Bill Text: TX HB2727 | 2023-2024 | 88th Legislature | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Relating to the provision of home telemonitoring services under Medicaid.

Spectrum: Slight Partisan Bill (Democrat 7-4)

Status: (Passed) 2023-06-13 - Effective immediately [HB2727 Detail]

Download: Texas-2023-HB2727-Comm_Sub.html

---

88R20672 BDP-D
By: Price, Thompson of Harris, Oliverson, H.B. No. 2727
Jetton, Guerra
Substitute the following for H.B. No. 2727:
By: Klick C.S.H.B. No. 2727

A BILL TO BE ENTITLED
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), 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) If the commission determines that establishing a
statewide program that permits reimbursement under Medicaid for
home telemonitoring services would be clinically effective
[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;
(xii) end stage renal disease;
(xiii) a condition that requires renal
dialysis treatment; or
(xiv) any other condition for which home
telemonitoring services would be clinically effective, as
determined by commission rule; 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;
(2) ensure that clinical information gathered by the
following providers while providing home telemonitoring services
is shared with the patient'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]
(3) ensure that the program does not duplicate disease
management program services provided under Section 32.057, Human
Resources Code;
(4) require a provider to:
(A) establish a plan of care that includes
outcome measures for each patient who receives home telemonitoring
services under the program; and
(B) share the plan and outcome measures with the
patient's physician; and
(5) subject to Subsection (c-2) and to the extent
permitted by state and federal law, provide patients experiencing a
high-risk pregnancy with clinically appropriate home
telemonitoring services equipment for temporary use in the
patient's home.
(c-2) For purposes of Subsection (c)(5), the executive
commissioner by rule shall:
(1) establish criteria to identify patients
experiencing a high-risk pregnancy who would benefit from access to
home telemonitoring services equipment;
(2) ensure that, if feasible and clinically
appropriate, the home telemonitoring services equipment available
under the program include uterine remote monitoring services
equipment and pregnancy-induced hypertension remote monitoring
services equipment;
(3) subject to Subsection (c-3), require that a
provider obtain:
(A) prior authorization from the commission
before providing home telemonitoring services equipment to a
patient during the first month the equipment is provided to the
patient; and
(B) an extension of the authorization under
Paragraph (A) from the commission before providing the equipment in
a subsequent month based on the ongoing medical need of the patient;
and
(4) prohibit payment or reimbursement for home
telemonitoring services equipment during any period that the
equipment was not in use because the patient was hospitalized or
away from the patient's home regardless of whether the equipment
remained in the patient's home while the patient 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)(3)(A) be based on an in-person assessment of the patient; and
(2) documentation of the patient's ongoing medical
need for the equipment is provided to the commission before the
commission grants an extension under Subsection (c-2)(3)(B).
(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.