Texas 2019 - 86th Regular

Texas Senate Bill SB670 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 670
	1	+	86R23578 MM-F
	2	+	By: Buckingham S.B. No. 670
	3	+	(Price, Guillen, Sheffield, Ashby,
	4	+	González of El Paso, et al.)
2	5
3	6
	7	+	A BILL TO BE ENTITLED
4	8		AN ACT
5		-	relating to telemedicine and telehealth services.
	9	+	relating to Medicaid telemedicine and telehealth services.
6	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
7	11		SECTION 1. Section 531.001, Government Code, is amended by
8	12		adding Subdivisions (4-c) and (4-d) to read as follows:
9	13		(4-c) "Medicaid managed care organization" means a
10	14		managed care organization as defined by Section 533.001 that
11	15		contracts with the commission under Chapter 533 to provide health
12	16		care services to Medicaid recipients.
13	17		(4-d) "Platform" means the technology, system,
14	18		software, application, modality, or other method through which a
15	19		health professional remotely interfaces with a patient when
16	20		providing a health care service or procedure as a telemedicine
17	21		medical service or telehealth service.
18	22		SECTION 2. Section 531.0216, Government Code, is amended by
19	23		amending Subsections (c) and (c-1) and adding Subsections (g), (h),
20	24		(i), and (j) to read as follows:
21	25		(c) The commission shall encourage health care providers
22	26		and health care facilities to provide [participate as] telemedicine
23	27		medical services and [service providers or] telehealth services
24	28		[service providers] in the health care delivery system. The
25	29		commission may not require that a service be provided to a patient
26	30		through telemedicine medical services or telehealth services [when
27	31		the service can reasonably be provided by a physician through a
28	32		face-to-face consultation with the patient in the community in
29	33		which the patient resides or works. This subsection does not
30	34		prohibit the authorization of the provision of any service to a
31	35		patient through telemedicine medical services or telehealth
32	36		services at the patient's request].
33	37		(c-1) The commission shall[:
34	38		[(1)] explore opportunities to increase STAR Health
35	39		program providers' use of telemedicine medical services in
36	40		medically underserved areas of this state[; and
37	41		[(2) encourage STAR Health program providers to use
38	42		telemedicine medical services as appropriate].
39	43		(g) The commission shall ensure that a Medicaid managed care
40	44		organization:
41	45		(1) does not deny reimbursement for a covered health
42	46		care service or procedure delivered by a health care provider with
43	47		whom the managed care organization contracts to a Medicaid
44	48		recipient as a telemedicine medical service or a telehealth service
45	49		solely because the covered service or procedure is not provided
46	50		through an in-person consultation;
47	51		(2) does not limit, deny, or reduce reimbursement for
48	52		a covered health care service or procedure delivered by a health
49	53		care provider with whom the managed care organization contracts to
50	54		a Medicaid recipient as a telemedicine medical service or a
51	55		telehealth service based on the health care provider's choice of
52	56		platform for providing the health care service or procedure; and
53	57		(3) ensures that the use of telemedicine medical
54	58		services or telehealth services promotes and supports
55	59		patient-centered medical homes by allowing a Medicaid recipient to
56	60		receive a telemedicine medical service or telehealth service from a
57	61		provider other than the recipient's primary care physician or
58	62		provider, except as provided by Section 531.0217(c-4), only if:
59	63		(A) the telemedicine medical service or
60	64		telehealth service is provided in accordance with the law and
61	65		contract requirements applicable to the provision of the same
62	66		health care service in an in-person setting, including requirements
63	67		regarding care coordination; and
64	68		(B) the provider of the telemedicine medical
65	69		service or telehealth service gives notice to the Medicaid
66	70		recipient's primary care physician or provider regarding the
67	71		telemedicine medical service or telehealth service, including a
68	72		summary of the service, exam findings, a list of prescribed or
69	73		administered medications, and patient instructions, for the
70	74		purpose of sharing medical information, provided that the recipient
71	75		has a primary care physician or provider and the recipient or, if
72	76		appropriate, the recipient's parent or legal guardian, consents to
73	77		the notice.
74	78		(h) The commission shall develop, document, and implement a
75	79		monitoring process to ensure that a Medicaid managed care
76	80		organization ensures that the use of telemedicine medical services
77	81		or telehealth services promotes and supports patient-centered
78	82		medical homes and care coordination in accordance with Subsection
79	83		(g)(3). The process must include monitoring of the rate at which a
80	84		telemedicine medical service or telehealth service provider gives
81	85		notice in accordance with Subsection (g)(3)(B).
82	86		(i) The executive commissioner by rule shall ensure that a
83	87		federally qualified health center as defined by 42 U.S.C. Section
84	88		1396d(l)(2)(B) may be reimbursed for the originating site facility
85	89		fee or the distant site practitioner fee or both, as appropriate,
86	90		for a covered telemedicine medical service or telehealth service
87	91		delivered by a health care provider to a Medicaid recipient. The
88	92		commission is required to implement this subsection only if the
89	93		legislature appropriates money specifically for that purpose. If
90	94		the legislature does not appropriate money specifically for that
91	95		purpose, the commission may, but is not required to, implement this
92	96		subsection using other money available to the commission for that
93	97		purpose.
94	98		(j) In complying with state and federal requirements to
95	99		provide access to medically necessary services under the Medicaid
96	100		managed care program, a Medicaid managed care organization
97	101		determining whether reimbursement for a telemedicine medical
98	102		service or telehealth service is appropriate shall continue to
99	103		consider other factors, including whether reimbursement is
100	104		cost-effective and whether the provision of the service is
101	105		clinically effective.
102	106		SECTION 3. Sections 531.0217(c-4), (d), and (k), Government
103	107		Code, are amended to read as follows:
104	108		(c-4) The commission shall ensure that Medicaid
105	109		reimbursement is provided to a physician for a telemedicine medical
106	110		service provided by the physician, even if the physician is not the
107	111		patient's primary care physician or provider, if:
108	112		(1) the physician is an authorized health care
109	113		provider under Medicaid;
110	114		(2) the patient is a child who receives the service in
111	115		a primary or secondary school-based setting; and
112	116		(3) the parent or legal guardian of the patient
113	117		provides consent before the service is provided[; and
114	118		[(4) a health professional is present with the patient
115	119		during the treatment].
116	120		(d) The commission shall require reimbursement for a
117	121		telemedicine medical service at the same rate as Medicaid
118	122		reimburses for the same [a comparable] in-person medical service.
119	123		A request for reimbursement may not be denied solely because an
120	124		in-person medical service between a physician and a patient did not
121	125		occur. The commission may not limit a physician's choice of
122	126		platform for providing a telemedicine medical service or telehealth
123	127		service by requiring that the physician use a particular platform
124	128		to receive reimbursement for the service.
125	129		(k) This section does not affect any requirement relating
126	130		to:
127	131		(1) [a federally qualified health center;
128	132		[(2)] a rural health clinic; or
129	133		(2) [(3)] physician delegation of the authority to
130	134		carry out or sign prescription drug orders to an advanced practice
131	135		nurse or physician assistant.
132		-	SECTION 4. Section 162.251(2), Occupations Code, is amended
133		-	to read as follows:
134		-	(2) "Direct primary care" means a primary medical care
135		-	service provided by a physician to a patient in return for payment
136		-	in accordance with a direct fee. The term includes telemedicine
137		-	medical services and telehealth services, as those terms are
138		-	defined by Section 111.001, provided using a technology platform.
139		-	SECTION 5. Section 562.110, Occupations Code, is amended by
140		-	amending Subsections (e) and (f) and adding Subsection (f-1) to
141		-	read as follows:
142		-	(e) The board shall adopt rules regarding the use of a
143		-	telepharmacy system under this section, including:
144		-	(1) the types of health care facilities at which a
145		-	telepharmacy system may be located under Subsection (d)(1), which
146		-	must include the following facilities:
147		-	(A) a clinic designated as a rural health clinic
148		-	regulated under 42 U.S.C. Section 1395x(aa); [and]
149		-	(B) a health center as defined by 42 U.S.C.
150		-	Section 254b; and
151		-	(C) a federally qualified health center as
152		-	defined by 42 U.S.C. Section 1396d(l)(2)(B);
153		-	(2) the locations eligible to be licensed as remote
154		-	dispensing sites, which must include locations in medically
155		-	underserved areas, areas with a medically underserved population,
156		-	and health professional shortage areas determined by the United
157		-	States Department of Health and Human Services;
158		-	(3) licensing and operating requirements for remote
159		-	dispensing sites, including:
160		-	(A) a requirement that a remote dispensing site
161		-	license identify the provider pharmacy that will provide pharmacy
162		-	services at the remote dispensing site;
163		-	(B) a requirement that a provider pharmacy be
164		-	allowed to provide pharmacy services at not more than two remote
165		-	dispensing sites;
166		-	(C) a requirement that a pharmacist employed by a
167		-	provider pharmacy make at least monthly on-site visits to a remote
168		-	dispensing site or more frequent visits if specified by board rule;
169		-	(D) a requirement that each month the perpetual
170		-	inventory of controlled substances at the remote dispensing site be
171		-	reconciled to the on-hand count of those controlled substances at
172		-	the site by a pharmacist employed by the provider pharmacy;
173		-	(E) a requirement that a pharmacist employed by a
174		-	provider pharmacy be physically present at a remote dispensing site
175		-	when the pharmacist is providing services requiring the physical
176		-	presence of the pharmacist, including immunizations;
177		-	(F) a requirement that a remote dispensing site
178		-	be staffed by an on-site pharmacy technician who is under the
179		-	continuous supervision of a pharmacist employed by the provider
180		-	pharmacy;
181		-	(G) a requirement that all pharmacy technicians
182		-	at a remote dispensing site be counted for the purpose of
183		-	establishing the pharmacist-pharmacy technician ratio of the
184		-	provider pharmacy, which, notwithstanding Section 568.006, may not
185		-	exceed three pharmacy technicians for each pharmacist providing
186		-	supervision;
187		-	(H) a requirement that, before working at a
188		-	remote dispensing site, a pharmacy technician must:
189		-	(i) have worked at least one year at a
190		-	retail pharmacy during the three years preceding the date the
191		-	pharmacy technician begins working at the remote dispensing site;
192		-	and
193		-	(ii) have completed a board-approved
194		-	training program on the proper use of a telepharmacy system;
195		-	(I) a requirement that pharmacy technicians at a
196		-	remote dispensing site may not perform extemporaneous sterile or
197		-	nonsterile compounding but may prepare commercially available
198		-	medications for dispensing, including the reconstitution of orally
199		-	administered powder antibiotics; and
200		-	(J) any additional training or practice
201		-	experience requirements for pharmacy technicians at a remote
202		-	dispensing site;
203		-	(4) the areas that qualify under Subsection (f);
204		-	(5) recordkeeping requirements; and
205		-	(6) security requirements.
206		-	(f) Except as provided by Subsection (f-1), a [A]
207		-	telepharmacy system located at a health care facility under
208		-	Subsection (d)(1) may not be located in a community in which a Class
209		-	A or Class C pharmacy is located as determined by board rule. If a
210		-	Class A or Class C pharmacy is established in a community in which a
211		-	telepharmacy system has been located under this section, the
212		-	telepharmacy system may continue to operate in that community.
213		-	(f-1) A telepharmacy system located at a federally
214		-	qualified health center as defined by 42 U.S.C. Section
215		-	1396d(l)(2)(B) may be located in a community in which a Class A or
216		-	Class C pharmacy is located as determined by board rule.
217		-	SECTION 6. The following provisions of the Government Code
	136	+	SECTION 4. The following provisions of the Government Code
218	137		are repealed:
219	138		(1) Sections 531.0216(b) and (e);
220	139		(2) Section 531.02161;
221	140		(3) Sections 531.0217(c-1), (c-2), (c-3), and (f);
222	141		(4) Section 531.02173; and
223	142		(5) Section 531.02176.
224		-	SECTION 7. If before implementing any provision of this Act
	143	+	SECTION 5. If before implementing any provision of this Act
225	144		a state agency determines that a waiver or authorization from a
226	145		federal agency is necessary for implementation of that provision,
227	146		the agency affected by the provision shall request the waiver or
228	147		authorization and may delay implementing that provision until the
229	148		waiver or authorization is granted.
230		-	SECTION 8. This Act takes effect September 1, 2019.
231		-	______________________________ ______________________________
232		-	President of the Senate Speaker of the House
233		-	I hereby certify that S.B. No. 670 passed the Senate on
234		-	March 27, 2019, by the following vote: Yeas 31, Nays 0; and that
235		-	the Senate concurred in House amendments on May 21, 2019, by the
236		-	following vote: Yeas 31, Nays 0.
237		-	______________________________
238		-	Secretary of the Senate
239		-	I hereby certify that S.B. No. 670 passed the House, with
240		-	amendments, on May 14, 2019, by the following vote: Yeas 138,
241		-	Nays 0, two present not voting.
242		-	______________________________
243		-	Chief Clerk of the House
244		-	Approved:
245		-	______________________________
246		-	Date
247		-	______________________________
248		-	Governor
	149	+	SECTION 6. This Act takes effect September 1, 2019.