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S.B. No. 1340
AN ACT
relating to the regulation and reimbursement of health care
services provided through telehealth or telemedicine under the
state Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsection (b), Section 531.0216, Government
Code, is amended to read as follows:
(b) In developing the system, the executive commissioner
[commission] by rule shall:
(1) review programs and pilot projects in other states
to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for
services;
(3) provide for an approval process before a provider
can receive reimbursement for services;
(4) consult with the [Texas] Department of State
Health Services and the telemedicine advisory committee to
establish procedures to:
(A) identify clinical evidence supporting
delivery of health care services using a telecommunications system
[by January 1, 2001];
(B) establish pilot studies for telemedicine
medical service delivery; and
(C) annually review health care services,
considering new clinical findings, to determine whether
reimbursement for particular services should be denied or
authorized;
(5) establish pilot programs in designated areas of
this state under which the commission, in administering
government-funded health programs, may reimburse a health
professional participating in the pilot program for telehealth
services authorized under the licensing law applicable to the
health professional; [and]
(6) establish a separate provider identifier for
telemedicine medical services providers; and
(7) establish a separate modifier for telemedicine
medical services eligible for reimbursement.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02163 to read as follows:
Sec. 531.02163. TELEPRESENTERS. (a) In this section,
"health professional" means an individual who:
(1) is licensed or certified in this state to perform
health care services; and
(2) is not a physician, registered nurse, advanced
practice nurse, or physician assistant.
(b) The executive commissioner by rule shall establish and
adopt minimum standards to permit the use of trained health
professionals in presenting patients who are Medicaid recipients
for telemedicine medical services consultations to be conducted by
physicians at distant sites.
(c) Notwithstanding Section 531.0217, the commission may
provide reimbursement under the state Medicaid program for a
telemedicine medical service initiated by a trained health
professional who complies with the minimum standards adopted under
this section.
(d) The commission shall provide reimbursement under the
state Medicaid program to a physician for overseeing a telemedicine
consultation at a telemedicine hub site if the telepresenter at the
remote site is another physician or is an advanced practice nurse,
registered nurse, or physician assistant acting under physician
delegation and supervision throughout the consultation.
SECTION 3. Section 531.0217, Government Code, is amended by
amending Subsection (i) and adding Subsection (i-1) to read as
follows:
(i) The Texas State Board of Medical Examiners, in
consultation with the commission, as appropriate, may adopt rules
as necessary to:
(1) ensure that appropriate care, including quality of
care, is provided to patients who receive telemedicine medical
services;
(2) prevent abuse and fraud through the use of
telemedicine medical services, including rules relating to filing
of claims and records required to be maintained in connection with
telemedicine; and
(3) [establish supervisory requirements for a service
delegated to and performed by an individual who is not a physician;
and
[(4)] define those situations when a face-to-face
consultation with a physician is required after a telemedicine
medical service.
(i-1) The Texas State Board of Medical Examiners, in
consultation with the commission and the Department of State Health
Services, as appropriate, shall adopt rules to establish
supervisory requirements for a physician delegating a service to be
performed by an individual who is not a physician, registered
nurse, advanced practice nurse, or physician assistant, including a
health professional who is authorized to be a telepresenter under
Section 531.02163. This section may not be construed as
authorizing the Texas State Board of Medical Examiners to regulate
another licensed or certified health care provider.
SECTION 4. Subsection (a), Section 531.02172, Government
Code, is amended to read as follows:
(a) The commissioner shall establish an advisory committee
to assist the commission in:
(1) evaluating policies for telemedical consultations
under Sections 531.02163 and [Section] 531.0217;
(2) evaluating policies for telemedicine medical
services or telehealth services pilot programs established under
Section 531.02171;
(3) ensuring the efficient and consistent development
and use of telecommunication technology for telemedical
consultations and telemedicine medical services or telehealth
services reimbursed under government-funded health programs;
(4) monitoring the type of programs receiving
reimbursement under Sections 531.0217 and 531.02171; and
(5) coordinating the activities of state agencies
concerned with the use of telemedical consultations and
telemedicine medical services or telehealth services.
SECTION 5. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02175 to read as follows:
Sec. 531.02175. PILOT PROGRAM FOR TELEHEALTH OR
TELEMEDICINE CONSULTATIONS FOR CERTAIN MEDICAID RECIPIENTS.
(a) In this section, "qualified mental health professional" means
an individual who:
(1) is credentialed to provide qualified mental health
professional community services; and
(2) holds a bachelor's or more advanced degree from an
accredited college or university with a minimum number of hours
that is equivalent to a major in psychology, social work, medicine,
nursing, rehabilitation, counseling, sociology, human growth and
development, physician assistant, gerontology, special education,
educational psychology, early childhood education, or early
childhood intervention.
(b) The executive commissioner by rule shall develop and the
Department of State Health Services shall implement a pilot program
under which Medicaid recipients in need of mental health services
are provided those services through telehealth or telemedicine.
(c) The executive commissioner shall design the pilot
program in a manner that:
(1) enhances the delivery of mental health services to
recipients;
(2) ensures adequate supervision of social workers,
psychologists, and other licensed professionals who are not
psychiatrists and who provide services through the use of
telehealth or telemedicine; and
(3) enables the state to determine whether extension
of the use of telehealth or telemedicine would improve the delivery
of mental health services.
(d) The executive commissioner may not require mental
health services to be provided through telehealth or telemedicine
under the pilot program if an in-person consultation with a
psychiatrist or other licensed mental health professional
qualified to provide those services is reasonably available where
the recipient resides or works.
(e) The executive commissioner by rule shall establish and
adopt minimum standards to permit the use of trained qualified
mental health professionals in presenting Medicaid recipients
participating in the pilot program for telehealth or telemedicine
consultations to be conducted by psychiatrists at distant sites.
(f) The commission may reimburse a provider participating
in the pilot program for services provided through telehealth or
telemedicine. Notwithstanding Section 531.0217, the commission
may provide reimbursement under the state Medicaid program for a
telehealth or telemedicine consultation initiated by a trained
qualified mental health professional who complies with the minimum
standards adopted under Subsection (e).
(g) The Texas State Board of Medical Examiners, in
consultation with the commission and the Department of State Health
Services, as appropriate, shall adopt rules to establish
supervisory requirements for a physician delegating a service to be
performed by a qualified mental health professional who is
authorized to be a telepresenter under this section. This section
may not be construed as authorizing the Texas State Board of Medical
Examiners to regulate another licensed or certified health care
provider.
(h) The commission may apply for and receive a grant to fund
the pilot program under the federal New Freedom Initiative on
Mental Health plan or from the Office of the National Coordinator
for Health Information Technology. The commission shall seek the
assistance of the Office of State-Federal Relations in identifying
and applying for federal grants for the pilot program.
(i) Not later than December 1, 2006, the commission shall
submit a report to the legislature regarding the results of the
pilot program. The report must include recommendations regarding
elimination, continuation, or expansion of the pilot program.
(j) This section expires September 1, 2007.
SECTION 6. (a) The Health and Human Services Commission
shall conduct a study to:
(1) identify any program or policy changes necessary
to facilitate the development of a network of providers of
telemedicine medical services under the state Medicaid program,
including:
(A) the establishment of new billing codes;
(B) the establishment of new provider
identifiers; and
(C) a description of telemedicine medical
services eligible for reimbursement;
(2) investigate the current use of digital medical
imaging in the provision of telemedicine medical services to
Medicaid recipients;
(3) investigate the feasibility, including the fiscal
impact, of expanding the use of digital medical imaging in the
provision of telemedicine medical services to Medicaid recipients;
(4) investigate the feasibility of reimbursing health
care providers under the state Medicaid program for telemedicine
medical services appropriately performed using digital medical
imaging; and
(5) investigate the feasibility of developing a system
to reimburse physicians for services performed through
telemedicine by health care providers acting under physician
delegation and supervision, regardless of whether the health care
service was initiated by the physician.
(b) Not later than January 1, 2006, the Health and Human
Services Commission shall submit a report regarding the results of
the study to the presiding officer of each house and senate standing
committee having jurisdiction over the state Medicaid program. The
report must:
(1) identify any significant barriers, in addition to
cost, to expanding the use of digital medical imaging in the
provision of telemedicine medical services to Medicaid recipients;
and
(2) include the fiscal impact to this state of each of
the proposed initiatives.
(c) This section expires September 1, 2007.
SECTION 7. As soon as practicable after the effective date
of this Act:
(1) the Texas State Board of Medical Examiners shall
adopt rules as required by Subsection (i-1), Section 531.0217, and
Subsection (g), Section 531.02175, Government Code, as added by
this Act; and
(2) the executive commissioner of the Health and Human
Services Commission shall adopt rules as required by Section
531.02163 and Subsection (e), Section 531.02175, Government Code,
as added by this Act.
SECTION 8. If before implementing any provision of this Act
a state agency determines that a waiver or other authorization from
a federal agency is necessary for implementation, 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 9. This Act takes effect September 1, 2005.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1340 passed the Senate on
April 26, 2005, by the following vote: Yeas 31, Nays 0; and that
the Senate concurred in House amendment on May 27, 2005, by the
following vote: Yeas 29, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1340 passed the House, with
amendment, on May 25, 2005, by a non-record vote.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor