Texas 2015 - 84th Regular

Texas House Bill HB3476 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	84R22116 EES-F
2		-	By: Coleman H.B. No. 3476
3		-	Substitute the following for H.B. No. 3476:
4		-	By: Crownover C.S.H.B. No. 3476
	1	+	By: Coleman, Guillen H.B. No. 3476
5	2
6	3
7	4		A BILL TO BE ENTITLED
8	5		AN ACT
9		-	relating to the provision and reimbursement of, or benefits for,
	6	+	rela
	7	+	ting to the provision and reimbursement of, or benefits for,
10	8		home telemonitoring services, telemedicine medical services, and
11	9		telehealth services under Medicaid and certain health benefit plans
12	10		provided to certain retired public employees.
13	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14		-	SECTION 1. Sections 531.02164(a) and (c), Government Code,
15		-	as amended by S.B. No. 219, Acts of the 84th Legislature, Regular
16		-	Session, 2015, are amended to read as follows:
	12	+	SECTION 1. Section 531.02164, Government Code, is amended
	13	+	by amending Subsections (a) and (c), as amended by S.B. No. 219,
	14	+	Acts of the 84th Legislature, Regular Session, 2015, and adding
	15	+	Subsection (c-2) to read as follows:
17	16		(a) In this section:
18	17		(1) "Elderly individual" means an individual 60 years
19	18		of age or older.
20	19		(2) "Home and community support services agency" means
21	20		a person licensed under Chapter 142, Health and Safety Code, to
22	21		provide home health, hospice, or personal assistance services as
23	22		defined by Section 142.001, Health and Safety Code.
24	23		(3) [(2)] "Hospital" means a hospital licensed under
25	24		Chapter 241, Health and Safety Code.
26	25		(4) "Individual with special health care needs" means
27	26		an individual who has:
28	27		(A) a chronic physical or developmental
29	28		condition; or
30	29		(B) a terminal illness.
31	30		(c) The program required under this section must:
32	31		(1) provide that home telemonitoring services are
33	32		available [only] to a person [persons] who is:
34	33		(A) an elderly individual;
35	34		(B) an individual with special health care needs;
36	35		or
37	36		(C) an individual who:
38	37		(i) is [are] diagnosed with one or more of
39	38		the following conditions:
40	39		(a) [(i)] pregnancy;
41	40		(b) [(ii)] diabetes;
42	41		(c) [(iii)] heart disease;
43	42		(d) [(iv)] cancer;
44	43		(e) [(v)] chronic obstructive
45	44		pulmonary disease;
46	45		(f) [(vi)] hypertension;
47	46		(g) [(vii)] congestive heart failure;
48	47		(h) [(viii)] mental illness or
49	48		serious emotional disturbance;
50	49		(i) [(ix)] asthma;
51	50		(j) [(x)] myocardial infarction; or
52	51		(k) [(xi)] stroke; and
53	52		(ii) exhibits [(B) exhibit] two or more of
54	53		the following risk factors:
55	54		(a) [(i)] two or more
56	55		hospitalizations in the prior 12-month period;
57	56		(b) [(ii)] frequent or recurrent
58	57		emergency room admissions;
59	58		(c) [(iii)] a documented history of
60	59		poor adherence to ordered medication regimens;
61	60		(d) [(iv)] a documented history of
62	61		falls in the prior six-month period;
63	62		(e) [(v)] limited or absent informal
64	63		support systems;
65	64		(f) [(vi)] living alone or being home
66	65		alone for extended periods of time; and
67	66		(g) [(vii)] a documented history of
68	67		care access challenges;
69	68		(2) ensure that clinical information gathered by a
70	69		home and community support services agency or hospital while
71	70		providing home telemonitoring services is shared with the patient's
72		-	physician; and
	71	+	physician; [and]
73	72		(3) ensure that the program does not duplicate disease
74	73		management program services provided under Section 32.057, Human
75		-	Resources Code.
	74	+	Resources Code; and
	75	+	(4) provide reimbursement for home telemonitoring
	76	+	services in the event of an unsuccessful data transmission if the
	77	+	provider of the services attempts to communicate with the patient
	78	+	by telephone or in person to establish a successful data
	79	+	transmission.
