86R23578 MM-F
By: Price, Guillen, Sheffield, Ashby, H.B. No. 870
González of El Paso, et al.
Substitute the following for H.B. No. 870:
By: Price C.S.H.B. No. 870
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid telemedicine and telehealth services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.001, Government Code, is amended by
adding Subdivisions (4-c) and (4-d) to read as follows:
(4-c) "Medicaid managed care organization" means a
managed care organization as defined by Section 533.001 that
contracts with the commission under Chapter 533 to provide health
care services to Medicaid recipients.
(4-d) "Platform" means the technology, system,
software, application, modality, or other method through which a
health professional remotely interfaces with a patient when
providing a health care service or procedure as a telemedicine
medical service or telehealth service.
SECTION 2. Section 531.0216, Government Code, is amended by
amending Subsections (c) and (c-1) and adding Subsections (g), (h),
(i), and (j) to read as follows:
(c) The commission shall encourage health care providers
and health care facilities to provide [participate as] telemedicine
medical services and [service providers or] telehealth services
[service providers] in the health care delivery system. The
commission may not require that a service be provided to a patient
through telemedicine medical services or telehealth services [when
the service can reasonably be provided by a physician through a
face-to-face consultation with the patient in the community in
which the patient resides or works. This subsection does not
prohibit the authorization of the provision of any service to a
patient through telemedicine medical services or telehealth
services at the patient's request].
(c-1) The commission shall[:
[(1)] explore opportunities to increase STAR Health
program providers' use of telemedicine medical services in
medically underserved areas of this state[; and
[(2) encourage STAR Health program providers to use
telemedicine medical services as appropriate].
(g) The commission shall ensure that a Medicaid managed care
organization:
(1) does not deny reimbursement for a covered health
care service or procedure delivered by a health care provider with
whom the managed care organization contracts to a Medicaid
recipient as a telemedicine medical service or a telehealth service
solely because the covered service or procedure is not provided
through an in-person consultation;
(2) does not limit, deny, or reduce reimbursement for
a covered health care service or procedure delivered by a health
care provider with whom the managed care organization contracts to
a Medicaid recipient as a telemedicine medical service or a
telehealth service based on the health care provider's choice of
platform for providing the health care service or procedure; and
(3) ensures that the use of telemedicine medical
services or telehealth services promotes and supports
patient-centered medical homes by allowing a Medicaid recipient to
receive a telemedicine medical service or telehealth service from a
provider other than the recipient's primary care physician or
provider, except as provided by Section 531.0217(c-4), only if:
(A) the telemedicine medical service or
telehealth service is provided in accordance with the law and
contract requirements applicable to the provision of the same
health care service in an in-person setting, including requirements
regarding care coordination; and
(B) the provider of the telemedicine medical
service or telehealth service gives notice to the Medicaid
recipient's primary care physician or provider regarding the
telemedicine medical service or telehealth service, including a
summary of the service, exam findings, a list of prescribed or
administered medications, and patient instructions, for the
purpose of sharing medical information, provided that the recipient
has a primary care physician or provider and the recipient or, if
appropriate, the recipient's parent or legal guardian, consents to
the notice.
(h) The commission shall develop, document, and implement a
monitoring process to ensure that a Medicaid managed care
organization ensures that the use of telemedicine medical services
or telehealth services promotes and supports patient-centered
medical homes and care coordination in accordance with Subsection
(g)(3). The process must include monitoring of the rate at which a
telemedicine medical service or telehealth service provider gives
notice in accordance with Subsection (g)(3)(B).
(i) The executive commissioner by rule shall ensure that a
federally qualified health center as defined by 42 U.S.C. Section
1396d(l)(2)(B) may be reimbursed for the originating site facility
fee or the distant site practitioner fee or both, as appropriate,
for a covered telemedicine medical service or telehealth service
delivered by a health care provider to a Medicaid recipient. The
commission is required to implement this subsection only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the commission may, but is not required to, implement this
subsection using other money available to the commission for that
purpose.
(j) In complying with state and federal requirements to
provide access to medically necessary services under the Medicaid
managed care program, a Medicaid managed care organization
determining whether reimbursement for a telemedicine medical
service or telehealth service is appropriate shall continue to
consider other factors, including whether reimbursement is
cost-effective and whether the provision of the service is
clinically effective.
SECTION 3. Sections 531.0217(c-4), (d), and (k), Government
Code, are amended to read as follows:
(c-4) The commission shall ensure that Medicaid
reimbursement is provided to a physician for a telemedicine medical
service provided by the physician, even if the physician is not the
patient's primary care physician or provider, if:
(1) the physician is an authorized health care
provider under Medicaid;
(2) the patient is a child who receives the service in
a primary or secondary school-based setting; and
(3) the parent or legal guardian of the patient
provides consent before the service is provided[; and
[(4) a health professional is present with the patient
during the treatment].
(d) The commission shall require reimbursement for a
telemedicine medical service at the same rate as Medicaid
reimburses for the same [a comparable] in-person medical service.
A request for reimbursement may not be denied solely because an
in-person medical service between a physician and a patient did not
occur. The commission may not limit a physician's choice of
platform for providing a telemedicine medical service or telehealth
service by requiring that the physician use a particular platform
to receive reimbursement for the service.
(k) This section does not affect any requirement relating
to:
(1) [a federally qualified health center;
[(2)] a rural health clinic; or
(2) [(3)] physician delegation of the authority to
carry out or sign prescription drug orders to an advanced practice
nurse or physician assistant.
SECTION 4. The following provisions of the Government Code
are repealed:
(1) Sections 531.0216(b) and (e);
(2) Section 531.02161;
(3) Sections 531.0217(c-1), (c-2), (c-3), and (f);
(4) Section 531.02173; and
(5) Section 531.02176.
SECTION 5. 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 6. This Act takes effect September 1, 2019.