Bill Text: TX HB870 | 2019-2020 | 86th Legislature | Comm Sub
Bill Title: Relating to Medicaid telemedicine and telehealth services.
Spectrum: Moderate Partisan Bill (Republican 5-1)
Status: (Introduced - Dead) 2019-04-22 - Committee report sent to Calendars [HB870 Detail]
Download: Texas-2019-HB870-Comm_Sub.html
86R23578 MM-F | |||
By: Price, Guillen, Sheffield, Ashby, | H.B. No. 870 | ||
González of El Paso, et al. | |||
Substitute the following for H.B. No. 870: | |||
By: Price | C.S.H.B. No. 870 |
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relating to Medicaid telemedicine and telehealth services. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.001, Government Code, is amended by | ||
adding Subdivisions (4-c) and (4-d) to read as follows: | ||
(4-c) "Medicaid managed care organization" means a | ||
managed care organization as defined by Section 533.001 that | ||
contracts with the commission under Chapter 533 to provide health | ||
care services to Medicaid recipients. | ||
(4-d) "Platform" means the technology, system, | ||
software, application, modality, or other method through which a | ||
health professional remotely interfaces with a patient when | ||
providing a health care service or procedure as a telemedicine | ||
medical service or telehealth service. | ||
SECTION 2. Section 531.0216, Government Code, is amended by | ||
amending Subsections (c) and (c-1) and adding Subsections (g), (h), | ||
(i), and (j) to read as follows: | ||
(c) The commission shall encourage health care providers | ||
and health care facilities to provide [ |
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medical services and [ |
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[ |
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commission may not require that a service be provided to a patient | ||
through telemedicine medical services or telehealth services [ |
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(c-1) The commission shall[ |
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[ |
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program providers' use of telemedicine medical services in | ||
medically underserved areas of this state[ |
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[ |
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(g) The commission shall ensure that a Medicaid managed care | ||
organization: | ||
(1) does not deny reimbursement for a covered health | ||
care service or procedure delivered by a health care provider with | ||
whom the managed care organization contracts to a Medicaid | ||
recipient as a telemedicine medical service or a telehealth service | ||
solely because the covered service or procedure is not provided | ||
through an in-person consultation; | ||
(2) does not limit, deny, or reduce reimbursement for | ||
a covered health care service or procedure delivered by a health | ||
care provider with whom the managed care organization contracts to | ||
a Medicaid recipient as a telemedicine medical service or a | ||
telehealth service based on the health care provider's choice of | ||
platform for providing the health care service or procedure; and | ||
(3) ensures that the use of telemedicine medical | ||
services or telehealth services promotes and supports | ||
patient-centered medical homes by allowing a Medicaid recipient to | ||
receive a telemedicine medical service or telehealth service from a | ||
provider other than the recipient's primary care physician or | ||
provider, except as provided by Section 531.0217(c-4), only if: | ||
(A) the telemedicine medical service or | ||
telehealth service is provided in accordance with the law and | ||
contract requirements applicable to the provision of the same | ||
health care service in an in-person setting, including requirements | ||
regarding care coordination; and | ||
(B) the provider of the telemedicine medical | ||
service or telehealth service gives notice to the Medicaid | ||
recipient's primary care physician or provider regarding the | ||
telemedicine medical service or telehealth service, including a | ||
summary of the service, exam findings, a list of prescribed or | ||
administered medications, and patient instructions, for the | ||
purpose of sharing medical information, provided that the recipient | ||
has a primary care physician or provider and the recipient or, if | ||
appropriate, the recipient's parent or legal guardian, consents to | ||
the notice. | ||
(h) The commission shall develop, document, and implement a | ||
monitoring process to ensure that a Medicaid managed care | ||
organization ensures that the use of telemedicine medical services | ||
or telehealth services promotes and supports patient-centered | ||
medical homes and care coordination in accordance with Subsection | ||
(g)(3). The process must include monitoring of the rate at which a | ||
telemedicine medical service or telehealth service provider gives | ||
notice in accordance with Subsection (g)(3)(B). | ||
(i) The executive commissioner by rule shall ensure that a | ||
federally qualified health center as defined by 42 U.S.C. Section | ||
1396d(l)(2)(B) may be reimbursed for the originating site facility | ||
fee or the distant site practitioner fee or both, as appropriate, | ||
for a covered telemedicine medical service or telehealth service | ||
delivered by a health care provider to a Medicaid recipient. The | ||
commission is required to implement this subsection only if the | ||
legislature appropriates money specifically for that purpose. If | ||
the legislature does not appropriate money specifically for that | ||
purpose, the commission may, but is not required to, implement this | ||
subsection using other money available to the commission for that | ||
purpose. | ||
(j) In complying with state and federal requirements to | ||
provide access to medically necessary services under the Medicaid | ||
managed care program, a Medicaid managed care organization | ||
determining whether reimbursement for a telemedicine medical | ||
service or telehealth service is appropriate shall continue to | ||
consider other factors, including whether reimbursement is | ||
cost-effective and whether the provision of the service is | ||
clinically effective. | ||
SECTION 3. Sections 531.0217(c-4), (d), and (k), Government | ||
Code, are amended to read as follows: | ||
(c-4) The commission shall ensure that Medicaid | ||
reimbursement is provided to a physician for a telemedicine medical | ||
service provided by the physician, even if the physician is not the | ||
patient's primary care physician or provider, if: | ||
(1) the physician is an authorized health care | ||
provider under Medicaid; | ||
(2) the patient is a child who receives the service in | ||
a primary or secondary school-based setting; and | ||
(3) the parent or legal guardian of the patient | ||
provides consent before the service is provided[ |
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[ |
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(d) The commission shall require reimbursement for a | ||
telemedicine medical service at the same rate as Medicaid | ||
reimburses for the same [ |
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A request for reimbursement may not be denied solely because an | ||
in-person medical service between a physician and a patient did not | ||
occur. The commission may not limit a physician's choice of | ||
platform for providing a telemedicine medical service or telehealth | ||
service by requiring that the physician use a particular platform | ||
to receive reimbursement for the service. | ||
(k) This section does not affect any requirement relating | ||
to: | ||
(1) [ |
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[ |
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(2) [ |
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carry out or sign prescription drug orders to an advanced practice | ||
nurse or physician assistant. | ||
SECTION 4. The following provisions of the Government Code | ||
are repealed: | ||
(1) Sections 531.0216(b) and (e); | ||
(2) Section 531.02161; | ||
(3) Sections 531.0217(c-1), (c-2), (c-3), and (f); | ||
(4) Section 531.02173; and | ||
(5) Section 531.02176. | ||
SECTION 5. 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 6. This Act takes effect September 1, 2019. |