S.B. No. 293
 
 
 
 
AN ACT
  relating to telemedicine medical services, telehealth services,
  and home telemonitoring services provided to certain Medicaid
  recipients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.001, Government Code, is amended by
  adding Subdivisions (4-a), (7), and (8) 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 health agency or a hospital, as those terms are defined by
  Section 531.02164(a).
               (7)  "Telehealth service" means a health service, other
  than a telemedicine medical service, that is delivered by a
  licensed or certified health professional acting within the scope
  of the health professional's license or certification who does not
  perform a telemedicine medical service and that requires the use of
  advanced telecommunications technology, other than telephone or
  facsimile technology, including:
                     (A)  compressed digital interactive video, audio,
  or data transmission;
                     (B)  clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     (C)  other technology that facilitates access to
  health care services or medical specialty expertise.
               (8)  "Telemedicine medical service" means a health care
  service that is initiated by a physician or provided by a health
  professional acting under physician delegation and supervision,
  that is provided for purposes of patient assessment by a health
  professional, diagnosis or consultation by a physician, or
  treatment, or for the transfer of medical data, and that requires
  the use of advanced telecommunications technology, other than
  telephone or facsimile technology, including:
                     (A)  compressed digital interactive video, audio,
  or data transmission;
                     (B)  clinical data transmission using computer
  imaging by way of still-image capture and store and forward; and
                     (C)  other technology that facilitates access to
  health care services or medical specialty expertise.
         SECTION 2.  Section 531.0216, Government Code, is amended to
  read as follows:
         Sec. 531.0216.  PARTICIPATION AND REIMBURSEMENT OF
  TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE
  PROVIDERS UNDER MEDICAID.  (a)  The commission by rule shall
  develop and implement a system to reimburse providers of services
  under the state Medicaid program for services performed using
  telemedicine medical services or telehealth services.
         (b)  In developing the system, the executive commissioner 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 Department of State Health
  Services and the telemedicine and telehealth advisory committee to
  establish procedures to:
                     (A)  identify clinical evidence supporting
  delivery of health care services using a telecommunications system;
  and
                     (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;
               [(6)]  establish a separate provider identifier for
  telemedicine medical services providers, telehealth services
  providers, and home telemonitoring services providers; and
               (6) [(7)]  establish a separate modifier for
  telemedicine medical services, telehealth services, and home
  telemonitoring services eligible for reimbursement.
         (c)  The commission shall encourage health care providers
  and health care facilities to participate as telemedicine medical
  service providers or telehealth service providers in the health
  care delivery system.  The commission may not require that a
  service be provided to a patient through telemedicine medical
  services or telehealth services when the service can reasonably be
  provided by a physician through a face-to-face consultation with
  the patient in the community in which the patient resides or
  works.  This subsection does not prohibit the authorization of the
  provision of any service to a patient through telemedicine medical
  services or telehealth services at the patient's request.
         (d)  Subject to Section 153.004, Occupations Code, the
  commission may adopt rules as necessary to implement this
  section.  In the rules adopted under this section, the commission
  shall:
               (1)  refer to the site where the patient is physically
  located as the patient site; and
               (2)  refer to the site where the physician or health
  professional providing the telemedicine medical service or
  telehealth service is physically located as the distant site.
         (e)  The commission may not reimburse a health care facility
  for telemedicine medical services or telehealth services provided
  to a Medicaid recipient unless the facility complies with the
  minimum standards adopted under Section 531.02161.
         (f)  Not later than December 1 of each even-numbered year,
  the commission shall report to the speaker of the house of
  representatives and the lieutenant governor on the effects of
  telemedicine medical services, telehealth services, and home
  telemonitoring services on the Medicaid program in the state,
  including the number of physicians, [and] health professionals, and
  licensed health care facilities using telemedicine medical
  services, telehealth services, or home telemonitoring services,
  the geographic and demographic disposition of the physicians and
  health professionals, the number of patients receiving
  telemedicine medical services, telehealth services, and home
  telemonitoring services, the types of services being provided, and
  the cost of utilization of telemedicine medical services,
  telehealth services, and home telemonitoring services to the
  program.
         [(g)  In this section:
               [(1)     "Telehealth service"   has the meaning assigned by
  Section 57.042, Utilities Code.
               [(2)     "Telemedicine medical service"   has the meaning
  assigned by Section 57.042, Utilities Code.]
         SECTION 3.  The heading to Section 531.02161, Government
  Code, is amended to read as follows:
         Sec. 531.02161.  TELEMEDICINE, TELEHEALTH, AND HOME
  TELEMONITORING TECHNOLOGY STANDARDS.
         SECTION 4.  Subsection (b), Section 531.02161, Government
  Code, is amended to read as follows:
         (b)  The commission and the Telecommunications
  Infrastructure Fund Board by joint rule shall establish and adopt
  minimum standards for an operating system used in the provision of
  telemedicine medical services, telehealth services, or home
  telemonitoring services by a health care facility participating in
  the state Medicaid program, including standards for electronic
  transmission, software, and hardware.
         SECTION 5.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02164 to read as follows:
         Sec. 531.02164.  MEDICAID SERVICES PROVIDED THROUGH HOME
  TELEMONITORING SERVICES. (a)  In this section:
               (1)  "Home health agency" means a facility licensed
  under Chapter 142, Health and Safety Code, to provide home health
  services as defined by Section 142.001, Health and Safety Code.
               (2)  "Hospital" means a hospital licensed under Chapter
  241, Health and Safety Code.
         (b)  If the commission determines that establishing a
  statewide program that permits reimbursement under the state
  Medicaid program for home telemonitoring services would be
  cost-effective and feasible, the executive commissioner by rule
  shall establish the program as provided under this section.
         (c)  The program required under this section must:
               (1)  provide that home telemonitoring services are
  available only to 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; and
                     (B)  exhibit 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 history of falls in the
  prior six-month period;
                           (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;
               (2)  ensure that clinical information gathered by a
  home health agency or hospital while providing home telemonitoring
  services is shared with the patient's physician; and
               (3)  ensure that the program does not duplicate disease
  management program services provided under Section 32.057, Human
  Resources Code.
         (d)  If, after implementation, the commission determines
  that the program established under this section is not
  cost-effective, the commission may discontinue the program and stop
  providing reimbursement under the state Medicaid program for home
  telemonitoring services, notwithstanding Section 531.0216 or any
  other law.
         (e)  The commission shall determine whether the provision of
  home telemonitoring services to persons who are eligible to receive
  benefits under both the Medicaid and Medicare programs achieves
  cost savings for the Medicare program.
         SECTION 6.  The heading to Section 531.02172, Government
  Code, is amended to read as follows:
         Sec. 531.02172.  TELEMEDICINE AND TELEHEALTH ADVISORY
  COMMITTEE.
         SECTION 7.  Subsections (a) and (b), Section 531.02172,
  Government Code, are amended to read as follows:
         (a)  The executive commissioner shall establish an advisory
  committee to assist the commission in:
               (1)  evaluating policies for telemedical consultations
  under Sections 531.02163 and 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;
               (3) [(4)]  monitoring the type of consultations and
  other services [programs] receiving reimbursement under Section
  [Sections] 531.0217 [and 531.02171]; and
               (4) [(5)]  coordinating the activities of state
  agencies concerned with the use of telemedical consultations and
  telemedicine medical services or telehealth services.
         (b)  The advisory committee must include:
               (1)  representatives of health and human services
  agencies and other state agencies concerned with the use of
  telemedical and telehealth consultations and home telemonitoring
  services in the Medicaid program and the state child health plan
  program, including representatives of:
                     (A)  the commission;
                     (B)  the Department of State Health Services;
                     (C)  the Texas Department of Rural Affairs;
                     (D)  the Texas Department of Insurance;
                     (E)  the Texas Medical Board;
                     (F)  the Texas Board of Nursing; and
                     (G)  the Texas State Board of Pharmacy;
               (2)  representatives of health science centers in this
  state;
               (3)  experts on telemedicine, telemedical
  consultation, and telemedicine medical services or telehealth
  services; [and]
               (4)  representatives of consumers of health services
  provided through telemedical consultations and telemedicine
  medical services or telehealth services; and
               (5)  representatives of providers of telemedicine
  medical services, telehealth services, and home telemonitoring
  services.
         SECTION 8.  Subsection (c), Section 531.02173, Government
  Code, is amended to read as follows:
         (c)  The commission shall perform its duties under this
  section with assistance from the telemedicine and telehealth
  advisory committee established under Section 531.02172.
         SECTION 9.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02176 to read as follows:
         Sec. 531.02176.  EXPIRATION OF MEDICAID REIMBURSEMENT FOR
  PROVISION OF HOME TELEMONITORING SERVICES.  Notwithstanding any
  other law, the commission may not reimburse providers under the
  Medicaid program for the provision of home telemonitoring services
  on or after September 1, 2015.
         SECTION 10.  The following provisions of the Government Code
  are repealed:
               (1)  Subsection (a), Section 531.02161;
               (2)  Subdivisions (3) and (4), Subsection (a), Section
  531.0217;
               (3)  Section 531.02171, as added by Chapter 661 (H.B.
  2700), Acts of the 77th Legislature, Regular Session, 2001; and
               (4)  Section 531.02171, as added by Chapter 959 (S.B.
  1536), Acts of the 77th Legislature, Regular Session, 2001.
         SECTION 11.  Not later than December 31, 2012, the Health and
  Human Services Commission shall submit a report to the governor,
  the lieutenant governor, and the speaker of the house of
  representatives regarding the establishment and implementation of
  the program to permit reimbursement under the state Medicaid
  program for home telemonitoring services under Section 531.02164,
  Government Code, as added by this Act.  The report must include:
               (1)  the methods used by the commission to determine
  whether the program was cost-effective and feasible; and
               (2)  if the program has been established, information
  regarding:
                     (A)  the utilization of home telemonitoring
  services by Medicaid recipients under the program;
                     (B)  the health outcomes of Medicaid recipients
  who receive home telemonitoring services under the program;
                     (C)  the hospital admission rate of Medicaid
  recipients who receive home telemonitoring services under the
  program;
                     (D)  the cost of the home telemonitoring services
  provided under the program; and
                     (E)  the estimated cost savings to the state as a
  result of the program.
         SECTION 12.  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 13.  This Act takes effect September 1, 2011.
 
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 293 passed the Senate on
  April 7, 2011, by the following vote:  Yeas 31, Nays 0;
  May 27, 2011, Senate refused to concur in House amendments and
  requested appointment of Conference Committee; May 27, 2011, House
  granted request of the Senate; May 29, 2011, Senate adopted
  Conference Committee Report by the following vote:  Yeas 31,
  Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 293 passed the House, with
  amendments, on May 25, 2011, by the following vote:  Yeas 146,
  Nays 0, two present not voting; May 27, 2011, House granted request
  of the Senate for appointment of Conference Committee;
  May 29, 2011, House adopted Conference Committee Report by the
  following vote:  Yeas 146, Nays 0, one present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
             Date
 
 
  ______________________________ 
            Governor