By: Buckingham S.B. No. 412
A BILL TO BE ENTITLED
AN ACT
relating to telemedicine, telehealth, and technology-related
health care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.0216, Government Code, is amended by
amending Subsection (i) and adding Subsections (k) and (l) to read
as follows:
(i) The executive commissioner by rule shall ensure that a
federally qualified health center as defined by 42 U.S.C. Section
1396d(l)(2)(B) or a rural health clinic as defined by 42 U.S.C.
Section 1396d(l)(1) 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.
(k) No later than January 1, 2022, the commission shall
implement reimbursement for telemedicine medical services and
telehealth services in the following programs, services and
benefits:
(1) Children with Special Health Care Needs program,
(2) Early Childhood Intervention,
(3) School and Health Related Services,
(4) physical therapy, occupational therapy and speech
therapy,
(5) targeted case management,
(6) nutritional counseling services,
(7) Texas Health Steps checkups,
(8) Medicaid 1915(c)waiver programs, including the
Community Living and Support Services waiver, and
(9) any other program, benefit, or service under the
commission's jurisdiction that the commissioner determines to be
cost effective and clinically effective.
(l) The commission shall implement audio-only benefits for
behavioral health services, and may implement audio-only benefits
in any program under the commission's jurisdiction, in accordance
with federal and state law and shall consider other factors,
including whether reimbursement is cost-effective and whether the
provision of the service is clinically effective, in making the
determination.
SECTION 2. Section 531.02164, Government Code, is amended
by adding Subsection (f) to read as follows:
(f) In complying 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 not
specifically defined in this section and shall consider other
factors, including whether reimbursement is cost-effective and
whether the provision of the service is clinically effective, in
making the determination.
SECTION 3. Section 533, Government Code, is amended by
adding Section 533.00252 to read as follows:
533.00252 DELIVERY OF TELECOMMUNICATION SERVICES. (a) The
commission shall implement policies and procedures to improve
access to care through telemedicine, telehealth, tele-monitoring,
and other telecommunication or information technology solutions.
(b) To the extent authorized by federal law, the commission
shall establish policies and procedures that allow managed care
organizations to conduct assessment and service coordination
activities for members receiving home and community-based services
through telecommunication or information technology in the
following circumstances:
(1) when the managed care organization determines it
appropriate;
(2) the member requests activities occur through
telecommunication or information technology;
(3) when in-person activities are not feasible due to
a natural disaster, pandemic, public health emergency; or
(4) in other circumstances identified by the
commission.
(c) If assessment or service coordination activities are
conducted through telecommunication or information technology, the
managed care organization must:
(1) monitor health care services provided to the
member for fraud, waste, and abuse; and
(2) determine the need for additional social services
and supports.
(d) Except as provided by Subsection (b)(3), a managed care
organization must conduct the following activities for members
receiving home and community-based services:
(1) at least one in-person visit for the population
that requires face to face visits as determined by HHSC; or
(2) additional in-person visits as determined
necessary by the managed care organization.
(e) To the extent authorized by federal law, the commission
must allow managed care members receiving assessments or service
coordination through telecommunication or information technology
to provide verbal authorizations in lieu of written signatures on
all required forms.
SECTION 4. Section 533.0061 (b), Government Code, is
amended by adding Subsection (b)(3) 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
telemedicine and telehealth services within the provider network
of a managed care organization.
SECTION 5. Chapter 533, Government Code, is amended by
adding Subsection 533.088(c)to read as follows:
Sec. 533.008. MARKETING GUIDELINES. (a) The commission
shall establish marketing guidelines for managed care
organizations that contract with the commission to provide health
care services to recipients, including guidelines that prohibit:
(1) door-to-door marketing to recipients by managed
care organizations or agents of those organizations;
(2) the use of marketing materials with inaccurate or
misleading information;
(3) misrepresentations to recipients or providers;
(4) offering recipients material or financial
incentives to choose a managed care plan other than nominal gifts or
free health screenings approved by the commission that the managed
care organization offers to all recipients regardless of whether
the recipients enroll in the managed care plan;
(5) the use of marketing agents who are paid solely by
commission; and
(6) face-to-face marketing at public assistance
offices by managed care organizations or agents of those
organizations.
(b) This section does not prohibit:
(1) the distribution of approved marketing materials
at public assistance offices; or
(2) the provision of information directly to
recipients under marketing guidelines established by the
commission.
(c) The executive commissioner shall adopt and publish
guidance that allows managed care plans that contract with the
commission to communicate with their enrolled recipients via text
message in accordance with this section. Such guidance shall
include the development and implementation of standardized consent
language to be used by managed care plans in obtaining patient
consent to receive text messages. The guidance must be published no
later than January 1, 2022.
SECTION 6. 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 7. This Act takes effect September 1, 2021.