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Texas House Bill HB3234

Texas 2009 - 81st Regular

Texas House Bill HB3234 Compare Versions

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11 By: Davis of Harris H.B. No. 3234
22
33
44 A BILL TO BE ENTITLED
55 AN ACT
66 relating to telehealth services and home telemonitoring services
77 provided to certain Medicaid recipients.
88 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
99 SECTION 1. Section 531.001, Government Code, is amended by
1010 adding Subdivisions (4-a), (7), and (8) to read as follows:
1111 (4-a) "Home telemonitoring service" means a health
1212 service that requires scheduled remote monitoring of data related
1313 to a patient's health and transmission of the data to a licensed
1414 home health agency as defined by Section 531.02164(a).
1515 (7) "Telehealth service" means a health service, other
1616 than a telemedicine medical service, delivered by a licensed or
1717 certified health professional acting within the scope of the health
1818 professional's license or certification who does not perform a
1919 telemedicine medical service, that requires the use of advanced
2020 telecommunications technology, other than by telephone or
2121 facsimile, including:
2222 (A) compressed digital interactive video, audio,
2323 or data transmission;
2424 (B) clinical data transmission using computer
2525 imaging by way of still-image capture and store and forward; and
2626 (C) other technology that facilitates access to
2727 health care services or medical specialty expertise.
2828 (8) "Telemedicine medical service" means a health care
2929 service, initiated by a physician or provided by a health
3030 professional acting under physician delegation and supervision,
3131 for purposes of patient assessment by a health professional,
3232 diagnosis or consultation by a physician, treatment, or the
3333 transfer of medical data, that requires the use of advanced
3434 telecommunications technology, other than by telephone or
3535 facsimile, including:
3636 (A) compressed digital interactive video, audio,
3737 or data transmission;
3838 (B) clinical data transmission using computer
3939 imaging by way of still-image capture and store and forward; and
4040 (C) other technology that facilitates access to
4141 health care services or medical specialty expertise.
4242 SECTION 2. The heading to Section 531.0216, Government
4343 Code, is amended to read as follows:
4444 Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
4545 TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE
4646 PROVIDERS UNDER MEDICAID.
4747 SECTION 3. Subsections (a), (b), (c), and (f), Section
4848 531.0216, Government Code, are amended to read as follows:
4949 (a) The commission by rule shall develop and implement a
5050 system to reimburse providers of services under the state Medicaid
5151 program for services performed using telemedicine medical services
5252 or telehealth services.
5353 (b) In developing the system, the executive commissioner by
5454 rule shall:
5555 (1) review programs and pilot projects in other states
5656 to determine the most effective method for reimbursement;
5757 (2) establish billing codes and a fee schedule for
5858 services;
5959 (3) provide for an approval process before a provider
6060 can receive reimbursement for services;
6161 (4) consult with the Department of State Health
6262 Services and the telemedicine advisory committee to establish
6363 procedures to:
6464 (A) identify clinical evidence supporting
6565 delivery of health care services using a telecommunications system;
6666 (B) establish pilot studies for telemedicine
6767 medical service delivery and telehealth service delivery; and
6868 (C) annually review health care services,
6969 considering new clinical findings, to determine whether
7070 reimbursement for particular services should be denied or
7171 authorized;
7272 (5) establish pilot programs in designated areas of
7373 this state under which the commission, in administering
7474 government-funded health programs, may reimburse a health
7575 professional participating in the pilot program for telehealth
7676 services authorized under the licensing law applicable to the
7777 health professional;
7878 (6) establish a separate provider identifier for
7979 telemedicine medical services providers, telehealth services
8080 providers, and home telemonitoring services providers; and
8181 (7) establish a separate modifier for telemedicine
8282 medical services, telehealth services, and home telemonitoring
8383 services eligible for reimbursement.
8484 (c) The commission shall encourage health care providers
8585 and health care facilities to participate as telemedicine medical
8686 service providers or telehealth service providers in the health
8787 care delivery system. The commission may not require that a service
8888 be provided to a patient through telemedicine medical services or
8989 telehealth services when the service can reasonably be provided by
9090 a physician through a face-to-face consultation with the patient in
9191 the community in which the patient resides or works. This
9292 subsection does not prohibit the authorization of the provision of
9393 any service to a patient through telemedicine medical services or
9494 telehealth services at the patient's request.
9595 (f) Not later than December 1 of each even-numbered year,
9696 the commission shall report to the speaker of the house of
9797 representatives and the lieutenant governor on the effects of
9898 telemedicine medical services, telehealth services, and home
9999 telemonitoring services on the Medicaid program in the state,
100100 including the number of physicians, [and] health professionals, and
101101 licensed health care facilities using telemedicine medical
102102 services, telehealth services, or home telemonitoring services,
103103 the geographic and demographic disposition of the physicians and
104104 health professionals, the number of patients receiving
105105 telemedicine medical services, telehealth services, or home
106106 telemonitoring services, the types of services being provided, and
107107 the cost of utilization of telemedicine medical services,
108108 telehealth services, and home telemonitoring services to the
109109 program.
110110 SECTION 4. Section 531.02161, Government Code, is amended
111111 to read as follows:
112112 Sec. 531.02161. TELEMEDICINE, TELEHEALTH, AND HOME
113113 TELEMONITORING TECHNOLOGY STANDARDS. (a) [In this section,
114114 "telemedicine medical service" has the meaning assigned by Section
115115 57.042, Utilities Code.
116116 [(b)] The commission and the Telecommunications
117117 Infrastructure Fund Board by joint rule shall establish and adopt
118118 minimum standards for an operating system used in the provision of
119119 telemedicine medical services, telehealth services, or home
120120 telemonitoring services by a health care facility participating in
121121 the state Medicaid program, including standards for electronic
122122 transmission, software, and hardware.
123123 (b) [(c)] In developing standards under this section, the
124124 commission and the Telecommunications Infrastructure Fund Board
125125 shall address:
126126 (1) authentication and authorization of users;
127127 (2) authentication of the origin of information;
128128 (3) the prevention of unauthorized access to the
129129 system or information;
130130 (4) system security, including the integrity of
131131 information that is collected, program integrity, and system
132132 integrity;
133133 (5) maintenance of documentation about system and
134134 information usage;
135135 (6) information storage, maintenance, and
136136 transmission; and
137137 (7) synchronization and verification of patient
138138 profile data.
139139 SECTION 5. Subchapter B, Chapter 531, Government Code, is
140140 amended by adding Section 531.02164 to read as follows:
141141 Sec. 531.02164. MEDICAID SERVICES PROVIDED THROUGH HOME
142142 TELEMONITORING SERVICES. (a) In this section, "home health
143143 agency" means a facility licensed under Chapter 142, Health and
144144 Safety Code, to provide home health services as defined by Section
145145 142.001, Health and Safety Code.
146146 (b) The executive commissioner by rule shall establish a
147147 statewide program that permits reimbursement under the state
148148 Medicaid program for home telemonitoring services as provided under
149149 this section.
150150 (c) The program required under this section must:
151151 (1) provide that home telemonitoring services are
152152 available only to persons diagnosed with one or more conditions
153153 described by Section 531.02171(c)(4), as added by Chapter 959 (S.B.
154154 1536), Acts of the 77th Legislature, Regular Session, 2001, and who
155155 exhibit two or more of the following risk factors:
156156 (A) two or more hospitalizations in the prior 12-
157157 month period;
158158 (B) frequent or recurrent emergency room
159159 admissions;
160160 (C) a documented history of poor adherence to
161161 ordered medication regimens;
162162 (D) a documented history of falls in the prior
163163 six-month period;
164164 (E) limited or absent informal support systems;
165165 (F) living alone or being home alone for extended
166166 periods of time; and
167167 (G) a documented history of care access
168168 challenges;
