84R22116 EES-F
By: Coleman H.B. No. 3476
Substitute the following for H.B. No. 3476:
By: Crownover C.S.H.B. No. 3476
A BILL TO BE ENTITLED
AN ACT
relating to the provision and reimbursement of, or benefits for,
home telemonitoring services, telemedicine medical services, and
telehealth services under Medicaid and certain health benefit plans
provided to certain retired public employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 531.02164(a) and (c), Government Code,
as amended by S.B. No. 219, Acts of the 84th Legislature, Regular
Session, 2015, are amended to read as follows:
(a) In this section:
(1) "Elderly individual" means an individual 60 years
of age or older.
(2) "Home and community support services agency" means
a person licensed under Chapter 142, Health and Safety Code, to
provide home health, hospice, or personal assistance 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 and community support services 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) Not later than June 1, 2016, the executive commissioner
shall develop and implement a pilot project under Medicaid 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) Not later than December 1, 2018, the executive
commissioner shall submit a report to the legislature on the
results of the pilot project established under Subsection (b). The
report must include:
(1) an evaluation of the pilot project'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
(3) a recommendation regarding the continuation,
expansion, or termination of the pilot project.
(d) The report required by Subsection (c) may be made in
conjunction with any other report the commission is required to
submit to the legislature if the executive commissioner determines
it appropriate.
(e) Subsections (c) and (d) and this subsection expire
September 1, 2019.
SECTION 3. Section 531.0217, Government Code, is amended by
adding Subsection (d-1) to read as follows:
(d-1) A request to the commission for reimbursement for a
telemedicine medical service that is medically necessary may not be
denied solely because of the delivery method of the service.
SECTION 4. Subchapter E, Chapter 1551, Insurance Code, is
amended by adding Section 1551.227 to read as follows:
Sec. 1551.227. PILOT PROJECT: TELEMEDICINE MEDICAL
SERVICES AND TELEHEALTH SERVICES TO ANNUITANTS AT RESIDENCE. (a)
In this section:
(1) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 531.001, Government
Code.
(2) "Residence" means a place where a person resides
and includes a home, a nursing home, a convalescent home, or a
residential unit.
(b) The board of trustees shall establish a pilot project
under which a group health benefit plan offered under the group
benefits program provides benefits for telemedicine medical
services and telehealth services provided to an annuitant at the
annuitant's residence.
(c) Not later than June 1, 2016, the board of trustees shall
enter into any agreements necessary to provide benefits for
telemedicine medical services and telehealth services to
annuitants who participate in the pilot project. The pilot project
must:
(1) provide services in a manner that allows at least
one percent of annuitants to participate in the pilot project;
(2) aim to provide quality and cost-effective care to
annuitants; and
(3) ensure that the pilot project is able to provide
services to annuitants.
(d) Not later than December 1, 2018, the board of trustees
shall submit a report to the legislature on the results of the pilot
project established under Subsection (b). The report must include:
(1) an evaluation of the pilot project's success;
(2) an evaluation of the cost savings to the state; and
(3) a recommendation regarding the continuation,
expansion, or termination of the pilot project.
(e) The board of trustees may adopt rules necessary to
implement this section.
(f) This section expires on September 1, 2019.
SECTION 5. Subchapter D, Chapter 1575, Insurance Code, is
amended by adding Section 1575.166 to read as follows:
Sec. 1575.166. PILOT PROJECT: TELEMEDICINE MEDICAL
SERVICES AND TELEHEALTH SERVICES TO RETIREES AT RESIDENCE. (a) In
this section:
(1) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 531.001, Government
Code.
(2) "Residence" means a place where a person resides
and includes a home, a nursing home, a convalescent home, or a
residential unit.
(b) The trustee shall establish a pilot project under which
a health benefit plan provided under this chapter provides benefits
for telemedicine medical services and telehealth services provided
to a retiree at the retiree's residence.
(c) Not later than June 1, 2016, the trustee shall enter
into any agreements necessary to provide benefits for telemedicine
medical services and telehealth services to retirees who
participate in the pilot project. The pilot project must:
(1) provide services in a manner that allows at least
one percent of retirees to participate in the pilot project;
(2) aim to provide quality and cost-effective care to
retirees; and
(3) ensure that the pilot project is able to provide
services to retirees.
(d) Not later than December 1, 2018, the trustee shall
submit a report to the legislature on the results of the pilot
project established under Subsection (b). The report must include:
(1) an evaluation of the pilot project's success;
(2) an evaluation of the cost savings to the state; and
(3) a recommendation regarding the continuation,
expansion, or termination of the pilot project.
(e) The trustee may adopt rules necessary to implement this
section.
(f) This section expires on September 1, 2019.
SECTION 6. Section 531.02176, Government Code, as amended
by S.B. No. 219, Acts of the 84th Legislature, Regular Session,
2015, is repealed.
SECTION 7. 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 8. (a) 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.
(b) Not later than May 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.
SECTION 9. Not later than May 1, 2016, the Employees
Retirement System of Texas shall adopt rules necessary to implement
Section 1551.227, Insurance Code, as added by this Act.
SECTION 10. Not later than May 1, 2016, the Teacher
Retirement System of Texas shall adopt rules necessary to implement
Section 1575.166, Insurance Code, as added by this Act.
SECTION 11. 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 12. This Act takes effect September 1, 2015.