86R6128 MM-D
By: Guillen H.B. No. 1738
A BILL TO BE ENTITLED
AN ACT
relating to telehealth and home telemonitoring services, including
the provision of those services under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02164, Government Code, is amended
by adding Subsections (c-1), (c-2), and (f) to read as follows:
(c-1) Notwithstanding Subsection (c)(1), the program
required under this section may also provide that home
telemonitoring services are available to a pediatric patient with
chronic or complex medical needs who:
(1) is being concurrently treated by at least three
medical specialists;
(2) is diagnosed with end-stage solid organ disease;
(3) has received an organ transplant; or
(4) is diagnosed with severe asthma.
(c-2) For purposes of the program established under this
section, the executive commissioner shall:
(1) establish an enhanced Medicaid reimbursement rate
for home telemonitoring services related to management of a
person's medication that is at least $6 per day more than the rate
in effect on January 1, 2019;
(2) establish billing codes and a fee schedule for
Medicaid reimbursement for home telemonitoring services provided
by a federally-qualified health center, as defined by 42 U.S.C.
Section 1396d(l)(2)(B), that are separate from other billing codes
and fee schedules established for reimbursement for services
provided by a federally-qualified health center;
(3) develop a process to prevent fraud and verify the
success of a data transmission that includes validation of the data
transmission by the service provider's data carrier; and
(4) allow for reimbursement for home telemonitoring
services provided for a period of at least 120 days per episode.
(f) Each provider of home telemonitoring services under the
program established under this section shall provide to the
commission data regarding the services provided for analytical
purposes.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02177 to read as follows:
Sec. 531.02177. STUDY CONCERNING HOME TELEMONITORING AND
TELEHEALTH SERVICES FRAUD, WASTE, AND ABUSE. (a) Subject to the
availability of funds, the commission shall conduct a study to
identify patterns or instances of fraud, waste, or abuse committed
by providers of Medicaid home telemonitoring services and
telehealth services.
(b) Not later than September 1, 2020, the commission shall
submit to the governor, the lieutenant governor, the speaker of the
house of representatives, and each legislative standing committee
with primary jurisdiction over Medicaid the results of the study
conducted under this section and recommendations for legislative or
other action.
(c) Based on the findings of the commission, the executive
commissioner may adopt rules necessary to prevent or reduce fraud,
waste, and abuse by providers of Medicaid home telemonitoring
services and telehealth services.
(d) This section expires September 1, 2021.
SECTION 3. Section 111.001(3), Occupations Code, is amended
to read as follows:
(3) "Telehealth service" means a health service, other
than a telemedicine medical service, delivered by a health
professional licensed, certified, or otherwise entitled to
practice in this state and acting within the scope of the health
professional's license, certification, or entitlement to a patient
at a different physical location than the health professional using
telecommunications or information technology. The term includes:
(A) peer services provided by a certified mental
health peer specialist or a certified substance use recovery
specialist;
(B) substance use counseling services; and
(C) targeted case management services.
SECTION 4. The following sections of the Government Code
are repealed:
(1) Section 531.02164(d); and
(2) Section 531.02176.
SECTION 5. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules necessary to implement the
changes in law made by this Act.
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, 2019.