By: Watson S.B. No. 293
(In the Senate - Filed December 21, 2010; January 31, 2011,
read first time and referred to Committee on Health and Human
Services; April 4, 2011, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 9, Nays 0;
April 4, 2011, sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 293 By: Deuell
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 providers [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
(C) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
(4) [(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;] and
(5) [(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. 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 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.
SECTION 4. Subsection (c), 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:
(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
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 within the area served by the pilot program.
SECTION 5. The following provisions of the Government Code
are repealed:
(1) Subsection (a), Section 531.02161;
(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) Section 531.02171, as added by Chapter 959 (S.B.
1536), Acts of the 77th Legislature, Regular Session, 2001.
SECTION 6. 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 7. This Act takes effect September 1, 2011.
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