H.B. No. 2727
AN ACT
relating to the provision of home telemonitoring services under
Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.001(4-a), Government Code, is
amended to read as follows:
(4-a) "Home telemonitoring service" means a health
service that requires scheduled remote monitoring of data related
to a patient's health and transmission of the data to a licensed
home and community support services agency, a federally qualified
health center, a rural health clinic, or a hospital, as those terms
are defined by Section 531.02164(a). The term is synonymous with
"remote patient monitoring."
SECTION 2. Section 531.02164, Government Code, is amended
by amending Subsections (a), (b), (c), (c-1), (d), and (f) and
adding Subsections (c-2) and (c-3) to read as follows:
(a) In this section:
(1) "Federally qualified health center" has the
meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
(1-a) "Home and community support services agency"
means a person licensed under Chapter 142, Health and Safety Code,
to provide home health, hospice, or personal assistance services as
defined by Section 142.001, Health and Safety Code.
(2) "Hospital" means a hospital licensed under Chapter
241, Health and Safety Code.
(3) "Rural health clinic" has the meaning assigned by
42 U.S.C. Section 1396d(l)(1).
(b) The [If the commission determines that establishing a
statewide program that permits reimbursement under Medicaid for
home telemonitoring services would be cost-effective and feasible,
the] executive commissioner [by rule] shall adopt rules for the
provision and reimbursement of home telemonitoring services under
Medicaid [establish the program] as provided under this section.
(c) For purposes of adopting rules [The program required]
under this section, the commission shall [must]:
(1) identify and provide home telemonitoring services
to persons diagnosed with conditions for which the commission
determines the provision of home telemonitoring services would be
cost-effective and clinically effective;
(2) consider providing home telemonitoring services
under Subdivision (1) [provide that home telemonitoring services
are available only] to Medicaid recipients [persons] who:
(A) are diagnosed with one or more of the
following conditions:
(i) pregnancy;
(ii) diabetes;
(iii) heart disease;
(iv) cancer;
(v) chronic obstructive pulmonary disease;
(vi) hypertension;
(vii) congestive heart failure;
(viii) mental illness or serious emotional
disturbance;
(ix) asthma;
(x) myocardial infarction; [or]
(xi) stroke;
(xii) end stage renal disease; or
(xiii) a condition that requires renal
dialysis treatment; and
(B) exhibit at least one [two or more] of the
following risk factors:
(i) two or more hospitalizations in the
prior 12-month period;
(ii) frequent or recurrent emergency room
admissions;
(iii) a documented history of poor
adherence to ordered medication regimens;
(iv) a documented risk [history] of falls
[in the prior six-month period]; and
(v) [limited or absent informal support
systems;
[(vi) living alone or being home alone for
extended periods of time; and
[(vii)] a documented history of care access
challenges;
(3) [(2)] ensure that clinical information gathered
by the following providers while providing home telemonitoring
services is shared with the recipient's physician:
(A) a home and community support services agency;
(B) a federally qualified health center;
(C) a rural health clinic; or
(D) a hospital [while providing home
telemonitoring services is shared with the patient's physician];
[and]
(4) [(3)] ensure that the home telemonitoring
services provided under this section do [program does] not
duplicate disease management program services provided under
Section 32.057, Human Resources Code; and
(5) require a provider to:
(A) establish a plan of care that includes
outcome measures for each recipient who receives home
telemonitoring services under this section; and
(B) share the plan and outcome measures with the
recipient's physician.
(c-1) Notwithstanding any other provision of this section
[Subsection (c)(1)], the commission shall ensure [the program
required under this section must also provide] that home
telemonitoring services are available to pediatric persons who:
(1) are diagnosed with end-stage solid organ disease;
(2) have received an organ transplant; or
(3) require mechanical ventilation.
(c-2) In addition to determining whether to provide home
telemonitoring services to Medicaid recipients with the conditions
described under Subsection (c)(2), the commission shall determine
whether high-risk pregnancy is a condition for which the provision
of home telemonitoring services is cost-effective and clinically
effective. If the commission determines that high-risk pregnancy
is a condition for which the provision of home telemonitoring
services is cost-effective and clinically effective:
(1) the commission shall, to the extent permitted by
state and federal law, provide recipients experiencing a high-risk
pregnancy with clinically appropriate home telemonitoring services
equipment for temporary use in the recipient's home; and
(2) the executive commissioner by rule shall:
(A) establish criteria to identify recipients
experiencing a high-risk pregnancy who would benefit from access to
home telemonitoring services equipment;
(B) ensure that, if cost-effective, feasible,
and clinically appropriate, the home telemonitoring services
equipment provided includes uterine remote monitoring services
equipment and pregnancy-induced hypertension remote monitoring
services equipment;
(C) subject to Subsection (c-3), require that a
provider obtain:
(i) prior authorization from the commission
before providing home telemonitoring services equipment to a
recipient during the first month the equipment is provided to the
recipient; and
(ii) an extension of the authorization
under Subparagraph (i) from the commission before providing the
equipment in a subsequent month based on the ongoing medical need of
the recipient; and
(D) prohibit payment or reimbursement for home
telemonitoring services equipment during any period that the
equipment was not in use because the recipient was hospitalized or
away from the recipient's home regardless of whether the equipment
remained in the recipient's home while the recipient was
hospitalized or away.
(c-3) For purposes of Subsection (c-2), the commission
shall require that:
(1) a request for prior authorization under Subsection
(c-2)(2)(C)(i) be based on an in-person assessment of the
recipient; and
(2) documentation of the recipient's ongoing medical
need for the equipment is provided to the commission before the
commission grants an extension under Subsection (c-2)(2)(C)(ii).
(d) If, after implementation, the commission determines
that a condition for which the commission has authorized the
provision and reimbursement of home telemonitoring services under
Medicaid [the program established] under this section is not
cost-effective and clinically effective, the commission may
discontinue the availability of home telemonitoring services for
that condition [program] and stop providing reimbursement under
Medicaid for home telemonitoring services for that condition,
notwithstanding Section 531.0216 or any other law.
(f) To comply with state and federal requirements to provide
access to medically necessary services under Medicaid, including
the Medicaid managed care program, and if the commission determines
it is cost-effective and clinically effective, the commission or a
Medicaid managed care organization, as applicable, 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 3. 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 4. 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, 2023.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2727 was passed by the House on April
27, 2023, by the following vote: Yeas 138, Nays 11, 1 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 2727 on May 26, 2023, by the following vote: Yeas 120, Nays 21,
1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 2727 was passed by the Senate, with
amendments, on May 24, 2023, by the following vote: Yeas 29, Nays
2.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor