By: Davis of Harris H.B. No. 3234
A BILL TO BE ENTITLED
AN ACT
relating to telehealth services and home telemonitoring services
provided to certain Medicaid recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.001, Government Code, is amended by
adding Subdivisions (4-a), (7), and (8) to read as follows:
(4-a) "Home telemonitoring service" means a health
service that requires scheduled remote monitoring of data related
to a patient's health and transmission of the data to a licensed
home health agency as defined by Section 531.02164(a).
(7) "Telehealth service" means a health service, other
than a telemedicine medical service, delivered by a licensed or
certified health professional acting within the scope of the health
professional's license or certification who does not perform a
telemedicine medical service, that requires the use of advanced
telecommunications technology, other than by telephone or
facsimile, including:
(A) compressed digital interactive video, audio,
or data transmission;
(B) clinical data transmission using computer
imaging by way of still-image capture and store and forward; and
(C) other technology that facilitates access to
health care services or medical specialty expertise.
(8) "Telemedicine medical service" means a health care
service, initiated by a physician or provided by a health
professional acting under physician delegation and supervision,
for purposes of patient assessment by a health professional,
diagnosis or consultation by a physician, treatment, or the
transfer of medical data, that requires the use of advanced
telecommunications technology, other than by telephone or
facsimile, including:
(A) compressed digital interactive video, audio,
or data transmission;
(B) clinical data transmission using computer
imaging by way of still-image capture and store and forward; and
(C) other technology that facilitates access to
health care services or medical specialty expertise.
SECTION 2. The heading to Section 531.0216, Government
Code, is amended to read as follows:
Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE
PROVIDERS UNDER MEDICAID.
SECTION 3. Subsections (a), (b), (c), and (f), Section
531.0216, Government Code, are amended to read as follows:
(a) The commission by rule shall develop and implement a
system to reimburse providers of services under the state Medicaid
program for services performed using telemedicine medical services
or telehealth services.
(b) In developing the system, the executive commissioner by
rule shall:
(1) review programs and pilot projects in other states
to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for
services;
(3) provide for an approval process before a provider
can receive reimbursement for services;
(4) consult with the Department of State Health
Services and the telemedicine advisory committee to establish
procedures to:
(A) identify clinical evidence supporting
delivery of health care services using a telecommunications system;
(B) establish pilot studies for telemedicine
medical service delivery and telehealth service delivery; and
(C) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
(5) establish pilot programs in designated areas of
this state under which the commission, in administering
government-funded health programs, may reimburse a health
professional participating in the pilot program for telehealth
services authorized under the licensing law applicable to the
health professional;
(6) establish a separate provider identifier for
telemedicine medical services providers, telehealth services
providers, and home telemonitoring services providers; and
(7) establish a separate modifier for telemedicine
medical services, telehealth services, and home telemonitoring
services eligible for reimbursement.
(c) The commission shall encourage health care providers
and health care facilities to participate as telemedicine medical
service providers or telehealth service providers in the health
care delivery system. The commission may not require that a service
be provided to a patient through telemedicine medical services or
telehealth services when the service can reasonably be provided by
a physician through a face-to-face consultation with the patient in
the community in which the patient resides or works. This
subsection does not prohibit the authorization of the provision of
any service to a patient through telemedicine medical services or
telehealth services at the patient's request.
(f) Not later than December 1 of each even-numbered year,
the commission shall report to the speaker of the house of
representatives and the lieutenant governor on the effects of
telemedicine medical services, telehealth services, and home
telemonitoring services on the Medicaid program in the state,
including the number of physicians, [and] health professionals, and
licensed health care facilities using telemedicine medical
services, telehealth services, or home telemonitoring services,
the geographic and demographic disposition of the physicians and
health professionals, the number of patients receiving
telemedicine medical services, telehealth services, or home
telemonitoring services, the types of services being provided, and
the cost of utilization of telemedicine medical services,
telehealth services, and home telemonitoring services to the
program.
SECTION 4. Section 531.02161, Government Code, is amended
to read as follows:
Sec. 531.02161. TELEMEDICINE, TELEHEALTH, AND HOME
TELEMONITORING TECHNOLOGY STANDARDS. (a) [In this section,
"telemedicine medical service" has the meaning assigned by Section
57.042, Utilities Code.
[(b)] The commission and the Telecommunications
Infrastructure Fund Board by joint rule shall establish and adopt
minimum standards for an operating system used in the provision of
telemedicine medical services, telehealth services, or home
telemonitoring services by a health care facility participating in
the state Medicaid program, including standards for electronic
transmission, software, and hardware.
(b) [(c)] In developing standards under this section, the
commission and the Telecommunications Infrastructure Fund Board
shall address:
(1) authentication and authorization of users;
(2) authentication of the origin of information;
(3) the prevention of unauthorized access to the
system or information;
(4) system security, including the integrity of
information that is collected, program integrity, and system
integrity;
(5) maintenance of documentation about system and
information usage;
(6) information storage, maintenance, and
transmission; and
(7) synchronization and verification of patient
profile data.
SECTION 5. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02164 to read as follows:
Sec. 531.02164. MEDICAID SERVICES PROVIDED THROUGH HOME
TELEMONITORING SERVICES. (a) In this section, "home health
agency" means a facility licensed under Chapter 142, Health and
Safety Code, to provide home health services as defined by Section
142.001, Health and Safety Code.
(b) The executive commissioner by rule shall establish a
statewide program that permits reimbursement under the state
Medicaid program for home telemonitoring services as provided under
this section.
(c) The program required under this section must:
(1) provide that home telemonitoring services are
available only to persons diagnosed with one or more conditions
described by Section 531.02171(c)(4), as added by Chapter 959 (S.B.
1536), Acts of the 77th Legislature, Regular Session, 2001, and who
exhibit two or more of the following risk factors:
(A) two or more hospitalizations in the prior 12-
month period;
(B) frequent or recurrent emergency room
admissions;
(C) a documented history of poor adherence to
ordered medication regimens;
(D) a documented history of falls in the prior
six-month period;
(E) limited or absent informal support systems;
(F) living alone or being home alone for extended
periods of time; and
(G) a documented history of care access
challenges;
(2) ensure that clinical information gathered by a
home health agency while providing home telemonitoring services is
shared with the patient's physician; and
(3) ensure that the program does not duplicate disease
management program services provided under Section 32.057, Human
Resources Code.
SECTION 6. Subsection (c), Section 531.02171, Government
Code, as added by Chapter 959 (S.B. 1536), Acts of the 77th
Legislature, Regular Session, 2001, is amended to read as follows:
(c) In developing and operating a pilot program under this
section, the commission shall:
(1) solicit and obtain support for the program from
local officials and the medical community;
(2) focus on enhancing health outcomes in the area
served by the pilot program through increased access to medical or
health care services, including:
(A) health screenings;
(B) prenatal care;
(C) medical or surgical follow-up visits;
(D) periodic consultation with specialists
regarding chronic disorders;
(E) triage and pretransfer arrangements; [and]
(F) transmission of diagnostic images or data;
and
(G) monitoring of chronic conditions;
(3) establish quantifiable measures and expected
health outcomes for each authorized telemedicine medical service or
telehealth service;
(4) consider condition-specific applications of
telemedicine medical services or telehealth services, including
applications for:
(A) pregnancy;
(B) diabetes;
(C) heart disease; [and]
(D) cancer; [and]
(E) chronic obstructive pulmonary disease;
(F) hypertension; and
(G) congestive heart failure; and
(5) demonstrate that the provision of services
authorized as telemedicine medical services or telehealth services
will not adversely affect the delivery of traditional medical
services or other health care services within the area served by the
pilot program.
SECTION 7. The heading to Section 531.02172, Government
Code, is amended to read as follows:
Sec. 531.02172. TELEMEDICINE AND TELEHEALTH ADVISORY
COMMITTEE.
SECTION 8. Subsection (b), Section 531.02172, Government
Code, is amended to read as follows:
(b) The advisory committee must include:
(1) representatives of health and human services
agencies and other state agencies concerned with the use of
telemedical and telehealth consultations and home telemonitoring
services in the Medicaid program and the state child health plan
program, including representatives of:
(A) the commission;
(B) the Department of State Health Services;
(C) the Office of Rural Community Affairs;
(D) the Texas Department of Insurance;
(E) the Texas Medical Board;
(F) the Texas Board of Nursing; and
(G) the Texas State Board of Pharmacy;
(2) representatives of health science centers in this
state;
(3) experts on telemedicine, telemedical
consultation, and telemedicine medical services or telehealth
services; [and]
(4) representatives of consumers of health services
provided through telemedical consultations and telemedicine
medical services or telehealth services; and
(5) representatives of providers of telemedicine
medical services, telehealth services, and home telemonitoring
services.
SECTION 9. Subsection (c), Section 531.02173, Government
Code, is amended to read as follows:
(c) The commission shall perform its duties under this
section with assistance from the telemedicine and telehealth
advisory committee established under Section 531.02172.
SECTION 10. The heading to Section 531.02175, Government
Code, as added by Chapter 370 (S.B. 1340), Acts of the 79th
Legislature, Regular Session, 2005, is amended to read as follows:
Sec. 531.02175. PILOT PROGRAM FOR MENTAL HEALTH TELEHEALTH
OR TELEMEDICINE CONSULTATIONS FOR CERTAIN MEDICAID RECIPIENTS.
SECTION 11. Subsections (i) and (j), Section 531.02175,
Government Code, as added by Chapter 370 (S.B. 1340), Acts of the
79th Legislature, Regular Session, 2005, are amended to read as
follows:
(i) Not later than September 1, 2010 [2008], the commission
shall submit a report to the legislature regarding the results of
the pilot program. The report must include recommendations
regarding elimination, continuation, or expansion of the pilot
program.
(j) This section expires September 1, 2011 [2009].
SECTION 12. The following provisions of the Government Code
are repealed:
(1) Subsection (g), Section 531.0216;
(2) Subdivisions (3) and (4), Subsection (a), Section
531.0217;
(3) Subdivisions (3) and (4), Subsection (a), Section
531.02171, as added by Chapter 661 (H.B. 2700), Acts of the 77th
Legislature, Regular Session, 2001; and
(4) Subdivisions (3) and (4), Subsection (a), Section
531.02171, as added by Chapter 959 (S.B. 1536), Acts of the 77th
Legislature, Regular Session, 2001.
SECTION 13. 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 14. This Act takes effect September 1, 2009.