Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL CONSULTATIONS. (a) In this section:
(1) "Health professional" means:
(A) a physician;
(B) an individual who is:
(i) licensed or certified in this state to perform health care services; and
(ii) authorized to assist a physician in providing telemedicine medical services that are delegated and supervised by the physician; or
(C) a licensed or certified health professional acting within the scope of the license or certification who does not perform a telemedicine medical service.
(2) "Physician" means a person licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.
(3) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1205, Sec. 10(2), eff. September 1, 2011.
(4) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1205, Sec. 10(2), eff. September 1, 2011.
(b) The executive commissioner by rule shall require each health and human services agency that administers a part of Medicaid to provide Medicaid reimbursement for a telemedicine medical service initiated or provided by a physician.
(c) The commission shall ensure that reimbursement is provided only for a telemedicine medical service initiated or provided by a physician.
(c-1) Notwithstanding Subsection (b) or (c), the commission shall provide for reimbursement under Medicaid for an office visit provided through telemedicine by a physician who is assessing and evaluating the patient from a distant site if:
(1) a health professional acting under the delegation and supervision of that physician is present with the patient at the time of the visit; and
(2) the medical condition, illness, or injury for which the patient is receiving the service is not likely, within a reasonable degree of medical certainty, to undergo material deterioration within the 30-day period following the date of the visit.
(c-2) The commission shall develop rules to allocate reimbursement provided under Subsection (c-1) between a physician consulting from a distant site and a health professional present with the patient or shall by rule establish a facility fee that a physician consulting from a distant site and receiving reimbursement under Subsection (c-1) must pay a health professional present with the patient.
(c-3) In adopting rules developed under Subsection (c-2), the executive commissioner shall confer with the Centers for Medicare and Medicaid Services on the legality of allocating reimbursement or establishing a facility fee as described in that subsection. Rules adopted by the executive commissioner under this subsection or Subsection (c-2) must reflect a policy to build capacity in medically underserved areas of this state.
(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;
(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 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.
(e) A health care facility that receives reimbursement under this section for a telemedicine medical service provided by a physician who practices in that facility or a health professional who participates in a telemedicine medical service under this section shall establish quality of care protocols and patient confidentiality guidelines to ensure that the telemedicine medical service meets legal requirements and acceptable patient care standards.
(f) The commission may not require a telemedicine medical service if an in-person consultation with a physician is reasonably available where the patient resides or works. The commission shall require facilities and providers of telemedicine medical services to make a good faith effort to identify and coordinate with existing providers to preserve and protect existing health care systems and medical relationships in an area.
(g) If a patient receiving a telemedicine medical service has a primary care physician or provider and consents or, if appropriate, the patient's parent or legal guardian consents to the notification, the commission shall require that the primary care physician or provider be notified of the telemedicine medical service for the purpose of sharing medical information. In the case of a service provided to a child in a school-based setting as described by Subsection (c-4), the notification, if any, must include a summary of the service, including exam findings, prescribed or administered medications, and patient instructions.
(g-1) If a patient receiving a telemedicine medical service in a school-based setting as described by Subsection (c-4) does not have a primary care physician or provider, the commission shall require that the patient's parent or legal guardian receive:
(1) the notification required under Subsection (g); and
(2) a list of primary care physicians or providers from which the patient may select the patient's primary care physician or provider.
(h) The commission in consultation with the Texas Medical Board shall monitor and regulate the use of telemedicine medical services to ensure compliance with this section. In addition to any other method of enforcement, the commission may use a corrective action plan to ensure compliance with this section.
(i) The Texas Medical Board, in consultation with the commission, as appropriate, may adopt rules as necessary to:
(1) ensure that appropriate care, including quality of care, is provided to patients who receive telemedicine medical services;
(2) prevent abuse and fraud through the use of telemedicine medical services, including rules relating to filing of claims and records required to be maintained in connection with telemedicine; and
(3) define those situations when a face-to-face consultation with a physician is required after a telemedicine medical service.
(i-1) The Texas Medical Board, in consultation with the commission and the Department of State Health Services, as appropriate, shall adopt rules to establish supervisory requirements for a physician delegating a service to be performed by an individual who is not a physician, registered nurse, advanced practice registered nurse, or physician assistant, including a health professional who is authorized to be a telepresenter under Section 531.02163. This section may not be construed as authorizing the Texas Medical Board to regulate another licensed or certified health care provider.
Section: Previous 531.02141 531.0215 531.0216 531.02161 531.02162 531.02163 531.02164 531.0217 531.02173 531.02174 531.02175 531.02176 531.0218 531.02191 531.02192 NextLast modified: September 28, 2016