82R20404 EES-F
By: Watson, et al. S.B. No. 293
(J. Davis of Harris)
Substitute the following for S.B. No. 293: No.
A BILL TO BE ENTITLED
AN ACT
relating to telemedicine medical services, 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, that is 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 and that requires the use of
advanced telecommunications technology, other than telephone or
facsimile technology, 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 that is initiated by a physician or provided by a health
professional acting under physician delegation and supervision,
that is provided for purposes of patient assessment by a health
professional, diagnosis or consultation by a physician, or
treatment, or for the transfer of medical data, and that requires
the use of advanced telecommunications technology, other than
telephone or facsimile technology, 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. 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. (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 and telehealth 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.
(d) Subject to Section 153.004, Occupations Code, the
commission may adopt rules as necessary to implement this
section. In the rules adopted under this section, the commission
shall:
(1) refer to the site where the patient is physically
located as the patient site; and
(2) refer to the site where the physician or health
professional providing the telemedicine medical service or
telehealth service is physically located as the distant site.
(e) The commission may not reimburse a health care facility
for telemedicine medical services or telehealth services provided
to a Medicaid recipient unless the facility complies with the
minimum standards adopted under Section 531.02161.
(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, and 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.
[(g) In this section:
[(1) "Telehealth service" has the meaning assigned by
Section 57.042, Utilities Code.
[(2) "Telemedicine medical service" has the meaning
assigned by Section 57.042, Utilities Code.]
SECTION 3. The heading to Section 531.02161, Government
Code, is amended to read as follows:
Sec. 531.02161. TELEMEDICINE, TELEHEALTH, AND HOME
TELEMONITORING TECHNOLOGY STANDARDS.
SECTION 4. Section 531.02161(b), Government Code, is
amended to read as follows:
(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.
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) If the commission determines that establishing a
statewide program that permits reimbursement under the state
Medicaid program for home telemonitoring services would be
cost-effective and feasible, the executive commissioner by rule
shall establish the program as provided under this section.
(c) A program established under this section must:
(1) provide that home telemonitoring services are
available only to persons who are diagnosed with one or more
conditions described by Section 531.02171(c)(4) 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.
(d) If, after implementation, the commission determines
that the program established under this section is not
cost-effective, the commission may discontinue the program and stop
providing reimbursement under the state Medicaid program for home
telemonitoring services, notwithstanding Section 531.0216 or any
other law.
(e) The commission shall determine whether the provision of
home telemonitoring services to persons who are eligible to receive
benefits under both the Medicaid and Medicare programs achieves
cost savings for the Medicare program. If the commission
determines that the provision of home telemonitoring services
achieves cost savings for the Medicare program, the commission
shall pursue the creation of accountable care organizations to
participate in the Medicare shared savings program in accordance
with 42 U.S.C. Section 1395jjj.
SECTION 6. The heading to Section 531.02171, Government
Code, as added by Chapter 661 (H.B. 2700), Acts of the 77th
Legislature, Regular Session, 2001, is amended to read as follows:
Sec. 531.02171. TELEMEDICINE MEDICAL SERVICES AND
TELEHEALTH SERVICES PILOT PROGRAMS.
SECTION 7. Section 531.02171(c), Government Code, as added
by Chapter 661 (H.B. 2700), 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;
(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 provision of traditional medical
services or other health care services within the area served by the
pilot program.
SECTION 8. The heading to Section 531.02172, Government
Code, is amended to read as follows:
Sec. 531.02172. TELEMEDICINE AND TELEHEALTH ADVISORY
COMMITTEE.
SECTION 9. Section 531.02172(b), 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 Texas Department of Rural 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 10. Section 531.02173(c), 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 11. The following provisions of the Government Code
are repealed:
(1) Section 531.02161(a);
(2) Sections 531.0217(a)(3) and (4);
(3) Sections 531.02171(a)(3) and (4), as added by
Chapter 661 (H.B. 2700), Acts of the 77th Legislature, Regular
Session, 2001; and
(4) Section 531.02171, as added by Chapter 959 (S.B.
1536), Acts of the 77th Legislature, Regular Session, 2001.
SECTION 12. Not later than December 31, 2012, the Health and
Human Services Commission shall submit a report to the governor,
the lieutenant governor, and the speaker of the house of
representatives regarding the establishment and implementation of
the program to permit reimbursement under the state Medicaid
program for home telemonitoring services under Section 531.02164,
Government Code, as added by this Act. The report must include:
(1) the methods used by the commission to determine
whether the program was cost-effective and feasible; and
(2) if the program has been established, information
regarding:
(A) the utilization of home telemonitoring
services by Medicaid recipients under the program;
(B) the health outcomes of Medicaid recipients
who receive home telemonitoring services under the program;
(C) the hospital admission rate of Medicaid
recipients who receive home telemonitoring services under the
program;
(D) the cost of the home telemonitoring services
provided under the program; and
(E) the estimated cost savings to the state as a
result of the program.
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, 2011.