Texas 2021 - 87th Regular

Texas House Bill HB4 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 4
	1	+	By: Price, et al. (Senate Sponsor - Buckingham) H.B. No. 4
	2	+	(In the Senate - Received from the House April 19, 2021;
	3	+	April 19, 2021, read first time and referred to Committee on Health &
	4	+	Human Services; May 20, 2021, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 8, Nays 0;
	6	+	May 20, 2021, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR H.B. No. 4 By: Miles
2	9
3	10
	11	+	A BILL TO BE ENTITLED
4	12		AN ACT
5	13		relating to the provision and delivery of certain health care
6	14		services in this state, including services under Medicaid and other
7	15		public benefits programs, using telecommunications or information
8	16		technology and to reimbursement for some of those services.
9	17		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	18		SECTION 1. Section 531.0216(i), Government Code, is amended
11	19		to read as follows:
12	20		(i) The executive commissioner by rule shall ensure that a
13	21		rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and
14	22		a federally qualified health center as defined by 42 U.S.C. Section
15	23		1396d(l)(2)(B) may be reimbursed for the originating site facility
16	24		fee or the distant site practitioner fee or both, as appropriate,
17	25		for a covered telemedicine medical service or telehealth service
18	26		delivered by a health care provider to a Medicaid recipient. The
19	27		commission is required to implement this subsection only if the
20	28		legislature appropriates money specifically for that purpose. If
21	29		the legislature does not appropriate money specifically for that
22	30		purpose, the commission may, but is not required to, implement this
23	31		subsection using other money available to the commission for that
24	32		purpose.
25	33		SECTION 2. Subchapter B, Chapter 531, Government Code, is
26	34		amended by adding Section 531.02161 to read as follows:
27	35		Sec. 531.02161. PROVISION OF SERVICES THROUGH
28	36		TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND
29	37		OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section:
30	38		(1) "Behavioral health services" has the meaning
31	39		assigned by Section 533.00255.
32	40		(2) "Case management services" includes service
33	41		coordination, service management, and care coordination.
34	42		(b) To the extent permitted by federal law and to the extent
35	43		it is cost-effective and clinically effective, as determined by the
36	44		commission, the commission shall ensure that Medicaid recipients,
37	45		child health plan program enrollees, and other individuals
38	46		receiving benefits under a public benefits program administered by
39	47		the commission or a health and human services agency, regardless of
40	48		whether receiving benefits through a managed care delivery model or
41	49		another delivery model, have the option to receive services as
42	50		telemedicine medical services, telehealth services, or otherwise
43	51		using telecommunications or information technology, including the
44	52		following services:
45	53		(1) preventive health and wellness services;
46	54		(2) case management services, including targeted case
47	55		management services;
48	56		(3) subject to Subsection (c), behavioral health
49	57		services;
50	58		(4) occupational, physical, and speech therapy
51	59		services;
52	60		(5) nutritional counseling services; and
53	61		(6) assessment services, including nursing
54	62		assessments under the following Section 1915(c) waiver programs:
55	63		(A) the community living assistance and support
56	64		services (CLASS) waiver program;
57	65		(B) the deaf-blind with multiple disabilities
58	66		(DBMD) waiver program;
59	67		(C) the home and community-based services (HCS)
60	68		waiver program; and
61	69		(D) the Texas home living (TxHmL) waiver program.
62	70		(c) To the extent permitted by state and federal law and to
63	71		the extent it is cost-effective and clinically effective, as
64	72		determined by the commission, the executive commissioner by rule
65	73		shall develop and implement a system that ensures behavioral health
66	74		services may be provided using an audio-only platform consistent
67	75		with Section 111.008, Occupations Code, to a Medicaid recipient, a
68	76		child health plan program enrollee, or another individual receiving
69	77		those services under another public benefits program administered
70	78		by the commission or a health and human services agency.
71	79		(d) If the executive commissioner determines that providing
72	80		services other than behavioral health services is appropriate using
73	81		an audio-only platform under a public benefits program administered
74	82		by the commission or a health and human services agency, in
75	83		accordance with applicable federal and state law, the executive
76	84		commissioner may by rule authorize the provision of those services
77	85		under the applicable program using the audio-only platform. In
78	86		determining whether the use of an audio-only platform in a program
79	87		is appropriate under this subsection, the executive commissioner
80	88		shall consider whether using the platform would be cost-effective
81	89		and clinically effective.
82	90		SECTION 3. Section 531.02164, Government Code, is amended
83	91		by adding Subsection (f) to read as follows:
84	92		(f) To comply with state and federal requirements to provide
85	93		access to medically necessary services under the Medicaid managed
86	94		care program, a Medicaid managed care organization may reimburse
87	95		providers for home telemonitoring services provided to persons who
88	96		have conditions and exhibit risk factors other than those expressly
89	97		authorized by this section. In determining whether the managed
90	98		care organization should provide reimbursement for services under
91	99		this subsection, the organization shall consider whether
92	100		reimbursement for the service is cost-effective and providing the
93	101		service is clinically effective.
94	102		SECTION 4. Section 533.0061(b), Government Code, is amended
95	103		to read as follows:
96	104		(b) To the extent it is feasible, the provider access
97	105		standards established under this section must:
98	106		(1) distinguish between access to providers in urban
99	107		and rural settings; [and]
100	108		(2) consider the number and geographic distribution of
101	109		Medicaid-enrolled providers in a particular service delivery area;
102	110		and
103	111		(3) subject to Section 531.0216(c) and consistent with
104	112		Section 111.007, Occupations Code, consider and include the
105	113		availability of telehealth services and telemedicine medical
106	114		services within the provider network of a Medicaid managed care
107	115		organization.
108	116		SECTION 5. Section 533.008, Government Code, is amended by
109	117		adding Subsection (c) to read as follows:
110	118		(c) The executive commissioner shall adopt and publish
111	119		guidelines for Medicaid managed care organizations regarding how
112	120		organizations may communicate by text message or e-mail with
113	121		recipients enrolled in the organization's managed care plan using
114	122		the contact information provided in a recipient's application for
115	123		Medicaid benefits under Section 32.025(g)(2), Human Resources
116		-	Code, including updated information provided to the organization in
117		-	accordance with Section 32.025(h), Human Resources Code.
	124	+	Code.
118	125		SECTION 6. Subchapter A, Chapter 533, Government Code, is
119	126		amended by adding Section 533.039 to read as follows:
120	127		Sec. 533.039. DELIVERY OF BENEFITS USING
121	128		TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY. (a) The commission
122	129		shall establish policies and procedures to improve access to care
123	130		under the Medicaid managed care program by encouraging the use of
124	131		telehealth services, telemedicine medical services, home
125	132		telemonitoring services, and other telecommunications or
126	133		information technology under the program.
127	134		(b) To the extent permitted by federal law, the executive
128	135		commissioner by rule shall establish policies and procedures that
129	136		allow a Medicaid managed care organization to conduct assessments
130	137		and provide care coordination services using telecommunications or
131	138		information technology. In establishing the policies and
132	139		procedures, the executive commissioner shall consider:
133	140		(1) the extent to which a managed care organization
134	141		determines using the telecommunications or information technology
135	142		is appropriate;
136	143		(2) whether the recipient requests that the assessment
137	144		or service be provided using telecommunications or information
138	145		technology;
139	146		(3) whether the recipient consents to receiving the
140	147		assessment or service using telecommunications or information
141	148		technology;
142	149		(4) whether conducting the assessment, including an
143	150		assessment for an initial waiver eligibility determination, or
144	151		providing the service in person is not feasible because of the
145	152		existence of an emergency or state of disaster, including a public
146	153		health emergency or natural disaster; and
147	154		(5) whether the commission determines using the
148	155		telecommunications or information technology is appropriate under
149	156		the circumstances.
150	157		(c) If a Medicaid managed care organization conducts an
151	158		assessment of or provides care coordination services to a recipient
152	159		using telecommunications or information technology, the managed
153	160		care organization shall:
154	161		(1) monitor the health care services provided to the
155	162		recipient for evidence of fraud, waste, and abuse; and
156	163		(2) determine whether additional social services or
157	164		supports are needed.
158	165		(d) To the extent permitted by federal law, the commission
159	166		shall allow a recipient who is assessed or provided with care
160	167		coordination services by a Medicaid managed care organization using
161	168		telecommunications or information technology to provide consent or
162	169		other authorizations to receive services verbally instead of in
163	170		writing.
