By: Price, et al. (Senate Sponsor - Buckingham) H.B. No. 4
(In the Senate - Received from the House April 19, 2021;
April 19, 2021, read first time and referred to Committee on Health &
Human Services; May 20, 2021, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 8, Nays 0;
May 20, 2021, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR H.B. No. 4 By: Miles
A BILL TO BE ENTITLED
AN ACT
relating to the provision and delivery of certain health care
services in this state, including 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:
(1) "Behavioral health services" has the meaning
assigned by Section 533.00255.
(2) "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) preventive 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) To the extent permitted by state and federal law and to
the extent it is cost-effective and clinically effective, as
determined by the commission, the executive commissioner by rule
shall develop and implement a system that ensures behavioral health
services may be provided using an audio-only platform consistent
with Section 111.008, Occupations Code, 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
an audio-only platform 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 the audio-only platform. In
determining whether the use of an audio-only platform in a program
is appropriate under this subsection, the executive commissioner
shall consider whether using the platform 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 who
have conditions and exhibit risk factors 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) subject to Section 531.0216(c) and consistent with
Section 111.007, Occupations Code, consider and include the
availability of telehealth services and telemedicine medical
services within the provider network of a Medicaid 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 or e-mail with
recipients enrolled in the organization's managed care plan using
the contact information provided in a recipient's application for
Medicaid benefits under Section 32.025(g)(2), Human Resources
Code.
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 executive
commissioner by rule shall establish policies and procedures that
allow a Medicaid managed care organization to conduct assessments
and provide care coordination services using telecommunications or
information technology. In establishing the policies and
procedures, the executive commissioner shall consider:
(1) the extent to which a managed care organization
determines using the telecommunications or information technology
is appropriate;
(2) whether the recipient requests that the assessment
or service be provided using telecommunications or information
technology;
(3) whether the recipient consents to receiving the
assessment or service using telecommunications or information
technology;
(4) whether conducting the assessment, including an
assessment for an initial waiver eligibility determination, or
providing the service in person is not feasible because of the
existence of an emergency or state of disaster, including a public
health emergency or natural disaster; and
(5) whether the commission determines using the
telecommunications or information technology is appropriate under
the circumstances.
(c) If a Medicaid 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)(4), 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 to
make an initial waiver eligibility determination; and
(2) additional in-person visits with the recipient if
necessary, as determined by the managed care organization.
(f) Notwithstanding the provisions of this section, the
commission may, on a case-by-case basis, require a Medicaid managed
care organization to discontinue the use of telecommunications or
information technology for assessment or service coordination
services if the commission determines that the discontinuation is
in the best interest of the recipient.
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. Subchapter A, Chapter 462, Health and Safety
Code, is amended by adding Section 462.015 to read as follows:
Sec. 462.015. OUTPATIENT TREATMENT SERVICES PROVIDED USING
TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a) An outpatient
chemical dependency treatment program provided by a treatment
facility licensed under Chapter 464 may provide services under the
program to adult and adolescent clients, consistent with commission
rule, using telecommunications or information technology.
(b) The executive commissioner shall adopt rules to
implement this section.
SECTION 9. Section 462.025, Health and Safety Code, is
amended by adding Subsection (d-1) to read as follows:
(d-1) The rules governing the intake, screening, and
assessment procedures shall establish minimum standards for
providing intake, screening, and assessment using
telecommunications or information technology.
SECTION 10. Section 32.025(g), Human Resources Code, is
amended to read as follows:
(g) The application form adopted under this section must
include:
(1) for an applicant who is pregnant, a question
regarding whether the pregnancy is the woman's first gestational
pregnancy; and
(2) for all applicants, a question regarding the
applicant's preferences for being contacted by a managed care
organization or health care provider, as follows:
"If you are determined eligible for benefits, your
managed care organization or health plan provider may contact you
by telephone, text message, or e-mail about health care matters,
including reminders for appointments and information about
immunizations or well check visits. All preferred methods of
contact listed on this application will be shared with your managed
care organization or health plan provider. Please indicate below
your preferred methods of contact in order of preference, with the
number 1 being the most preferable method:
(1) By telephone (if contacted by cellular telephone, the
call may be autodialed or prerecorded, and your carrier's usage
rates may apply)? Yes No
Telephone number: _____________
Order of preference: 1 2 3 (circle a number)
(2) By text message (a free autodialed service, but your
carrier may charge message and data rates)? Yes No
Cellular telephone number: ______________
Order of preference: 1 2 3 (circle a number)
(3) By e-mail? Yes No
E-mail address: __________________
Order of preference: 1 2 3 (circle a number)".
SECTION 11. 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 12. 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 13. 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.
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