By: Buckingham S.B. No. 670
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 531.0216, Government Code, is amended by
amending Subsection (b) and adding Subsection (g) to read as
follows:
(b) In developing the system, the executive commissioner by
rule shall:
(1) review programs and pilot projects in other states
to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for
services;
(3) [consult with the Department of State Health
Services to establish procedures to:
[(A) identify clinical evidence supporting
delivery of health care services using a telecommunications system;
and
[(B) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
[(4)] establish a separate provider identifier for
telemedicine medical services providers, telehealth services
providers, and home telemonitoring services providers; and
(4) [(5)] establish a separate modifier for
telemedicine medical services, telehealth services, and home
telemonitoring services eligible for reimbursement.
(g) The commission shall ensure a managed care organization
that contracts with the commission under Chapter 533 to provide
health care services to Medicaid recipients 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 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. In
complying with state and federal requirements to provide access to
medically necessary services under the Medicaid managed care
program, a 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 2. Section 531.0217(c-4), Government Code, is
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].
SECTION 3. The following provisions of the Government Code
are repealed:
(1) Section 531.0216(e);
(2) Section 531.02161;
(3) Sections 531.0217(c-2) and (c-3); and
(4) Section 531.02173.
SECTION 4. 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 5. This Act takes effect September 1, 2019.