169169 (2) ensure that clinical information gathered by a
170170 home health agency while providing home telemonitoring services is
171171 shared with the patient's physician; and
172172 (3) ensure that the program does not duplicate disease
173173 management program services provided under Section 32.057, Human
174174 Resources Code.
175175 SECTION 6. Subsection (c), Section 531.02171, Government
176176 Code, as added by Chapter 959 (S.B. 1536), Acts of the 77th
177177 Legislature, Regular Session, 2001, is amended to read as follows:
178178 (c) In developing and operating a pilot program under this
179179 section, the commission shall:
180180 (1) solicit and obtain support for the program from
181181 local officials and the medical community;
182182 (2) focus on enhancing health outcomes in the area
183183 served by the pilot program through increased access to medical or
184184 health care services, including:
185185 (A) health screenings;
186186 (B) prenatal care;
187187 (C) medical or surgical follow-up visits;
188188 (D) periodic consultation with specialists
189189 regarding chronic disorders;
190190 (E) triage and pretransfer arrangements; [and]
191191 (F) transmission of diagnostic images or data;
192192 and
193193 (G) monitoring of chronic conditions;
194194 (3) establish quantifiable measures and expected
195195 health outcomes for each authorized telemedicine medical service or
196196 telehealth service;
197197 (4) consider condition-specific applications of
198198 telemedicine medical services or telehealth services, including
199199 applications for:
200200 (A) pregnancy;
201201 (B) diabetes;
202202 (C) heart disease; [and]
203203 (D) cancer; [and]
204204 (E) chronic obstructive pulmonary disease;
205205 (F) hypertension; and
206206 (G) congestive heart failure; and
207207 (5) demonstrate that the provision of services
208208 authorized as telemedicine medical services or telehealth services
209209 will not adversely affect the delivery of traditional medical
210210 services or other health care services within the area served by the
211211 pilot program.
212212 SECTION 7. The heading to Section 531.02172, Government
213213 Code, is amended to read as follows:
214214 Sec. 531.02172. TELEMEDICINE AND TELEHEALTH ADVISORY
215215 COMMITTEE.
216216 SECTION 8. Subsection (b), Section 531.02172, Government
217217 Code, is amended to read as follows:
218218 (b) The advisory committee must include:
219219 (1) representatives of health and human services
220220 agencies and other state agencies concerned with the use of
221221 telemedical and telehealth consultations and home telemonitoring
222222 services in the Medicaid program and the state child health plan
223223 program, including representatives of:
224224 (A) the commission;
225225 (B) the Department of State Health Services;
226226 (C) the Office of Rural Community Affairs;
227227 (D) the Texas Department of Insurance;
228228 (E) the Texas Medical Board;
229229 (F) the Texas Board of Nursing; and
230230 (G) the Texas State Board of Pharmacy;
231231 (2) representatives of health science centers in this
232232 state;
233233 (3) experts on telemedicine, telemedical
234234 consultation, and telemedicine medical services or telehealth
235235 services; [and]
236236 (4) representatives of consumers of health services
237237 provided through telemedical consultations and telemedicine
238238 medical services or telehealth services; and
239239 (5) representatives of providers of telemedicine
240240 medical services, telehealth services, and home telemonitoring
241241 services.
242242 SECTION 9. Subsection (c), Section 531.02173, Government
243243 Code, is amended to read as follows:
244244 (c) The commission shall perform its duties under this
245245 section with assistance from the telemedicine and telehealth
246246 advisory committee established under Section 531.02172.
247247 SECTION 10. The heading to Section 531.02175, Government
248248 Code, as added by Chapter 370 (S.B. 1340), Acts of the 79th
249249 Legislature, Regular Session, 2005, is amended to read as follows:
250250 Sec. 531.02175. PILOT PROGRAM FOR MENTAL HEALTH TELEHEALTH
251251 OR TELEMEDICINE CONSULTATIONS FOR CERTAIN MEDICAID RECIPIENTS.
252252 SECTION 11. Subsections (i) and (j), Section 531.02175,
253253 Government Code, as added by Chapter 370 (S.B. 1340), Acts of the
254254 79th Legislature, Regular Session, 2005, are amended to read as
255255 follows:
256256 (i) Not later than September 1, 2010 [2008], the commission
257257 shall submit a report to the legislature regarding the results of
258258 the pilot program. The report must include recommendations
259259 regarding elimination, continuation, or expansion of the pilot
260260 program.
261261 (j) This section expires September 1, 2011 [2009].
262262 SECTION 12. The following provisions of the Government Code
263263 are repealed:
264264 (1) Subsection (g), Section 531.0216;
265265 (2) Subdivisions (3) and (4), Subsection (a), Section
266266 531.0217;
267267 (3) Subdivisions (3) and (4), Subsection (a), Section
268268 531.02171, as added by Chapter 661 (H.B. 2700), Acts of the 77th
269269 Legislature, Regular Session, 2001; and
270270 (4) Subdivisions (3) and (4), Subsection (a), Section
271271 531.02171, as added by Chapter 959 (S.B. 1536), Acts of the 77th
272272 Legislature, Regular Session, 2001.
273273 SECTION 13. If before implementing any provision of this
274274 Act a state agency determines that a waiver or authorization from a
275275 federal agency is necessary for implementation of that provision,
276276 the agency affected by the provision shall request the waiver or
277277 authorization and may delay implementing that provision until the
278278 waiver or authorization is granted.
279279 SECTION 14. This Act takes effect September 1, 2009.