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AN ACT
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relating to the provision of home telemonitoring services under |
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Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.001(4-a), Government Code, is |
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amended to read as follows: |
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(4-a) "Home telemonitoring service" means a health |
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service that requires scheduled remote monitoring of data related |
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to a patient's health and transmission of the data to a licensed |
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home and community support services agency, a federally qualified |
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health center, a rural health clinic, or a hospital, as those terms |
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are defined by Section 531.02164(a). The term is synonymous with |
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"remote patient monitoring." |
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SECTION 2. Section 531.02164, Government Code, is amended |
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by amending Subsections (a), (b), (c), (c-1), (d), and (f) and |
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adding Subsections (c-2) and (c-3) to read as follows: |
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(a) In this section: |
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(1) "Federally qualified health center" has the |
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meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B). |
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(1-a) "Home and community support services agency" |
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means a person licensed under Chapter 142, Health and Safety Code, |
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to provide home health, hospice, or personal assistance services as |
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defined by Section 142.001, Health and Safety Code. |
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(2) "Hospital" means a hospital licensed under Chapter |
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241, Health and Safety Code. |
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(3) "Rural health clinic" has the meaning assigned by |
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42 U.S.C. Section 1396d(l)(1). |
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(b) The [If the commission determines that establishing a |
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statewide program that permits reimbursement under Medicaid for |
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home telemonitoring services would be cost-effective and feasible, |
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the] executive commissioner [by rule] shall adopt rules for the |
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provision and reimbursement of home telemonitoring services under |
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Medicaid [establish the program] as provided under this section. |
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(c) For purposes of adopting rules [The program required] |
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under this section, the commission shall [must]: |
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(1) identify and provide home telemonitoring services |
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to persons diagnosed with conditions for which the commission |
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determines the provision of home telemonitoring services would be |
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cost-effective and clinically effective; |
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(2) consider providing home telemonitoring services |
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under Subdivision (1) [provide that home telemonitoring services |
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are available only] to Medicaid recipients [persons] who: |
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(A) are diagnosed with one or more of the |
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following conditions: |
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(i) pregnancy; |
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(ii) diabetes; |
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(iii) heart disease; |
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(iv) cancer; |
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(v) chronic obstructive pulmonary disease; |
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(vi) hypertension; |
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(vii) congestive heart failure; |
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(viii) mental illness or serious emotional |
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disturbance; |
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(ix) asthma; |
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(x) myocardial infarction; [or] |
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(xi) stroke; |
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(xii) end stage renal disease; or |
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(xiii) a condition that requires renal |
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dialysis treatment; and |
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(B) exhibit at least one [two or more] of the |
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following risk factors: |
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(i) two or more hospitalizations in the |
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prior 12-month period; |
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(ii) frequent or recurrent emergency room |
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admissions; |
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(iii) a documented history of poor |
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adherence to ordered medication regimens; |
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(iv) a documented risk [history] of falls |
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[in the prior six-month period]; and |
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(v) [limited or absent informal support |
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systems; |
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[(vi) living alone or being home alone for |
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extended periods of time; and |
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[(vii)] a documented history of care access |
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challenges; |
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(3) [(2)] ensure that clinical information gathered |
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by the following providers while providing home telemonitoring |
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services is shared with the recipient's physician: |
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(A) a home and community support services agency; |
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(B) a federally qualified health center; |
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(C) a rural health clinic; or |
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(D) a hospital [while providing home |
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telemonitoring services is shared with the patient's physician]; |
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[and] |
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(4) [(3)] ensure that the home telemonitoring |
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services provided under this section do [program does] not |
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duplicate disease management program services provided under |
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Section 32.057, Human Resources Code; and |
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(5) require a provider to: |
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(A) establish a plan of care that includes |
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outcome measures for each recipient who receives home |
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telemonitoring services under this section; and |
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(B) share the plan and outcome measures with the |