	80	+	(c-2) A provider that is reimbursed under Subsection (c)(4)
	81	+	for home telemonitoring services provided to a patient may not also
	82	+	be reimbursed for communicating with the patient by telephone or in
	83	+	person to establish a successful data transmission as described by
	84	+	Subsection (c)(4).
76	85		SECTION 2. Subchapter B, Chapter 531, Government Code, is
77	86		amended by adding Section 531.02165 to read as follows:
78	87		Sec. 531.02165. PROVISION OF TELEMEDICINE MEDICAL SERVICES
79	88		AND TELEHEALTH SERVICES TO RECIPIENTS AT RESIDENCE. (a) In this
80	89		section, "residence" means a place where a person resides and
81	90		includes a home, a nursing home, a convalescent home, or a
82	91		residential unit.
83	92		(b) Not later than June 1, 2016, the executive commissioner
84	93		shall develop and implement a pilot project under Medicaid that
85	94		provides for the reimbursement of telemedicine medical services and
86	95		telehealth services provided to a recipient while the recipient is
87	96		at the recipient's residence.
88	97		(c) Not later than December 1, 2018, the executive
89	98		commissioner shall submit a report to the legislature on the
90	99		results of the pilot project established under Subsection (b). The
91	100		report must include:
92	101		(1) an evaluation of the pilot project's success in
93	102		increasing health care access for Medicaid recipients;
94	103		(2) an evaluation of the cost savings to the state and
95	104		Medicaid recipients attributable to the pilot project; and
96	105		(3) a recommendation regarding the continuation,
97	106		expansion, or termination of the pilot project.
98	107		(d) The report required by Subsection (c) may be made in
99	108		conjunction with any other report the commission is required to
100	109		submit to the legislature if the executive commissioner determines
101	110		it appropriate.
102	111		(e) Subsections (c) and (d) and this subsection expire
103	112		September 1, 2019.
104	113		SECTION 3. Section 531.0217, Government Code, is amended by
105	114		adding Subsection (d-1) to read as follows:
106	115		(d-1) A request to the commission for reimbursement for a
107	116		telemedicine medical service that is medically necessary may not be
108	117		denied solely because of the delivery method of the service.
109	118		SECTION 4. Subchapter E, Chapter 1551, Insurance Code, is
110	119		amended by adding Section 1551.227 to read as follows:
111	120		Sec. 1551.227. PILOT PROJECT: TELEMEDICINE MEDICAL
112	121		SERVICES AND TELEHEALTH SERVICES TO ANNUITANTS AT RESIDENCE. (a)
113	122		In this section:
114	123		(1) "Telehealth service" and "telemedicine medical
115	124		service" have the meanings assigned by Section 531.001, Government
116	125		Code.
117	126		(2) "Residence" means a place where a person resides
118	127		and includes a home, a nursing home, a convalescent home, or a
119	128		residential unit.
120	129		(b) The board of trustees shall establish a pilot project
121	130		under which a group health benefit plan offered under the group
122	131		benefits program provides benefits for telemedicine medical
123	132		services and telehealth services provided to an annuitant at the
124	133		annuitant's residence.
125	134		(c) Not later than June 1, 2016, the board of trustees shall
126	135		enter into any agreements necessary to provide benefits for
127	136		telemedicine medical services and telehealth services to
128	137		annuitants who participate in the pilot project. The pilot project
129	138		must:
130	139		(1) provide services in a manner that allows at least
131	140		one percent of annuitants to participate in the pilot project;
132	141		(2) aim to provide quality and cost-effective care to
133	142		annuitants; and
134	143		(3) ensure that the pilot project is able to provide
135	144		services to annuitants.
136	145		(d) Not later than December 1, 2018, the board of trustees
137	146		shall submit a report to the legislature on the results of the pilot
138	147		project established under Subsection (b). The report must include:
139	148		(1) an evaluation of the pilot project's success;
140	149		(2) an evaluation of the cost savings to the state; and
141	150		(3) a recommendation regarding the continuation,
142	151		expansion, or termination of the pilot project.
