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
 
 
  By: Price, et al. (Senate Sponsor - Perry) H.B. No. 2727
         (In the Senate - Received from the House May 1, 2023;
  May 2, 2023, read first time and referred to Committee on Health &
  Human Services; May 21, 2023, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 9, Nays 0;
  May 21, 2023, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR H.B. No. 2727 By:  Perry
 
 
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), (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.
 
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