Texas 2019 - 86th Regular

Texas House Bill HB870 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	86R23578 MM-F
2		-	By: Price, Guillen, Sheffield, Ashby, H.B. No. 870
3		-	González of El Paso, et al.
4		-	Substitute the following for H.B. No. 870:
5		-	By: Price C.S.H.B. No. 870
	1	+	86R3452 MM-F
	2	+	By: Price H.B. No. 870
6	3
7	4
8	5		A BILL TO BE ENTITLED
9	6		AN ACT
10	7		relating to Medicaid telemedicine and telehealth services.
11	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12		-	SECTION 1. Section 531.001, Government Code, is amended by
13		-	adding Subdivisions (4-c) and (4-d) to read as follows:
14		-	(4-c) "Medicaid managed care organization" means a
15		-	managed care organization as defined by Section 533.001 that
16		-	contracts with the commission under Chapter 533 to provide health
17		-	care services to Medicaid recipients.
18		-	(4-d) "Platform" means the technology, system,
19		-	software, application, modality, or other method through which a
20		-	health professional remotely interfaces with a patient when
21		-	providing a health care service or procedure as a telemedicine
22		-	medical service or telehealth service.
23		-	SECTION 2. Section 531.0216, Government Code, is amended by
24		-	amending Subsections (c) and (c-1) and adding Subsections (g), (h),
25		-	(i), and (j) to read as follows:
26		-	(c) The commission shall encourage health care providers
27		-	and health care facilities to provide [participate as] telemedicine
28		-	medical services and [service providers or] telehealth services
29		-	[service providers] in the health care delivery system. The
30		-	commission may not require that a service be provided to a patient
31		-	through telemedicine medical services or telehealth services [when
32		-	the service can reasonably be provided by a physician through a
33		-	face-to-face consultation with the patient in the community in
34		-	which the patient resides or works. This subsection does not
35		-	prohibit the authorization of the provision of any service to a
36		-	patient through telemedicine medical services or telehealth
37		-	services at the patient's request].
38		-	(c-1) The commission shall[:
39		-	[(1)] explore opportunities to increase STAR Health
40		-	program providers' use of telemedicine medical services in
41		-	medically underserved areas of this state[; and
42		-	[(2) encourage STAR Health program providers to use
43		-	telemedicine medical services as appropriate].
44		-	(g) The commission shall ensure that a Medicaid managed care
45		-	organization:
46		-	(1) does not deny reimbursement for a covered health
47		-	care service or procedure delivered by a health care provider with
48		-	whom the managed care organization contracts to a Medicaid
49		-	recipient as a telemedicine medical service or a telehealth service
50		-	solely because the covered service or procedure is not provided
51		-	through an in-person consultation;
52		-	(2) does not limit, deny, or reduce reimbursement for
53		-	a covered health care service or procedure delivered by a health
54		-	care provider with whom the managed care organization contracts to
55		-	a Medicaid recipient as a telemedicine medical service or a
56		-	telehealth service based on the health care provider's choice of
57		-	platform for providing the health care service or procedure; and
58		-	(3) ensures that the use of telemedicine medical
59		-	services or telehealth services promotes and supports
60		-	patient-centered medical homes by allowing a Medicaid recipient to
61		-	receive a telemedicine medical service or telehealth service from a
62		-	provider other than the recipient's primary care physician or
63		-	provider, except as provided by Section 531.0217(c-4), only if:
64		-	(A) the telemedicine medical service or
65		-	telehealth service is provided in accordance with the law and
66		-	contract requirements applicable to the provision of the same
67		-	health care service in an in-person setting, including requirements
68		-	regarding care coordination; and
69		-	(B) the provider of the telemedicine medical
70		-	service or telehealth service gives notice to the Medicaid
71		-	recipient's primary care physician or provider regarding the
72		-	telemedicine medical service or telehealth service, including a
73		-	summary of the service, exam findings, a list of prescribed or
74		-	administered medications, and patient instructions, for the
75		-	purpose of sharing medical information, provided that the recipient
76		-	has a primary care physician or provider and the recipient or, if
77		-	appropriate, the recipient's parent or legal guardian, consents to
78		-	the notice.
79		-	(h) The commission shall develop, document, and implement a
80		-	monitoring process to ensure that a Medicaid managed care
81		-	organization ensures that the use of telemedicine medical services
82		-	or telehealth services promotes and supports patient-centered
83		-	medical homes and care coordination in accordance with Subsection
84		-	(g)(3). The process must include monitoring of the rate at which a
85		-	telemedicine medical service or telehealth service provider gives
86		-	notice in accordance with Subsection (g)(3)(B).
87		-	(i) The executive commissioner by rule shall ensure that a
88		-	federally qualified health center as defined by 42 U.S.C. Section
89		-	1396d(l)(2)(B) may be reimbursed for the originating site facility
90		-	fee or the distant site practitioner fee or both, as appropriate,
91		-	for a covered telemedicine medical service or telehealth service
92		-	delivered by a health care provider to a Medicaid recipient. The
93		-	commission is required to implement this subsection only if the
94		-	legislature appropriates money specifically for that purpose. If
95		-	the legislature does not appropriate money specifically for that
96		-	purpose, the commission may, but is not required to, implement this
97		-	subsection using other money available to the commission for that
98		-	purpose.
99		-	(j) In complying with state and federal requirements to
100		-	provide access to medically necessary services under the Medicaid
101		-	managed care program, a Medicaid managed care organization
102		-	determining whether reimbursement for a telemedicine medical
103		-	service or telehealth service is appropriate shall continue to
104		-	consider other factors, including whether reimbursement is
105		-	cost-effective and whether the provision of the service is
106		-	clinically effective.
107		-	SECTION 3. Sections 531.0217(c-4), (d), and (k), Government
108		-	Code, are amended to read as follows:
	9	+	SECTION 1. Section 531.0216, Government Code, is amended by
	10	+	amending Subsection (b) and adding Subsection (g) to read as
	11	+	follows:
	12	+	(b) In developing the system, the executive commissioner by
	13	+	rule shall:
	14	+	(1) review programs and pilot projects in other states
	15	+	to determine the most effective method for reimbursement;
	16	+	(2) establish billing codes and a fee schedule for
	17	+	services;
	18	+	(3) [consult with the Department of State Health
	19	+	Services to establish procedures to:
	20	+	[(A) identify clinical evidence supporting
	21	+	delivery of health care services using a telecommunications system;
	22	+	and
	23	+	[(B) annually review health care services,
	24	+	considering new clinical findings, to determine whether
	25	+	reimbursement for particular services should be denied or
	26	+	authorized;
	27	+	[(4)] establish a separate provider identifier for
	28	+	telemedicine medical services providers, telehealth services
	29	+	providers, and home telemonitoring services providers; and
	30	+	(4) [(5)] establish a separate modifier for
	31	+	telemedicine medical services, telehealth services, and home
	32	+	telemonitoring services eligible for reimbursement.
	33	+	(g) The commission shall ensure a managed care organization
	34	+	that contracts with the commission under Chapter 533 to provide
	35	+	health care services to Medicaid recipients does not deny
	36	+	reimbursement for a covered health care service or procedure
	37	+	delivered by a health care provider with whom the managed care
	38	+	organization contracts to a recipient as a telemedicine medical
	39	+	service or a telehealth service solely because the covered service
	40	+	or procedure is not provided through an in-person consultation.
	41	+	SECTION 2. Section 531.0217(c-4), Government Code, is
	42	+	amended to read as follows:
109	43		(c-4) The commission shall ensure that Medicaid
110	44		reimbursement is provided to a physician for a telemedicine medical
111	45		service provided by the physician, even if the physician is not the
112	46		patient's primary care physician or provider, if:
113	47		(1) the physician is an authorized health care
114	48		provider under Medicaid;
115	49		(2) the patient is a child who receives the service in
116	50		a primary or secondary school-based setting; and
117	51		(3) the parent or legal guardian of the patient
118	52		provides consent before the service is provided[; and
119	53		[(4) a health professional is present with the patient
120	54		during the treatment].
121		-	(d) The commission shall require reimbursement for a
122		-	telemedicine medical service at the same rate as Medicaid
123		-	reimburses for the same [a comparable] in-person medical service.
124		-	A request for reimbursement may not be denied solely because an
125		-	in-person medical service between a physician and a patient did not
126		-	occur. The commission may not limit a physician's choice of
127		-	platform for providing a telemedicine medical service or telehealth
128		-	service by requiring that the physician use a particular platform
129		-	to receive reimbursement for the service.
130		-	(k) This section does not affect any requirement relating
131		-	to:
132		-	(1) [a federally qualified health center;
133		-	[(2)] a rural health clinic; or
134		-	(2) [(3)] physician delegation of the authority to
135		-	carry out or sign prescription drug orders to an advanced practice
136		-	nurse or physician assistant.
137		-	SECTION 4. The following provisions of the Government Code
	55	+	SECTION 3. The following provisions of the Government Code
138	56		are repealed:
139		-	(1) ~~Sections~~ 531.0216(~~b) and (~~e);
	57	+	(1) Section 531.0216(e);
140	58		(2) Section 531.02161;
141		-	(3) Sections 531.0217(c-1), (c-2), (c-3), and (f);
142		-	(4) Section 531.02173; and
143		-	(5) Section 531.02176.
144		-	SECTION 5. If before implementing any provision of this Act
	59	+	(3) Sections 531.0217(c-2) and (c-3); and
	60	+	(4) Section 531.02173.
	61	+	SECTION 4. If before implementing any provision of this Act
145	62		a state agency determines that a waiver or authorization from a
146	63		federal agency is necessary for implementation of that provision,
147	64		the agency affected by the provision shall request the waiver or
148	65		authorization and may delay implementing that provision until the
149	66		waiver or authorization is granted.
150		-	SECTION 6. This Act takes effect September 1, 2019.
	67	+	SECTION 5. This Act takes effect September 1, 2019.