143	152		(e) The board of trustees may adopt rules necessary to
144	153		implement this section.
145	154		(f) This section expires on September 1, 2019.
146	155		SECTION 5. Subchapter D, Chapter 1575, Insurance Code, is
147	156		amended by adding Section 1575.166 to read as follows:
148	157		Sec. 1575.166. PILOT PROJECT: TELEMEDICINE MEDICAL
149	158		SERVICES AND TELEHEALTH SERVICES TO RETIREES AT RESIDENCE. (a) In
150	159		this section:
151	160		(1) "Telehealth service" and "telemedicine medical
152	161		service" have the meanings assigned by Section 531.001, Government
153	162		Code.
154	163		(2) "Residence" means a place where a person resides
155	164		and includes a home, a nursing home, a convalescent home, or a
156	165		residential unit.
157	166		(b) The trustee shall establish a pilot project under which
158	167		a health benefit plan provided under this chapter provides benefits
159	168		for telemedicine medical services and telehealth services provided
160	169		to a retiree at the retiree's residence.
161	170		(c) Not later than June 1, 2016, the trustee shall enter
162	171		into any agreements necessary to provide benefits for telemedicine
163	172		medical services and telehealth services to retirees who
164	173		participate in the pilot project. The pilot project must:
165	174		(1) provide services in a manner that allows at least
166	175		one percent of retirees to participate in the pilot project;
167	176		(2) aim to provide quality and cost-effective care to
168	177		retirees; and
169	178		(3) ensure that the pilot project is able to provide
170	179		services to retirees.
171	180		(d) Not later than December 1, 2018, the trustee shall
172	181		submit a report to the legislature on the results of the pilot
173	182		project established under Subsection (b). The report must include:
174	183		(1) an evaluation of the pilot project's success;
175	184		(2) an evaluation of the cost savings to the state; and
176	185		(3) a recommendation regarding the continuation,
177	186		expansion, or termination of the pilot project.
178	187		(e) The trustee may adopt rules necessary to implement this
179	188		section.
180	189		(f) This section expires on September 1, 2019.
181	190		SECTION 6. Section 531.02176, Government Code, as amended
182	191		by S.B. No. 219, Acts of the 84th Legislature, Regular Session,
183	192		2015, is repealed.
184	193		SECTION 7. Section 531.02164, Government Code, as amended
185	194		by this Act, applies only to an insurance claim filed, an insurance
186	195		policy entered into, or a legal cause arising on or after the
187	196		effective date of this Act. An insurance claim filed, an insurance
188	197		policy entered into, or a legal cause that arose before the
189	198		effective date of this Act is governed by the law as it existed
190	199		immediately before the effective date of this Act, and that law is
191	200		continued in effect for that purpose.
192	201		SECTION 8. (a) Not later than March 1, 2016, the executive
193	202		commissioner of the Health and Human Services Commission shall
194	203		adopt the rules necessary to implement Section 531.02164,
195	204		Government Code, as amended by this Act.
196	205		(b) Not later than May 1, 2016, the executive commissioner of
197	206		the Health and Human Services Commission shall adopt the rules
198	207		necessary to implement Section 531.02165, Government Code, as added
199	208		by this Act, and Section 531.0217, Government Code, as amended by
200	209		this Act.
201	210		SECTION 9. Not later than May 1, 2016, the Employees
202	211		Retirement System of Texas shall adopt rules necessary to implement
203	212		Section 1551.227, Insurance Code, as added by this Act.
204	213		SECTION 10. Not later than May 1, 2016, the Teacher
205	214		Retirement System of Texas shall adopt rules necessary to implement
206	215		Section 1575.166, Insurance Code, as added by this Act.
207	216		SECTION 11. If before implementing any provision of this
208	217		Act a state agency determines that a waiver or authorization from a
209	218		federal agency is necessary for implementation of that provision,
210	219		the agency affected by the provision shall request the waiver or
211	220		authorization and may delay implementing that provision until the
212	221		waiver or authorization is granted.
213	222		SECTION 12. This Act takes effect September 1, 2015.