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recipient's physician. |
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(c-1) Notwithstanding any other provision of this section |
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[Subsection (c)(1)], the commission shall ensure [the program |
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required under this section must also provide] that home |
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telemonitoring services are available to pediatric persons who: |
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(1) are diagnosed with end-stage solid organ disease; |
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(2) have received an organ transplant; or |
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(3) require mechanical ventilation. |
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(c-2) In addition to determining whether to provide home |
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telemonitoring services to Medicaid recipients with the conditions |
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described under Subsection (c)(2), the commission shall determine |
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whether high-risk pregnancy is a condition for which the provision |
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of home telemonitoring services is cost-effective and clinically |
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effective. If the commission determines that high-risk pregnancy |
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is a condition for which the provision of home telemonitoring |
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services is cost-effective and clinically effective: |
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(1) the commission shall, to the extent permitted by |
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state and federal law, provide recipients experiencing a high-risk |
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pregnancy with clinically appropriate home telemonitoring services |
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equipment for temporary use in the recipient's home; and |
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(2) the executive commissioner by rule shall: |
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(A) establish criteria to identify recipients |
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experiencing a high-risk pregnancy who would benefit from access to |
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home telemonitoring services equipment; |
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(B) ensure that, if cost-effective, feasible, |
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and clinically appropriate, the home telemonitoring services |
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equipment provided includes uterine remote monitoring services |
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equipment and pregnancy-induced hypertension remote monitoring |
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services equipment; |
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(C) subject to Subsection (c-3), require that a |
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provider obtain: |
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(i) prior authorization from the commission |
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before providing home telemonitoring services equipment to a |
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recipient during the first month the equipment is provided to the |
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recipient; and |
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(ii) an extension of the authorization |
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under Subparagraph (i) from the commission before providing the |
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equipment in a subsequent month based on the ongoing medical need of |
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the recipient; and |
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(D) prohibit payment or reimbursement for home |
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telemonitoring services equipment during any period that the |
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equipment was not in use because the recipient was hospitalized or |
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away from the recipient's home regardless of whether the equipment |
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remained in the recipient's home while the recipient was |
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hospitalized or away. |
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(c-3) For purposes of Subsection (c-2), the commission |
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shall require that: |
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(1) a request for prior authorization under Subsection |
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(c-2)(2)(C)(i) be based on an in-person assessment of the |
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recipient; and |
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(2) documentation of the recipient's ongoing medical |
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need for the equipment is provided to the commission before the |
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commission grants an extension under Subsection (c-2)(2)(C)(ii). |
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(d) If, after implementation, the commission determines |
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that a condition for which the commission has authorized the |
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provision and reimbursement of home telemonitoring services under |
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Medicaid [the program established] under this section is not |
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cost-effective and clinically effective, the commission may |
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discontinue the availability of home telemonitoring services for |
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that condition [program] and stop providing reimbursement under |
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Medicaid for home telemonitoring services for that condition, |
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notwithstanding Section 531.0216 or any other law. |
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(f) To comply with state and federal requirements to provide |
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access to medically necessary services under Medicaid, including |
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the Medicaid managed care program, and if the commission determines |
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it is cost-effective and clinically effective, the commission or a |
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Medicaid managed care organization, as applicable, may reimburse |
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providers for home telemonitoring services provided to persons who |
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have conditions and exhibit risk factors other than those expressly |
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authorized by this section. [In determining whether the managed |
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care organization should provide reimbursement for services under |
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this subsection, the organization shall consider whether |
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reimbursement for the service is cost-effective and providing the |
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service is clinically effective.] |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 2727 was passed by the House on April |
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27, 2023, by the following vote: Yeas 138, Nays 11, 1 present, not |
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voting; and that the House concurred in Senate amendments to H.B. |
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No. 2727 on May 26, 2023, by the following vote: Yeas 120, Nays 21, |
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1 present, not voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 2727 was passed by the Senate, with |
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amendments, on May 24, 2023, by the following vote: Yeas 29, Nays |
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2. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |