Texas 2023 - 88th Regular

Texas House Bill HB2727 Compare Versions

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Version 2 (New)

Old	New	Differences
1	1	H.B. No. 2727
2	2
3	3
4	4	AN ACT
5	5	relating to the provision of home telemonitoring services under
6	6	Medicaid.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 531.001(4-a), Government Code, is
9	9	amended to read as follows:
10	10	(4-a) "Home telemonitoring service" means a health
11	11	service that requires scheduled remote monitoring of data related
12	12	to a patient's health and transmission of the data to a licensed
13	13	home and community support services agency, a federally qualified
14	14	health center, a rural health clinic, or a hospital, as those terms
15	15	are defined by Section 531.02164(a). The term is synonymous with
16	16	"remote patient monitoring."
17	17	SECTION 2. Section 531.02164, Government Code, is amended
18	18	by amending Subsections (a), (b), (c), (c-1), (d), and (f) and
19	19	adding Subsections (c-2) and (c-3) to read as follows:
20	20	(a) In this section:
21	21	(1) "Federally qualified health center" has the
22	22	meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
23	23	(1-a) "Home and community support services agency"
24	24	means a person licensed under Chapter 142, Health and Safety Code,
25	25	to provide home health, hospice, or personal assistance services as
26	26	defined by Section 142.001, Health and Safety Code.
27	27	(2) "Hospital" means a hospital licensed under Chapter
28	28	241, Health and Safety Code.
29	29	(3) "Rural health clinic" has the meaning assigned by
30	30	42 U.S.C. Section 1396d(l)(1).
31	31	(b) The [If the commission determines that establishing a
32	32	statewide program that permits reimbursement under Medicaid for
33	33	home telemonitoring services would be cost-effective and feasible,
34	34	the] executive commissioner [by rule] shall adopt rules for the
35	35	provision and reimbursement of home telemonitoring services under
36	36	Medicaid [establish the program] as provided under this section.
37	37	(c) For purposes of adopting rules [The program required]
38	38	under this section, the commission shall [must]:
39	39	(1) identify and provide home telemonitoring services
40	40	to persons diagnosed with conditions for which the commission
41	41	determines the provision of home telemonitoring services would be
42	42	cost-effective and clinically effective;
43	43	(2) consider providing home telemonitoring services
44	44	under Subdivision (1) [provide that home telemonitoring services
45	45	are available only] to Medicaid recipients [persons] who:
46	46	(A) are diagnosed with one or more of the
47	47	following conditions:
48	48	(i) pregnancy;
49	49	(ii) diabetes;
50	50	(iii) heart disease;
51	51	(iv) cancer;
52	52	(v) chronic obstructive pulmonary disease;
53	53	(vi) hypertension;
54	54	(vii) congestive heart failure;
55	55	(viii) mental illness or serious emotional
56	56	disturbance;
57	57	(ix) asthma;
58	58	(x) myocardial infarction; [or]
59	59	(xi) stroke;
60	60	(xii) end stage renal disease; or
61	61	(xiii) a condition that requires renal
62	62	dialysis treatment; and
63	63	(B) exhibit at least one [two or more] of the
64	64	following risk factors:
65	65	(i) two or more hospitalizations in the
66	66	prior 12-month period;
67	67	(ii) frequent or recurrent emergency room
68	68	admissions;
69	69	(iii) a documented history of poor
70	70	adherence to ordered medication regimens;
71	71	(iv) a documented risk [history] of falls
72	72	[in the prior six-month period]; and
73	73	(v) [limited or absent informal support
74	74	systems;
75	75	[(vi) living alone or being home alone for
76	76	extended periods of time; and
77	77	[(vii)] a documented history of care access
78	78	challenges;
79	79	(3) [(2)] ensure that clinical information gathered
80	80	by the following providers while providing home telemonitoring
81	81	services is shared with the recipient's physician:
82	82	(A) a home and community support services agency;
83	83	(B) a federally qualified health center;
84	84	(C) a rural health clinic; or
85	85	(D) a hospital [while providing home
86	86	telemonitoring services is shared with the patient's physician];
87	87	[and]
88	88	(4) [(3)] ensure that the home telemonitoring
89	89	services provided under this section do [program does] not
90	90	duplicate disease management program services provided under
91	91	Section 32.057, Human Resources Code; and
92	92	(5) require a provider to:
93	93	(A) establish a plan of care that includes
94	94	outcome measures for each recipient who receives home
95	95	telemonitoring services under this section; and
96	96	(B) share the plan and outcome measures with the
97	97	recipient's physician.
98	98	(c-1) Notwithstanding any other provision of this section
99	99	[Subsection (c)(1)], the commission shall ensure [the program
100	100	required under this section must also provide] that home
101	101	telemonitoring services are available to pediatric persons who:
102	102	(1) are diagnosed with end-stage solid organ disease;
103	103	(2) have received an organ transplant; or
104	104	(3) require mechanical ventilation.
105	105	(c-2) In addition to determining whether to provide home
106	106	telemonitoring services to Medicaid recipients with the conditions
107	107	described under Subsection (c)(2), the commission shall determine
108	108	whether high-risk pregnancy is a condition for which the provision
109	109	of home telemonitoring services is cost-effective and clinically
110	110	effective. If the commission determines that high-risk pregnancy
111	111	is a condition for which the provision of home telemonitoring
112	112	services is cost-effective and clinically effective:
113	113	(1) the commission shall, to the extent permitted by
114	114	state and federal law, provide recipients experiencing a high-risk
115	115	pregnancy with clinically appropriate home telemonitoring services
116	116	equipment for temporary use in the recipient's home; and
117	117	(2) the executive commissioner by rule shall:
118	118	(A) establish criteria to identify recipients
119	119	experiencing a high-risk pregnancy who would benefit from access to
120	120	home telemonitoring services equipment;
121	121	(B) ensure that, if cost-effective, feasible,
122	122	and clinically appropriate, the home telemonitoring services
123	123	equipment provided includes uterine remote monitoring services
124	124	equipment and pregnancy-induced hypertension remote monitoring
125	125	services equipment;
126	126	(C) subject to Subsection (c-3), require that a
127	127	provider obtain:
128	128	(i) prior authorization from the commission
129	129	before providing home telemonitoring services equipment to a
130	130	recipient during the first month the equipment is provided to the
131	131	recipient; and
132	132	(ii) an extension of the authorization
133	133	under Subparagraph (i) from the commission before providing the
134	134	equipment in a subsequent month based on the ongoing medical need of
135	135	the recipient; and
136	136	(D) prohibit payment or reimbursement for home
137	137	telemonitoring services equipment during any period that the
138	138	equipment was not in use because the recipient was hospitalized or
139	139	away from the recipient's home regardless of whether the equipment
140	140	remained in the recipient's home while the recipient was
141	141	hospitalized or away.
142	142	(c-3) For purposes of Subsection (c-2), the commission
143	143	shall require that:
144	144	(1) a request for prior authorization under Subsection
145	145	(c-2)(2)(C)(i) be based on an in-person assessment of the
146	146	recipient; and
147	147	(2) documentation of the recipient's ongoing medical
148	148	need for the equipment is provided to the commission before the
149	149	commission grants an extension under Subsection (c-2)(2)(C)(ii).
150	150	(d) If, after implementation, the commission determines
151	151	that a condition for which the commission has authorized the
152	152	provision and reimbursement of home telemonitoring services under
153	153	Medicaid [the program established] under this section is not
154	154	cost-effective and clinically effective, the commission may
155	155	discontinue the availability of home telemonitoring services for
156	156	that condition [program] and stop providing reimbursement under
157	157	Medicaid for home telemonitoring services for that condition,
158	158	notwithstanding Section 531.0216 or any other law.
159	159	(f) To comply with state and federal requirements to provide
160	160	access to medically necessary services under Medicaid, including
161	161	the Medicaid managed care program, and if the commission determines
162	162	it is cost-effective and clinically effective, the commission or a
163	163	Medicaid managed care organization, as applicable, may reimburse
164	164	providers for home telemonitoring services provided to persons who
165	165	have conditions and exhibit risk factors other than those expressly
166	166	authorized by this section. [In determining whether the managed
167	167	care organization should provide reimbursement for services under
168	168	this subsection, the organization shall consider whether
169	169	reimbursement for the service is cost-effective and providing the
170	170	service is clinically effective.]
171	171	SECTION 3. If before implementing any provision of this Act
172	172	a state agency determines that a waiver or authorization from a
173	173	federal agency is necessary for implementation of that provision,
174	174	the agency affected by the provision shall request the waiver or
175	175	authorization and may delay implementing that provision until the
176	176	waiver or authorization is granted.
177	177	SECTION 4. This Act takes effect immediately if it receives
178	178	a vote of two-thirds of all the members elected to each house, as
179	179	provided by Section 39, Article III, Texas Constitution. If this
180	180	Act does not receive the vote necessary for immediate effect, this
181	181	Act takes effect September 1, 2023.
182	182	______________________________ ______________________________
183	183	President of the Senate Speaker of the House
184	184	I certify that H.B. No. 2727 was passed by the House on April
185	185	27, 2023, by the following vote: Yeas 138, Nays 11, 1 present, not
186	186	voting; and that the House concurred in Senate amendments to H.B.
187	187	No. 2727 on May 26, 2023, by the following vote: Yeas 120, Nays 21,
188	188	1 present, not voting.
189	189	______________________________
190	190	Chief Clerk of the House
191	191	I certify that H.B. No. 2727 was passed by the Senate, with
192	192	amendments, on May 24, 2023, by the following vote: Yeas 29, Nays
193	193	2.
194	194	______________________________
195	195	Secretary of the Senate
196	196	APPROVED: __________________
197	197	Date
198	198	__________________
199	199	Governor