87R14291 KKR-F
By: Price, Oliverson, Coleman, Ashby, H.B. No. 4
Guillen, et al.
Substitute the following for H.B. No. 4:
By: Klick C.S.H.B. No. 4
A BILL TO BE ENTITLED
AN ACT
relating to the provision and delivery of health care services
under Medicaid and other public benefits programs using
telecommunications or information technology and to reimbursement
for some of those services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.0216(i), Government Code, is amended
to read as follows:
(i) The executive commissioner by rule shall ensure that a
rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and
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.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02161 to read as follows:
Sec. 531.02161. PROVISION OF SERVICES THROUGH
TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND
OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section, "case
management services" includes service coordination, service
management, and care coordination.
(b) To the extent permitted by federal law and to the extent
it is cost-effective and clinically effective, as determined by the
commission, the commission shall ensure that Medicaid recipients,
child health plan program enrollees, and other individuals
receiving benefits under a public benefits program administered by
the commission or a health and human services agency, regardless of
whether receiving benefits through a managed care delivery model or
another delivery model, have the option to receive services as
telemedicine medical services, telehealth services, or otherwise
using telecommunications or information technology, including the
following services:
(1) preventative health and wellness services;
(2) case management services, including targeted case
management services;
(3) subject to Subsection (c), behavioral health
services;
(4) occupational, physical, and speech therapy
services;
(5) nutritional counseling services; and
(6) assessment services, including nursing
assessments under the following Section 1915(c) waiver programs:
(A) the community living assistance and support
services (CLASS) waiver program;
(B) the deaf-blind with multiple disabilities
(DBMD) waiver program;
(C) the home and community-based services (HCS)
waiver program; and
(D) the Texas home living (TxHmL) waiver program.
(c) The commission by rule shall develop and implement a
system to ensure behavioral health services may be provided using
audio-only technology to a Medicaid recipient, a child health plan
program enrollee, or another individual receiving those services
under another public benefits program administered by the
commission or a health and human services agency.
(d) If the executive commissioner determines that providing
services other than behavioral health services is appropriate using
audio-only technology under a public benefits program administered
by the commission or a health and human services agency, in
accordance with applicable federal and state law, the executive
commissioner may by rule authorize the provision of those services
under the applicable program using that technology. In determining
whether the use of audio-only technology in a program is
appropriate under this subsection, the executive commissioner
shall consider whether using the technology would be cost-effective
and clinically effective.
SECTION 3. Section 531.02164, Government Code, is amended
by adding Subsection (f) to read as follows:
(f) To comply with state and federal requirements to provide
access to medically necessary services under the Medicaid managed
care program, a Medicaid managed care organization may reimburse
providers for home telemonitoring services provided to persons and
in circumstances other than those expressly authorized by this
section. In determining whether the managed care organization
should provide reimbursement for services under this subsection,
the organization shall consider whether reimbursement for the
service is cost-effective and providing the service is clinically
effective.
SECTION 4. Section 533.0061(b), Government Code, is amended
to read as follows:
(b) To the extent it is feasible, the provider access
standards established under this section must:
(1) distinguish between access to providers in urban
and rural settings; [and]
(2) consider the number and geographic distribution of
Medicaid-enrolled providers in a particular service delivery area;
and
(3) consider and include the availability of
telehealth services and telemedicine medical services within the
provider network of a managed care organization.
SECTION 5. Section 533.008, Government Code, is amended by
adding Subsection (c) to read as follows:
(c) The executive commissioner shall adopt and publish
guidelines for Medicaid managed care organizations regarding how
organizations may communicate by text message with recipients
enrolled in the organization's managed care plan. The guidelines
must include standardized consent language to be used by
organizations in obtaining a recipient's consent to receive
communications by text message.
SECTION 6. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.039 to read as follows:
Sec. 533.039. DELIVERY OF BENEFITS USING
TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY. (a) The commission
shall establish policies and procedures to improve access to care
under the Medicaid managed care program by encouraging the use of
telehealth services, telemedicine medical services, home
telemonitoring services, and other telecommunications or
information technology under the program.
(b) To the extent permitted by federal law, the commission
by rule shall establish policies and procedures that allow a
Medicaid managed care organization to conduct assessments of and
provide care coordination services to recipients receiving home and
community-based services using another telecommunications or
information technology if:
(1) the managed care organization determines using the
telecommunications or information technology is appropriate;
(2) the recipient requests that the assessment or
activity is provided using telecommunications or information
technology;
(3) an in-person assessment or activity is not
feasible because of the existence of an emergency or state of
disaster, including a public health emergency or natural disaster;
or
(4) the commission determines using the
telecommunications or information technology is appropriate under
the circumstances.
(c) If a managed care organization conducts an assessment of
or provides care coordination services to a recipient using
telecommunications or information technology, the managed care
organization shall:
(1) monitor the health care services provided to the
recipient for evidence of fraud, waste, and abuse; and
(2) determine whether additional social services or
supports are needed.
(d) To the extent permitted by federal law, the commission
shall allow a recipient who is assessed or provided with care
coordination services by a Medicaid managed care organization using
telecommunications or information technology to provide consent or
other authorizations to receive services verbally instead of in
writing.
(e) The commission shall determine categories of recipients
of home and community-based services who must receive in-person
visits. Except during circumstances described by Subsection
(b)(3), a Medicaid managed care organization shall, for a recipient
of home and community-based services for which the commission
requires in-person visits, conduct:
(1) at least one in-person visit with the recipient;
and
(2) additional in-person visits with the recipient if
necessary, as determined by the managed care organization.
SECTION 7. Section 62.1571, Health and Safety Code, is
amended to read as follows:
Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
SERVICES. (a) In providing covered benefits to a child, a health
plan provider must permit benefits to be provided through
telemedicine medical services and telehealth services in
accordance with policies developed by the commission.
(b) The policies must provide for:
(1) the availability of covered benefits
appropriately provided through telemedicine medical services or
telehealth services that are comparable to the same types of
covered benefits provided without the use of telemedicine medical
services or telehealth services; and
(2) the availability of covered benefits for different
services performed by multiple health care providers during a
single session of telemedicine medical services or telehealth
services, if the executive commissioner determines that delivery of
the covered benefits in that manner is cost-effective in comparison
to the costs that would be involved in obtaining the services from
providers without the use of telemedicine medical services or
telehealth services, including the costs of transportation and
lodging and other direct costs.
(d) In this section, "telehealth service" and "telemedicine
medical service" have [has] the meanings [meaning] assigned by
Section 531.001, Government Code.
SECTION 8. Not later than January 1, 2022, the Health and
Human Services Commission shall:
(1) implement Section 531.02161, Government Code, as
added by this Act; and
(2) publish the guidelines required by Section
533.008(c), Government Code, as added by this Act.
SECTION 9. 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 10. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2021.