services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.0216(i), Government Code, is amended |
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to read as follows: |
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(i) The executive commissioner by rule shall ensure that a |
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rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and |
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a federally qualified health center as defined by 42 U.S.C. Section |
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1396d(l)(2)(B) may be reimbursed for the originating site facility |
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fee or the distant site practitioner fee or both, as appropriate, |
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for a covered telemedicine medical service or telehealth service |
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delivered by a health care provider to a Medicaid recipient. The |
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commission is required to implement this subsection only if the |
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legislature appropriates money specifically for that purpose. If |
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the legislature does not appropriate money specifically for that |
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purpose, the commission may, but is not required to, implement this |
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subsection using other money available to the commission for that |
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purpose. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02161 to read as follows: |
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Sec. 531.02161. PROVISION OF SERVICES THROUGH |
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TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND |
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OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section: |
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(1) "Behavioral health services" has the meaning |
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assigned by Section 533.00255. |
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(2) "Case management services" includes service |
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coordination, service management, and care coordination. |
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(b) To the extent permitted by federal law and to the extent |
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it is cost-effective and clinically effective, as determined by the |
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commission, the commission shall ensure that Medicaid recipients, |
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child health plan program enrollees, and other individuals |
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receiving benefits under a public benefits program administered by |
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the commission or a health and human services agency, regardless of |
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whether receiving benefits through a managed care delivery model or |
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another delivery model, have the option to receive services as |
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telemedicine medical services, telehealth services, or otherwise |
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using telecommunications or information technology, including the |
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following services: |
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(1) preventive health and wellness services; |
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(2) case management services, including targeted case |
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management services; |
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(3) subject to Subsection (c), behavioral health |
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services; |
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(4) occupational, physical, and speech therapy |
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services; |
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(5) nutritional counseling services; and |
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(6) assessment services, including nursing |
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assessments under the following Section 1915(c) waiver programs: |
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(A) the community living assistance and support |
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services (CLASS) waiver program; |
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(B) the deaf-blind with multiple disabilities |
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(DBMD) waiver program; |
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(C) the home and community-based services (HCS) |
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waiver program; and |
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(D) the Texas home living (TxHmL) waiver program. |
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(c) To the extent permitted by state and federal law and to |
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the extent it is cost-effective and clinically effective, as |
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determined by the commission, the executive commissioner by rule |
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shall develop and implement a system that ensures behavioral health |
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services may be provided using an audio-only platform consistent |
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with Section 111.008, Occupations Code, to a Medicaid recipient, a |
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child health plan program enrollee, or another individual receiving |
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those services under another public benefits program administered |
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by the commission or a health and human services agency. |
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(d) If the executive commissioner determines that providing |
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services other than behavioral health services is appropriate using |
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an audio-only platform under a public benefits program administered |
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by the commission or a health and human services agency, in |
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accordance with applicable federal and state law, the executive |
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commissioner may by rule authorize the provision of those services |
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under the applicable program using the audio-only platform. In |
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determining whether the use of an audio-only platform in a program |
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is appropriate under this subsection, the executive commissioner |
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shall consider whether using the platform would be cost-effective |
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and clinically effective. |
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SECTION 3. Section 531.02164, Government Code, is amended |
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by adding Subsection (f) to read as follows: |
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(f) To comply with state and federal requirements to provide |
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access to medically necessary services under the Medicaid managed |
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care program, a Medicaid managed care organization may reimburse |
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providers for home telemonitoring services provided to persons who |
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have conditions and exhibit risk factors other than those expressly |
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authorized by this section. In determining whether the managed |
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care organization should provide reimbursement for services under |
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this subsection, the organization shall consider whether |
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reimbursement for the service is cost-effective and providing the |
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service is clinically effective. |
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SECTION 4. Section 533.0061(b), Government Code, is amended |
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to read as follows: |
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(b) To the extent it is feasible, the provider access |
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standards established under this section must: |
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(1) distinguish between access to providers in urban |
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and rural settings; [and] |
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(2) consider the number and geographic distribution of |
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Medicaid-enrolled providers in a particular service delivery area; |
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and |
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(3) subject to Section 531.0216(c) and consistent with |
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Section 111.007, Occupations Code, consider and include the |
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availability of telehealth services and telemedicine medical |
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services within the provider network of a Medicaid managed care |
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organization. |
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SECTION 5. Section 533.008, Government Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) The executive commissioner shall adopt and publish |
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guidelines for Medicaid managed care organizations regarding how |
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organizations may communicate by text message or e-mail with |
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recipients enrolled in the organization's managed care plan using |
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the contact information provided in a recipient's application for |
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Medicaid benefits under Section 32.025(g)(2), Human Resources |
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Code. |
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SECTION 6. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.039 to read as follows: |
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Sec. 533.039. DELIVERY OF BENEFITS USING |
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TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY. (a) The commission |
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shall establish policies and procedures to improve access to care |
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under the Medicaid managed care program by encouraging the use of |
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telehealth services, telemedicine medical services, home |
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telemonitoring services, and other telecommunications or |
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information technology under the program. |
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(b) To the extent permitted by federal law, the executive |
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commissioner by rule shall establish policies and procedures that |
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allow a Medicaid managed care organization to conduct assessments |
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and provide care coordination services using telecommunications or |
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information technology. In establishing the policies and |
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procedures, the executive commissioner shall consider: |
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(1) the extent to which a managed care organization |
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determines using the telecommunications or information technology |
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is appropriate; |
