84R9542 EES-F
By: Coleman H.B. No. 3476
A BILL TO BE ENTITLED
AN ACT
relating to the provision and reimbursement of home telemonitoring
services, telemedicine medical services, and telehealth services
under the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 531.02164(a) and (c), Government Code,
are amended to read as follows:
(a) In this section:
(1) "Elderly individual" means an individual 60 years
of age or older.
(2) "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.
(3) [(2)] "Hospital" means a hospital licensed under
Chapter 241, Health and Safety Code.
(4) "Individual with special health care needs" means
an individual who has:
(A) a chronic physical or developmental
condition; or
(B) a terminal illness.
(c) The program required under this section must:
(1) provide that home telemonitoring services are
available [only] to a person [persons] who is:
(A) an elderly individual;
(B) an individual with special health care needs;
or
(C) an individual who:
(i) is [are] diagnosed with one or more of
the following conditions:
(a) [(i)] pregnancy;
(b) [(ii)] diabetes;
(c) [(iii)] heart disease;
(d) [(iv)] cancer;
(e) [(v)] chronic obstructive
pulmonary disease;
(f) [(vi)] hypertension;
(g) [(vii)] congestive heart failure;
(h) [(viii)] mental illness or
serious emotional disturbance;
(i) [(ix)] asthma;
(j) [(x)] myocardial infarction; or
(k) [(xi)] stroke; and
(ii) exhibits [(B) exhibit] two or more of
the following risk factors:
(a) [(i)] two or more
hospitalizations in the prior 12-month period;
(b) [(ii)] frequent or recurrent
emergency room admissions;
(c) [(iii)] a documented history of
poor adherence to ordered medication regimens;
(d) [(iv)] a documented history of
falls in the prior six-month period;
(e) [(v)] limited or absent informal
support systems;
(f) [(vi)] living alone or being home
alone for extended periods of time; and
(g) [(vii)] a documented history of
care access challenges;
(2) ensure that clinical information gathered by a
home health agency or hospital 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 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02165 to read as follows:
Sec. 531.02165. PROVISION OF TELEMEDICINE MEDICAL SERVICES
AND TELEHEALTH SERVICES TO RECIPIENTS AT RESIDENCE. (a) In this
section, "residence" means a place where a person resides and
includes a home, a nursing home, a convalescent home, or a
residential unit.
(b) The executive commissioner shall develop and implement
a pilot project under the state Medicaid program that provides for
the reimbursement of telemedicine medical services and telehealth
services provided to a recipient while the recipient is at the
recipient's residence.
(c) Based on the results of the pilot project established
under Subsection (b), if the executive commissioner determines that
it would be cost-effective and feasible to develop and implement a
statewide program under the state Medicaid program that provides
for the reimbursement of telemedicine medical services and
telehealth services provided to a recipient while the recipient is
at the recipient's residence, the executive commissioner shall
establish the statewide program by rule.
(d) Not later than December 1, 2016, the executive
commissioner shall submit a report to the legislature on the
results of the pilot project established under Subsection (b) and,
if applicable, the progress on the implementation of the statewide
program established under Subsection (c). The report must include:
(1) an evaluation of the pilot project's success and,
if applicable, the statewide program's success in increasing health
care access for Medicaid recipients;
(2) an evaluation of the cost savings to the state and
Medicaid recipients attributable to the pilot project and, if
applicable, the statewide program; and
(3) a recommendation regarding the continuation,
expansion, or termination of the statewide program, if applicable.
(e) Subsection (d) and this subsection expire September 1,
2017.
SECTION 3. Section 531.0217, Government Code, is amended by
adding Subsections (d-1) and (d-2) to read as follows:
(d-1) The commission shall require that requests for
reimbursement for telemedicine medical services be approved at a
similar frequency as requests for reimbursement for comparable
in-person medical services. A request for reimbursement for a
telemedicine medical service may not be denied if the service is
medically necessary.
(d-2) Not later than December 1 of each even-numbered year,
the commission shall prepare and submit a report on telemedicine
medical services billing procedures to the legislative committees
having jurisdiction over the Medicaid program. The report required
by this subsection may be made in conjunction with any other report
the commission is required to submit to the legislature if the
commission determines it appropriate.
SECTION 4. Section 531.02176, Government Code, is repealed.
SECTION 5. Section 531.02164, Government Code, as amended
by this Act, applies only to an insurance claim filed, an insurance
policy entered into, or a legal cause arising on or after the
effective date of this Act. An insurance claim filed, an insurance
policy entered into, or a legal cause that arose before the
effective date of this Act is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 6. (a) Not later than January 1, 2016, the
executive commissioner of the Health and Human Services Commission
shall adopt the rules necessary to implement Section 531.02165,
Government Code, as added by this Act, and Section 531.0217,
Government Code, as amended by this Act.
(b) Not later than March 1, 2016, the executive commissioner
of the Health and Human Services Commission shall adopt the rules
necessary to implement Section 531.02164, Government Code, as
amended by this Act.
SECTION 7. 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 8. This Act takes effect September 1, 2015.