164	171		(e) The commission shall determine categories of recipients
165	172		of home and community-based services who must receive in-person
166	173		visits. Except during circumstances described by Subsection
167	174		(b)(4), a Medicaid managed care organization shall, for a recipient
168	175		of home and community-based services for which the commission
169	176		requires in-person visits, conduct:
170	177		(1) at least one in-person visit with the recipient to
171	178		make an initial waiver eligibility determination; and
172	179		(2) additional in-person visits with the recipient if
173	180		necessary, as determined by the managed care organization.
174	181		(f) Notwithstanding the provisions of this section, the
175	182		commission may, on a case-by-case basis, require a Medicaid managed
176	183		care organization to discontinue the use of telecommunications or
177	184		information technology for assessment or service coordination
178	185		services if the commission determines that the discontinuation is
179	186		in the best interest of the recipient.
180	187		SECTION 7. Section 62.1571, Health and Safety Code, is
181	188		amended to read as follows:
182	189		Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
183	190		SERVICES. (a) In providing covered benefits to a child, a health
184	191		plan provider must permit benefits to be provided through
185	192		telemedicine medical services and telehealth services in
186	193		accordance with policies developed by the commission.
187	194		(b) The policies must provide for:
188	195		(1) the availability of covered benefits
189	196		appropriately provided through telemedicine medical services or
190	197		telehealth services that are comparable to the same types of
191	198		covered benefits provided without the use of telemedicine medical
192	199		services or telehealth services; and
193	200		(2) the availability of covered benefits for different
194	201		services performed by multiple health care providers during a
195	202		single session of telemedicine medical services or telehealth
196	203		services, if the executive commissioner determines that delivery of
197	204		the covered benefits in that manner is cost-effective in comparison
198	205		to the costs that would be involved in obtaining the services from
199	206		providers without the use of telemedicine medical services or
200	207		telehealth services, including the costs of transportation and
201	208		lodging and other direct costs.
202	209		(d) In this section, "telehealth service" and "telemedicine
203	210		medical service" have [has] the meanings [meaning] assigned by
204	211		Section 531.001, Government Code.
205	212		SECTION 8. Subchapter A, Chapter 462, Health and Safety
206	213		Code, is amended by adding Section 462.015 to read as follows:
207	214		Sec. 462.015. OUTPATIENT TREATMENT SERVICES PROVIDED USING
208	215		TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a) An outpatient
209	216		chemical dependency treatment program provided by a treatment
210	217		facility licensed under Chapter 464 may provide services under the
211	218		program to adult and adolescent clients, consistent with commission
212	219		rule, using telecommunications or information technology.
213	220		(b) The executive commissioner shall adopt rules to
214	221		implement this section.
215	222		SECTION 9. Section 462.025, Health and Safety Code, is
216	223		amended by adding Subsection (d-1) to read as follows:
217	224		(d-1) The rules governing the intake, screening, and
218	225		assessment procedures shall establish minimum standards for
219	226		providing intake, screening, and assessment using
220	227		telecommunications or information technology.
221		-	SECTION 10. Section 32.025, Human Resources Code, is
222		-	amended by amending Subsection (g) and adding Subsection (h) to
223		-	read as follows:
224		-	(g) The application form, including a renewal form, adopted
225		-	under this section must include:
	228	+	SECTION 10. Section 32.025(g), Human Resources Code, is
	229	+	amended to read as follows:
	230	+	(g) The application form adopted under this section must
	231	+	include:
226	232		(1) for an applicant who is pregnant, a question
227	233		regarding whether the pregnancy is the woman's first gestational
228		-	pregnancy; [and]
	234	+	pregnancy; and
229	235		(2) for all applicants, a question regarding the
230	236		applicant's preferences for being contacted by a managed care
231		-	organization or health plan provider that provides the applicant
232		-	with the option to be contacted[, as follows:
233		-	["If you are determined eligible for benefits,
234		-	your managed care organization or health plan provider may contact
235		-	you] by telephone, text message, or e-mail about health care
236		-	matters, including reminders for appointments and information
237		-	about immunizations or well check visits; and
238		-	(3) language that:
239		-	(A) notifies the applicant that, if determined
240		-	eligible for benefits, all preferred contact methods listed on the
241		-	application and renewal forms will be shared with the applicant's
242		-	managed care organization or health plan provider;