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(2) whether the recipient requests that the assessment |
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or service be provided using telecommunications or information |
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technology; |
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(3) whether the recipient consents to receiving the |
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assessment or service using telecommunications or information |
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technology; |
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(4) whether conducting the assessment, including an |
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assessment for an initial waiver eligibility determination, or |
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providing the service in person is not feasible because of the |
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existence of an emergency or state of disaster, including a public |
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health emergency or natural disaster; and |
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(5) whether the commission determines using the |
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telecommunications or information technology is appropriate under |
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the circumstances. |
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(c) If a Medicaid managed care organization conducts an |
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assessment of or provides care coordination services to a recipient |
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using telecommunications or information technology, the managed |
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care organization shall: |
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(1) monitor the health care services provided to the |
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recipient for evidence of fraud, waste, and abuse; and |
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(2) determine whether additional social services or |
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supports are needed. |
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(d) To the extent permitted by federal law, the commission |
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shall allow a recipient who is assessed or provided with care |
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coordination services by a Medicaid managed care organization using |
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telecommunications or information technology to provide consent or |
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other authorizations to receive services verbally instead of in |
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writing. |
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(e) The commission shall determine categories of recipients |
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of home and community-based services who must receive in-person |
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visits. Except during circumstances described by Subsection |
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(b)(4), a Medicaid managed care organization shall, for a recipient |
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of home and community-based services for which the commission |
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requires in-person visits, conduct: |
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(1) at least one in-person visit with the recipient to |
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make an initial waiver eligibility determination; and |
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(2) additional in-person visits with the recipient if |
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necessary, as determined by the managed care organization. |
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(f) Notwithstanding the provisions of this section, the |
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commission may, on a case-by-case basis, require a Medicaid managed |
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care organization to discontinue the use of telecommunications or |
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information technology for assessment or service coordination |
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services if the commission determines that the discontinuation is |
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in the best interest of the recipient. |
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SECTION 7. Section 62.1571, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH |
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SERVICES. (a) In providing covered benefits to a child, a health |
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plan provider must permit benefits to be provided through |
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telemedicine medical services and telehealth services in |
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accordance with policies developed by the commission. |
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(b) The policies must provide for: |
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(1) the availability of covered benefits |
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appropriately provided through telemedicine medical services or |
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telehealth services that are comparable to the same types of |
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covered benefits provided without the use of telemedicine medical |
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services or telehealth services; and |
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(2) the availability of covered benefits for different |
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services performed by multiple health care providers during a |
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single session of telemedicine medical services or telehealth |
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services, if the executive commissioner determines that delivery of |
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the covered benefits in that manner is cost-effective in comparison |
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to the costs that would be involved in obtaining the services from |
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providers without the use of telemedicine medical services or |
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telehealth services, including the costs of transportation and |
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lodging and other direct costs. |
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(d) In this section, "telehealth service" and "telemedicine |
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medical service" have [has] the meanings [meaning] assigned by |
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Section 531.001, Government Code. |
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SECTION 8. Subchapter A, Chapter 462, Health and Safety |
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Code, is amended by adding Section 462.015 to read as follows: |
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Sec. 462.015. OUTPATIENT TREATMENT SERVICES PROVIDED USING |
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TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a) An outpatient |
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chemical dependency treatment program provided by a treatment |
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facility licensed under Chapter 464 may provide services under the |
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program to adult and adolescent clients, consistent with commission |
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rule, using telecommunications or information technology. |
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(b) The executive commissioner shall adopt rules to |
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implement this section. |
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SECTION 9. Section 462.025, Health and Safety Code, is |
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amended by adding Subsection (d-1) to read as follows: |
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(d-1) The rules governing the intake, screening, and |
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assessment procedures shall establish minimum standards for |
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providing intake, screening, and assessment using |
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telecommunications or information technology. |
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SECTION 10. Section 32.025(g), Human Resources Code, is |
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amended to read as follows: |
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(g) The application form adopted under this section must |
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include: |
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(1) for an applicant who is pregnant, a question |
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regarding whether the pregnancy is the woman's first gestational |
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pregnancy; and |
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(2) for all applicants, a question regarding the |
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applicant's preferences for being contacted by a managed care |
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organization or health care provider, as follows: |
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"If you are determined eligible for benefits, your |
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managed care organization or health plan provider may contact you |
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by telephone, text message, or e-mail about health care matters, |
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including reminders for appointments and information about |
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immunizations or well check visits. All preferred methods of |
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contact listed on this application will be shared with your managed |
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care organization or health plan provider. Please indicate below |
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your preferred methods of contact in order of preference, with the |
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number 1 being the most preferable method: |
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(1) By telephone (if contacted by cellular telephone, the |
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call may be autodialed or prerecorded, and your carrier's usage |
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rates may apply)? Yes No |
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Telephone number: _____________ |
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Order of preference: 1 2 3 (circle a number) |
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(2) By text message (a free autodialed service, but your |
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carrier may charge message and data rates)? Yes No |
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Cellular telephone number: ______________ |
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Order of preference: 1 2 3 (circle a number) |
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(3) By e-mail? Yes No |
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E-mail address: __________________ |
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Order of preference: 1 2 3 (circle a number)". |
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SECTION 11. Not later than January 1, 2022, the Health and |
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Human Services Commission shall: |
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(1) implement Section 531.02161, Government Code, as |
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added by this Act; and |
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(2) publish the guidelines required by Section |
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533.008(c), Government Code, as added by this Act. |
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SECTION 12. If before implementing any provision of this |
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Act 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 13. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, this Act takes effect September 1, 2021. |
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* * * * * |