Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF TELEMEDICINE MEDICAL SERVICE PROVIDERS AND TELEHEALTH SERVICE PROVIDERS UNDER MEDICAID. (a) The executive commissioner by rule shall develop and implement a system to reimburse providers of services under Medicaid for services performed using telemedicine medical services or telehealth services.
(b) In developing the system, the executive commissioner by rule shall:
(1) review programs and pilot projects in other states to determine the most effective method for reimbursement;
(2) establish billing codes and a fee schedule for services;
(3) provide for an approval process before a provider can receive reimbursement for services;
(4) consult with the Department of State Health Services to establish procedures to:
(A) identify clinical evidence supporting delivery of health care services using a telecommunications system; and
(B) annually review health care services, considering new clinical findings, to determine whether reimbursement for particular services should be denied or authorized;
(5) establish a separate provider identifier for telemedicine medical services providers, telehealth services providers, and home telemonitoring services providers; and
(6) establish a separate modifier for telemedicine medical services, telehealth services, and home telemonitoring services eligible for reimbursement.
(c) The commission shall encourage health care providers and health care facilities to participate as telemedicine medical service providers or telehealth 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.
(d) Subject to Section 153.004, Occupations Code, the executive commissioner may adopt rules as necessary to implement this section. In the rules adopted under this section, the executive commissioner shall:
(1) refer to the site where the patient is physically located as the patient site; and
(2) refer to the site where the physician or health professional providing the telemedicine medical service or telehealth service is physically located as the distant site.
(e) The commission may not reimburse a health care facility for telemedicine medical services or telehealth services provided to a Medicaid recipient unless the facility complies with the minimum standards adopted under Section 531.02161.
(f) Not later than December 1 of each even-numbered year, the commission shall report to the speaker of the house of representatives and the lieutenant governor on the effects of telemedicine medical services, telehealth services, and home telemonitoring services on Medicaid in the state, including the number of physicians, health professionals, and licensed health care facilities using telemedicine medical services, telehealth services, or home telemonitoring services, the geographic and demographic disposition of the physicians and health professionals, the number of patients receiving telemedicine medical services, telehealth services, and home telemonitoring services, the types of services being provided, and the cost of utilization of telemedicine medical services, telehealth services, and home telemonitoring services to Medicaid.
Added by Acts 1997, 75th Leg., ch. 1244, Sec. 1, eff. June 20, 1997. Amended by Acts 1999, 76th Leg., ch. 62, Sec. 18.22, eff; Sept. 1, 1999. Renumbered from Sec. 531.0215 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(46), eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch. 1255, Sec. 1, eff. June 15, 2001; Acts 2001, 77th Leg., ch. 1420, Sec. 14.765, eff. Sept. 1, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 370 (S.B. 1340), Sec. 1, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 525 (S.B. 760), Sec. 1, eff. September 1, 2007.
Acts 2011, 82nd Leg., R.S., Ch. 371 (S.B. 219), Sec. 2, eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1205 (S.B. 293), Sec. 2, eff. September 1, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.029, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.04, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.04, eff. January 1, 2016.
Section: Previous 531.02115 531.02118 531.0212 531.0213 531.0214 531.02141 531.0215 531.0216 531.02161 531.02162 531.02163 531.02164 531.0217 531.02173 531.02174 NextLast modified: September 28, 2016