243		-	(B) allows the applicant to consent to being
244		-	contacted through the preferred contact methods by the applicant's
245		-	managed care organization or health plan provider; and
246		-	(C) explains the security risks of electronic
247		-	communication. [All preferred methods of contact listed on this
248		-	application will be shared with your managed care organization or
249		-	health plan provider. Please indicate below your preferred methods
250		-	of contact in order of preference, with the number 1 being the most
251		-	preferable method:
252		-	[(1) By telephone (if contacted by cellular telephone,
253		-	the call may be autodialed or prerecorded, and your carrier's usage
	237	+	organization or health care provider, as follows:
	238	+	"If you are determined eligible for benefits, your
	239	+	managed care organization or health plan provider may contact you
	240	+	by telephone, text message, or e-mail about health care matters,
	241	+	including reminders for appointments and information about
	242	+	immunizations or well check visits. All preferred methods of
	243	+	contact listed on this application will be shared with your managed
	244	+	care organization or health plan provider. Please indicate below
	245	+	your preferred methods of contact in order of preference, with the
	246	+	number 1 being the most preferable method:
	247	+	(1) By telephone (if contacted by cellular telephone, the
	248	+	call may be autodialed or prerecorded, and your carrier's usage
254	249		rates may apply)? Yes No
255		-	[Telephone number: _____________
256		-	[Order of preference: 1 2 3 (circle a number)
257		-	[(2) By text message (a free autodialed service, but
258		-	your carrier may charge message and data rates)? Yes No
259		-	[Cellular telephone number: ______________
260		-	[Order of preference: 1 2 3 (circle a number)
261		-	[(3) By e-mail? Yes No
262		-	[E-mail address: __________________
263		-	[Order of preference: 1 2 3 (circle a number)".]
264		-	(h) For purposes of Subsections (g)(2) and (3), the
265		-	commission shall implement a process to:
266		-	(1) transmit the applicant's preferred contact methods
267		-	and consent to the managed care organization or health plan
268		-	provider;
269		-	(2) allow an applicant to change the applicant's
270		-	preferences in the future, including providing for an option to opt
271		-	out of electronic communication; and
272		-	(3) communicate updated information to the managed
273		-	care organization or health plan provider.
	250	+	Telephone number: _____________
	251	+	Order of preference: 1 2 3 (circle a number)
	252	+	(2) By text message (a free autodialed service, but your
	253	+	carrier may charge message and data rates)? Yes No
	254	+	Cellular telephone number: ______________
	255	+	Order of preference: 1 2 3 (circle a number)
	256	+	(3) By e-mail? Yes No
	257	+	E-mail address: __________________
	258	+	Order of preference: 1 2 3 (circle a number)".
274	259		SECTION 11. Not later than January 1, 2022, the Health and
275	260		Human Services Commission shall:
276		-	(1) adopt a revised application form for medical
277		-	assistance benefits that conforms to the requirements of Section
278		-	32.025(g), Human Resources Code, as amended by this Act;
279		-	(2) implement Section 531.02161, Government Code, as
	261	+	(1) implement Section 531.02161, Government Code, as
280	262		added by this Act; and
281		-	(3) publish the guidelines required by Section
	263	+	(2) publish the guidelines required by Section
282	264		533.008(c), Government Code, as added by this Act.
283	265		SECTION 12. If before implementing any provision of this
284	266		Act a state agency determines that a waiver or authorization from a
285	267		federal agency is necessary for implementation of that provision,
286	268		the agency affected by the provision shall request the waiver or
287	269		authorization and may delay implementing that provision until the
288	270		waiver or authorization is granted.
289	271		SECTION 13. This Act takes effect immediately if it
290	272		receives a vote of two-thirds of all the members elected to each
291	273		house, as provided by Section 39, Article III, Texas Constitution.
292	274		If this Act does not receive the vote necessary for immediate
293	275		effect, this Act takes effect September 1, 2021.
294		-	______________________________ ______________________________
295		-	President of the Senate Speaker of the House
296		-	I certify that H.B. No. 4 was passed by the House on April 15,
297		-	2021, by the following vote: Yeas 145, Nays 0, 1 present, not
298		-	voting; and that the House concurred in Senate amendments to H.B.
299		-	No. 4 on May 28, 2021, by the following vote: Yeas 147, Nays 0, 1
300		-	present, not voting.
301		-	______________________________
302		-	Chief Clerk of the House
303		-	I certify that H.B. No. 4 was passed by the Senate, with
304		-	amendments, on May 24, 2021, by the following vote: Yeas 30, Nays
305		-	0.
306		-	______________________________
307		-	Secretary of the Senate
308		-	APPROVED: __________________
309		-	Date
310		-	__________________
311		-	Governor
	276	+	* * * * *