By: Price, et al. (Senate Sponsor - Buckingham) H.B. No. 4
         (In the Senate - Received from the House April 19, 2021;
  April 19, 2021, read first time and referred to Committee on Health &
  Human Services; May 20, 2021, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 8, Nays 0;
  May 20, 2021, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR H.B. No. 4 By:  Miles
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the provision and delivery of certain health care
  services in this state, including services under Medicaid and other
  public benefits programs, using telecommunications or information
  technology and to reimbursement for some of those services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.0216(i), Government Code, is amended
  to read as follows:
         (i)  The executive commissioner by rule shall ensure that a
  rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and
  a federally qualified health center as defined by 42 U.S.C. Section
  1396d(l)(2)(B) 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.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02161 to read as follows:
         Sec. 531.02161.  PROVISION OF SERVICES THROUGH
  TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND
  OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section:
               (1)  "Behavioral health services" has the meaning
  assigned by Section 533.00255.
               (2)  "Case management services" includes service
  coordination, service management, and care coordination.
         (b)  To the extent permitted by federal law and to the extent
  it is cost-effective and clinically effective, as determined by the
  commission, the commission shall ensure that Medicaid recipients,
  child health plan program enrollees, and other individuals
  receiving benefits under a public benefits program administered by
  the commission or a health and human services agency, regardless of
  whether receiving benefits through a managed care delivery model or
  another delivery model, have the option to receive services as
  telemedicine medical services, telehealth services, or otherwise
  using telecommunications or information technology, including the
  following services:
               (1)  preventive health and wellness services;
               (2)  case management services, including targeted case
  management services;
               (3)  subject to Subsection (c), behavioral health
  services;
               (4)  occupational, physical, and speech therapy
  services;
               (5)  nutritional counseling services; and
               (6)  assessment services, including nursing
  assessments under the following Section 1915(c) waiver programs:
                     (A)  the community living assistance and support
  services (CLASS) waiver program;
                     (B)  the deaf-blind with multiple disabilities
  (DBMD) waiver program;
                     (C)  the home and community-based services (HCS)
  waiver program; and
                     (D)  the Texas home living (TxHmL) waiver program.
         (c)  To the extent permitted by state and federal law and to
  the extent it is cost-effective and clinically effective, as
  determined by the commission, the executive commissioner by rule
  shall develop and implement a system that ensures behavioral health
  services may be provided using an audio-only platform consistent
  with Section 111.008, Occupations Code, to a Medicaid recipient, a
  child health plan program enrollee, or another individual receiving
  those services under another public benefits program administered
  by the commission or a health and human services agency.
         (d)  If the executive commissioner determines that providing
  services other than behavioral health services is appropriate using
  an audio-only platform under a public benefits program administered
  by the commission or a health and human services agency, in
  accordance with applicable federal and state law, the executive
  commissioner may by rule authorize the provision of those services
  under the applicable program using the audio-only platform.  In
  determining whether the use of an audio-only platform in a program
  is appropriate under this subsection, the executive commissioner
  shall consider whether using the platform would be cost-effective
  and clinically effective.
         SECTION 3.  Section 531.02164, Government Code, is amended
  by adding Subsection (f) to read as follows:
         (f)  To comply 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 provided to persons who
  have conditions and exhibit risk factors other than those expressly
  authorized by this section.  In determining whether the managed
  care organization should provide reimbursement for services under
  this subsection, the organization shall consider whether
  reimbursement for the service is cost-effective and providing the
  service is clinically effective.
         SECTION 4.  Section 533.0061(b), Government Code, is amended
  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)  subject to Section 531.0216(c) and consistent with
  Section 111.007, Occupations Code, consider and include the
  availability of telehealth services and telemedicine medical
  services within the provider network of a Medicaid managed care
  organization.
         SECTION 5.  Section 533.008, Government Code, is amended by
  adding Subsection (c) to read as follows:
         (c)  The executive commissioner shall adopt and publish
  guidelines for Medicaid managed care organizations regarding how
  organizations may communicate by text message or e-mail with
  recipients enrolled in the organization's managed care plan using
  the contact information provided in a recipient's application for
  Medicaid benefits under Section 32.025(g)(2), Human Resources
  Code.
         SECTION 6.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.039 to read as follows:
         Sec. 533.039.  DELIVERY OF BENEFITS USING
  TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY. (a)  The commission
  shall establish policies and procedures to improve access to care
  under the Medicaid managed care program by encouraging the use of
  telehealth services, telemedicine medical services, home
  telemonitoring services, and other telecommunications or
  information technology under the program.
         (b)  To the extent permitted by federal law, the executive
  commissioner by rule shall establish policies and procedures that
  allow a Medicaid managed care organization to conduct assessments
  and provide care coordination services using telecommunications or
  information technology. In establishing the policies and
  procedures, the executive commissioner shall consider:
               (1)  the extent to which a managed care organization
  determines using the telecommunications or information technology
  is appropriate;
               (2)  whether the recipient requests that the assessment
  or service be provided using telecommunications or information
  technology;
               (3)  whether the recipient consents to receiving the
  assessment or service using telecommunications or information
  technology;
               (4)  whether conducting the assessment, including an
  assessment for an initial waiver eligibility determination, or
  providing the service in person is not feasible because of the
  existence of an emergency or state of disaster, including a public
  health emergency or natural disaster; and
               (5)  whether the commission determines using the
  telecommunications or information technology is appropriate under
  the circumstances.
         (c)  If a Medicaid managed care organization conducts an
  assessment of or provides care coordination services to a recipient
  using telecommunications or information technology, the managed
  care organization shall:
               (1)  monitor the health care services provided to the
  recipient for evidence of fraud, waste, and abuse; and
               (2)  determine whether additional social services or
  supports are needed.
         (d)  To the extent permitted by federal law, the commission
  shall allow a recipient who is assessed or provided with care
  coordination services by a Medicaid managed care organization using
  telecommunications or information technology to provide consent or
  other authorizations to receive services verbally instead of in
  writing.
         (e)  The commission shall determine categories of recipients
  of home and community-based services who must receive in-person
  visits.  Except during circumstances described by Subsection
  (b)(4), a Medicaid managed care organization shall, for a recipient
  of home and community-based services for which the commission
  requires in-person visits, conduct:
               (1)  at least one in-person visit with the recipient to
  make an initial waiver eligibility determination; and
               (2)  additional in-person visits with the recipient if
  necessary, as determined by the managed care organization.
         (f)  Notwithstanding the provisions of this section, the
  commission may, on a case-by-case basis, require a Medicaid managed
  care organization to discontinue the use of telecommunications or
  information technology for assessment or service coordination
  services if the commission determines that the discontinuation is
  in the best interest of the recipient.
         SECTION 7.  Section 62.1571, Health and Safety Code, is
  amended to read as follows:
         Sec. 62.1571.  TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
  SERVICES. (a) In providing covered benefits to a child, a health
  plan provider must permit benefits to be provided through
  telemedicine medical services and telehealth services in
  accordance with policies developed by the commission.
         (b)  The policies must provide for:
               (1)  the availability of covered benefits
  appropriately provided through telemedicine medical services or
  telehealth services that are comparable to the same types of
  covered benefits provided without the use of telemedicine medical
  services or telehealth services; and
               (2)  the availability of covered benefits for different
  services performed by multiple health care providers during a
  single session of telemedicine medical services or telehealth
  services, if the executive commissioner determines that delivery of
  the covered benefits in that manner is cost-effective in comparison
  to the costs that would be involved in obtaining the services from
  providers without the use of telemedicine medical services or
  telehealth services, including the costs of transportation and
  lodging and other direct costs.
         (d)  In this section, "telehealth service" and "telemedicine
  medical service" have [has] the meanings [meaning] assigned by
  Section 531.001, Government Code.
         SECTION 8.  Subchapter A, Chapter 462, Health and Safety
  Code, is amended by adding Section 462.015 to read as follows:
         Sec. 462.015.  OUTPATIENT TREATMENT SERVICES PROVIDED USING
  TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a) An outpatient
  chemical dependency treatment program provided by a treatment
  facility licensed under Chapter 464 may provide services under the
  program to adult and adolescent clients, consistent with commission
  rule, using telecommunications or information technology.
         (b)  The executive commissioner shall adopt rules to
  implement this section.
         SECTION 9.  Section 462.025, Health and Safety Code, is
  amended by adding Subsection (d-1) to read as follows:
         (d-1)  The rules governing the intake, screening, and
  assessment procedures shall establish minimum standards for
  providing intake, screening, and assessment using
  telecommunications or information technology.
         SECTION 10.  Section 32.025(g), Human Resources Code, is
  amended to read as follows:
         (g)  The application form adopted under this section must
  include:
               (1)  for an applicant who is pregnant, a question
  regarding whether the pregnancy is the woman's first gestational
  pregnancy; and
               (2)  for all applicants, a question regarding the
  applicant's preferences for being contacted by a managed care
  organization or health care provider, as follows:
                     "If you are determined eligible for benefits, your
  managed care organization or health plan provider may contact you
  by telephone, text message, or e-mail about health care matters,
  including reminders for appointments and information about
  immunizations or well check visits. All preferred methods of
  contact listed on this application will be shared with your managed
  care organization or health plan provider. Please indicate below
  your preferred methods of contact in order of preference, with the
  number 1 being the most preferable method:
         (1)  By telephone (if contacted by cellular telephone, the
  call may be autodialed or prerecorded, and your carrier's usage
  rates may apply)? Yes No
         Telephone number: _____________
         Order of preference: 1 2 3 (circle a number)
         (2)  By text message (a free autodialed service, but your
  carrier may charge message and data rates)? Yes No
         Cellular telephone number: ______________
         Order of preference: 1 2 3 (circle a number)
         (3)  By e-mail? Yes No
         E-mail address: __________________
         Order of preference: 1 2 3 (circle a number)".
         SECTION 11.  Not later than January 1, 2022, the Health and
  Human Services Commission shall:
               (1)  implement Section 531.02161, Government Code, as
  added by this Act; and
               (2)  publish the guidelines required by Section
  533.008(c), Government Code, as added by this Act.
         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 immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2021.
 
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