Bill Text: TX SB670 | 2019-2020 | 86th Legislature | Enrolled


Bill Title: Relating to telemedicine and telehealth services.

Spectrum: Slight Partisan Bill (Republican 5-2)

Status: (Passed) 2019-06-14 - Effective on 9/1/19 [SB670 Detail]

Download: Texas-2019-SB670-Enrolled.html
 
 
  S.B. No. 670
 
 
 
 
AN ACT
  relating to 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 [participate as] telemedicine
  medical services and [service providers or] telehealth services
  [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].
         (c-1)  The commission shall[:
               [(1)]  explore opportunities to increase STAR Health
  program providers' use of telemedicine medical services in
  medically underserved areas of this state[; and
               [(2)     encourage STAR Health program providers to use
  telemedicine medical services as appropriate].
         (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[; and
               [(4)     a health professional is present with the patient
  during the treatment].
         (d)  The commission shall require reimbursement for a
  telemedicine medical service at the same rate as Medicaid
  reimburses for the same [a comparable] in-person medical service.
  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)  [a federally qualified health center;
               [(2)]  a rural health clinic; or
               (2) [(3)]  physician delegation of the authority to
  carry out or sign prescription drug orders to an advanced practice
  nurse or physician assistant.
         SECTION 4.  Section 162.251(2), Occupations Code, is amended
  to read as follows:
               (2)  "Direct primary care" means a primary medical care
  service provided by a physician to a patient in return for payment
  in accordance with a direct fee. The term includes telemedicine
  medical services and telehealth services, as those terms are
  defined by Section 111.001, provided using a technology platform.
         SECTION 5.  Section 562.110, Occupations Code, is amended by
  amending Subsections (e) and (f) and adding Subsection (f-1) to
  read as follows:
         (e)  The board shall adopt rules regarding the use of a
  telepharmacy system under this section, including:
               (1)  the types of health care facilities at which a
  telepharmacy system may be located under Subsection (d)(1), which
  must include the following facilities:
                     (A)  a clinic designated as a rural health clinic
  regulated under 42 U.S.C. Section 1395x(aa); [and]
                     (B)  a health center as defined by 42 U.S.C.
  Section 254b; and
                     (C)  a federally qualified health center as
  defined by 42 U.S.C. Section 1396d(l)(2)(B); 
               (2)  the locations eligible to be licensed as remote
  dispensing sites, which must include locations in medically
  underserved areas, areas with a medically underserved population,
  and health professional shortage areas determined by the United
  States Department of Health and Human Services;
               (3)  licensing and operating requirements for remote
  dispensing sites, including:
                     (A)  a requirement that a remote dispensing site
  license identify the provider pharmacy that will provide pharmacy
  services at the remote dispensing site;
                     (B)  a requirement that a provider pharmacy be
  allowed to provide pharmacy services at not more than two remote
  dispensing sites;
                     (C)  a requirement that a pharmacist employed by a
  provider pharmacy make at least monthly on-site visits to a remote
  dispensing site or more frequent visits if specified by board rule;
                     (D)  a requirement that each month the perpetual
  inventory of controlled substances at the remote dispensing site be
  reconciled to the on-hand count of those controlled substances at
  the site by a pharmacist employed by the provider pharmacy;
                     (E)  a requirement that a pharmacist employed by a
  provider pharmacy be physically present at a remote dispensing site
  when the pharmacist is providing services requiring the physical
  presence of the pharmacist, including immunizations;
                     (F)  a requirement that a remote dispensing site
  be staffed by an on-site pharmacy technician who is under the
  continuous supervision of a pharmacist employed by the provider
  pharmacy;
                     (G)  a requirement that all pharmacy technicians
  at a remote dispensing site be counted for the purpose of
  establishing the pharmacist-pharmacy technician ratio of the
  provider pharmacy, which, notwithstanding Section 568.006, may not
  exceed three pharmacy technicians for each pharmacist providing
  supervision;
                     (H)  a requirement that, before working at a
  remote dispensing site, a pharmacy technician must:
                           (i)  have worked at least one year at a
  retail pharmacy during the three years preceding the date the
  pharmacy technician begins working at the remote dispensing site;
  and
                           (ii)  have completed a board-approved
  training program on the proper use of a telepharmacy system;
                     (I)  a requirement that pharmacy technicians at a
  remote dispensing site may not perform extemporaneous sterile or
  nonsterile compounding but may prepare commercially available
  medications for dispensing, including the reconstitution of orally
  administered powder antibiotics; and
                     (J)  any additional training or practice
  experience requirements for pharmacy technicians at a remote
  dispensing site;
               (4)  the areas that qualify under Subsection (f);
               (5)  recordkeeping requirements; and
               (6)  security requirements.
         (f)  Except as provided by Subsection (f-1), a [A]
  telepharmacy system located at a health care facility under
  Subsection (d)(1) may not be located in a community in which a Class
  A or Class C pharmacy is located as determined by board rule.  If a
  Class A or Class C pharmacy is established in a community in which a
  telepharmacy system has been located under this section, the
  telepharmacy system may continue to operate in that community.
         (f-1)  A telepharmacy system located at a federally
  qualified health center as defined by 42 U.S.C. Section
  1396d(l)(2)(B) may be located in a community in which a Class A or
  Class C pharmacy is located as determined by board rule. 
         SECTION 6.  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 7.  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 8.  This Act takes effect September 1, 2019.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 670 passed the Senate on
  March 27, 2019, by the following vote: Yeas 31, Nays 0; and that
  the Senate concurred in House amendments on May 21, 2019, by the
  following vote: Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 670 passed the House, with
  amendments, on May 14, 2019, by the following vote: Yeas 138,
  Nays 0, two present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor
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