Bill Text: TX HB4 | 2021-2022 | 87th Legislature | Engrossed


Bill Title: Relating to the provision and delivery of health care services under Medicaid and other public benefits programs using telecommunications or information technology and to reimbursement for some of those services.

Spectrum: Bipartisan Bill

Status: (Engrossed) 2021-05-12 - Scheduled for public hearing on . . . [HB4 Detail]

Download: Texas-2021-HB4-Engrossed.html
  87R14291 KKR-F
 
  By: Price, Oliverson, Coleman, Ashby, H.B. No. 4
      Guillen, et al.
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the provision and delivery of health care services
  under Medicaid and other public benefits programs using
  telecommunications or information technology and to reimbursement
  for some of those services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.0216(i), Government Code, is amended
  to read as follows:
         (i)  The executive commissioner by rule shall ensure that a
  rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and
  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.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02161 to read as follows:
         Sec. 531.02161.  PROVISION OF SERVICES THROUGH
  TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND
  OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section, "case
  management services" includes service coordination, service
  management, and care coordination.
         (b)  To the extent permitted by federal law and to the extent
  it is cost-effective and clinically effective, as determined by the
  commission, the commission shall ensure that Medicaid recipients,
  child health plan program enrollees, and other individuals
  receiving benefits under a public benefits program administered by
  the commission or a health and human services agency, regardless of
  whether receiving benefits through a managed care delivery model or
  another delivery model, have the option to receive services as
  telemedicine medical services, telehealth services, or otherwise
  using telecommunications or information technology, including the
  following services:
               (1)  preventative health and wellness services;
               (2)  case management services, including targeted case
  management services;
               (3)  subject to Subsection (c), behavioral health
  services;
               (4)  occupational, physical, and speech therapy
  services;
               (5)  nutritional counseling services; and
               (6)  assessment services, including nursing
  assessments under the following Section 1915(c) waiver programs:
                     (A)  the community living assistance and support
  services (CLASS) waiver program;
                     (B)  the deaf-blind with multiple disabilities
  (DBMD) waiver program;
                     (C)  the home and community-based services (HCS)
  waiver program; and
                     (D)  the Texas home living (TxHmL) waiver program.
         (c)  The commission by rule shall develop and implement a
  system to ensure behavioral health services may be provided using
  audio-only technology to a Medicaid recipient, a child health plan
  program enrollee, or another individual receiving those services
  under another public benefits program administered by the
  commission or a health and human services agency.
         (d)  If the executive commissioner determines that providing
  services other than behavioral health services is appropriate using
  audio-only technology under a public benefits program administered
  by the commission or a health and human services agency, in
  accordance with applicable federal and state law, the executive
  commissioner may by rule authorize the provision of those services
  under the applicable program using that technology.  In determining
  whether the use of audio-only technology in a program is
  appropriate under this subsection, the executive commissioner
  shall consider whether using the technology would be cost-effective
  and clinically effective.
         SECTION 3.  Section 531.02164, Government Code, is amended
  by adding Subsection (f) to read as follows:
         (f)  To comply with state and federal requirements to provide
  access to medically necessary services under the Medicaid managed
  care program, a Medicaid managed care organization may reimburse
  providers for home telemonitoring services provided to persons and
  in circumstances 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 4.  Section 533.0061(b), Government Code, is amended
  to read as follows:
         (b)  To the extent it is feasible, the provider access
  standards established under this section must:
               (1)  distinguish between access to providers in urban
  and rural settings; [and]
               (2)  consider the number and geographic distribution of
  Medicaid-enrolled providers in a particular service delivery area;
  and
               (3)  consider and include the availability of
  telehealth services and telemedicine medical services within the
  provider network of a managed care organization.
         SECTION 5.  Section 533.008, Government Code, is amended by
  adding Subsection (c) to read as follows:
         (c)  The executive commissioner shall adopt and publish
  guidelines for Medicaid managed care organizations regarding how
  organizations may communicate by text message with recipients
  enrolled in the organization's managed care plan.  The guidelines
  must include standardized consent language to be used by
  organizations in obtaining a recipient's consent to receive
  communications by text message.
         SECTION 6.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.039 to read as follows:
         Sec. 533.039.  DELIVERY OF BENEFITS USING
  TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY. (a)  The commission
  shall establish policies and procedures to improve access to care
  under the Medicaid managed care program by encouraging the use of
  telehealth services, telemedicine medical services, home
  telemonitoring services, and other telecommunications or
  information technology under the program.
         (b)  To the extent permitted by federal law, the commission
  by rule shall establish policies and procedures that allow a
  Medicaid managed care organization to conduct assessments of and
  provide care coordination services to recipients receiving home and
  community-based services using another telecommunications or
  information technology if:
               (1)  the managed care organization determines using the
  telecommunications or information technology is appropriate;
               (2)  the recipient requests that the assessment or
  activity is provided using telecommunications or information
  technology;
               (3)  an in-person assessment or activity is not
  feasible because of the existence of an emergency or state of
  disaster, including a public health emergency or natural disaster;
  or
               (4)  the commission determines using the
  telecommunications or information technology is appropriate under
  the circumstances.
         (c)  If a managed care organization conducts an assessment of
  or provides care coordination services to a recipient using
  telecommunications or information technology, the managed care
  organization shall:
               (1)  monitor the health care services provided to the
  recipient for evidence of fraud, waste, and abuse; and
               (2)  determine whether additional social services or
  supports are needed.
         (d)  To the extent permitted by federal law, the commission
  shall allow a recipient who is assessed or provided with care
  coordination services by a Medicaid managed care organization using
  telecommunications or information technology to provide consent or
  other authorizations to receive services verbally instead of in
  writing.
         (e)  The commission shall determine categories of recipients
  of home and community-based services who must receive in-person
  visits.  Except during circumstances described by Subsection
  (b)(3), a Medicaid managed care organization shall, for a recipient
  of home and community-based services for which the commission
  requires in-person visits, conduct:
               (1)  at least one in-person visit with the recipient;
  and
               (2)  additional in-person visits with the recipient if
  necessary, as determined by the managed care organization.
         SECTION 7.  Section 62.1571, Health and Safety Code, is
  amended to read as follows:
         Sec. 62.1571.  TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH
  SERVICES. (a) In providing covered benefits to a child, a health
  plan provider must permit benefits to be provided through
  telemedicine medical services and telehealth services in
  accordance with policies developed by the commission.
         (b)  The policies must provide for:
               (1)  the availability of covered benefits
  appropriately provided through telemedicine medical services or
  telehealth services that are comparable to the same types of
  covered benefits provided without the use of telemedicine medical
  services or telehealth services; and
               (2)  the availability of covered benefits for different
  services performed by multiple health care providers during a
  single session of telemedicine medical services or telehealth
  services, if the executive commissioner determines that delivery of
  the covered benefits in that manner is cost-effective in comparison
  to the costs that would be involved in obtaining the services from
  providers without the use of telemedicine medical services or
  telehealth services, including the costs of transportation and
  lodging and other direct costs.
         (d)  In this section, "telehealth service" and "telemedicine
  medical service" have [has] the meanings [meaning] assigned by
  Section 531.001, Government Code.
         SECTION 8.  Not later than January 1, 2022, the Health and
  Human Services Commission shall:
               (1)  implement Section 531.02161, Government Code, as
  added by this Act; and
               (2)  publish the guidelines required by Section
  533.008(c), Government Code, as added by this Act.
         SECTION 9.  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 10.  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, 2021.
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