Texas State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Texas Medicaid

Texas

Medicaid Program: Texas Medicaid

Medicaid Program Administrator: Texas Health and Human Services Commission

Regional Telehealth Resource Center:

TexLa Telehealth Resource Center
3601 4th Street, Ste. 2B440

Lubbock, TX 79430
(806) 743-4440/(877) 391-0487

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine is “the use of health care information exchanged from one site to another via electronic communications for the health and education of the individual or provider, and for the purpose of improving patient care, treatment, and services.”

Source: TX Admin. Code, Title 25 Sec. 412.303.

“Telemedicine medical service–A health care service, initiated by a physician who is licensed to practice medicine in Texas under Title 3, Subtitle B of the Occupations Code or provided by a health professional acting under physician delegation and supervision, that is provided for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, or treatment, or for the transfer of medical data, and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

Compressed digital interactive video, audio, or data transmission;

Clinical data transmission using computer imaging by way of still-image capture and store and forward; and

Other technology that facilitates access to health care services or medical specialty expertise.”

Source: TX Admin. Code, Title 1 Sec. 354.1430

Speech-Language Pathology and Audiology

Telehealth is “the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of speech-language pathology or audiology services to an individual from a provider through hardwire or internet connection.”

Source: TX Admin. Code, Title 22 Sec. 741.1.

“Telehealth service” means a health service, other than a telemedicine medical service, that is delivered by a licensed or certified health professional acting within the scope of the health professional’s license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

Compressed digital interactive video, audio, or data transmission;

Clinical data transmission using computer imaging by way of still-image capture and store and forward; and

Other technology that facilitates access to health care services or medical specialty expertise.

Source: TX Government Code, Sec. 531.001 & TX Admin. Code, Title 1 Sec. 354.1430 & TX Medicaid Telecommunication Services Handbook, pg. 6, (Oct. 2017).

Telemedicine is defined as a health-care service that is either initiated by a physician who is licensed to practice medicine in Texas or provided by a health professional who is acting under physician delegation and supervision. Telemedicine is provided for the purpose of the following:

Client assessment by a health professional Diagnosis, consultation or treatment by a physician

Transfer of medical data that requires the use of advanced telecommunications technology, other than telephone or facsimile, including the following: (1) Compressed digital interactive video, audio or data transmission, (2) clinical data transmission using computer imaging by way of still-image and store and forward; and (3) Other technology that facilitates access to health-care services or medical specialty expertise.

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Telehealth services–The fitting and dispensing of Source: TX Admin. Code, Title 1 Sec. 354.1430 & TX Medicaid

hearing instruments through telepractice to a client who Telecommunication Services Handbook, pg. 5, (Oct. 2017).
is physically located at a site other than the site where “Telemedicine medical service” means a health care
the provider is located.
service that is initiated by a physician or provided by a

Source: TX Admin. Code, Ch. 112, Sec.112.150. (2016). health professional acting under physician delegation and
Occupational Therapy supervision, that is provided for purposes of patient
assessment by a health professional, diagnosis or
consultation by a physician, or treatment, or for the
Telehealth is a “mode of service delivery through the
use of visual and auditory, real time interactive transfer of medical data, and that requires the use of
electronic information/communications technologies. As advanced telecommunications technology, other than
a mode of service delivery, telehealth is contact with the telephone or facsimile technology, including:
client and the occupational therapy practitioner(s).
Telehealth refers only to the practice of occupational Compressed digital interactive video, audio, or
therapy by occupational therapy practitioners who are data transmission;
licensed by this Board with clients who are located in Clinical data transmission using computer
Texas at the time of the provision of occupational imaging by way of still-image capture and store
therapy services. Also may be known as other terms and forward; and
including but not limited to telepractice, telecare, Other technology that facilitates access to health
telerehabilitation, and e-health services.” care services or medical specialty expertise.
Source: TX Admin. Code, Title 40 Sec. 362.1. (2016). Source: TX Government Code, Sec. 531.001.
Recently Passed Legislation (Now Effective) Home telemonitoring is “a health service that requires
Telehealth service means a health service, other than a scheduled remote monitoring of data related to patient’s
telemedicine medical service, delivered by a health health and transmission of the data to a licensed home
professional licensed, certified, or otherwise entitled to health agency or a hospital”.
practice in this state and acting within the scope of the
health professional’s license, certification, or entitlement Source: TX Government Code, Sec. 531.001.
to a patient at a different physical location than the
health professional using telecommunications or
information technology.
Telemedicine service means a health care service
delivered by a physician licensed in this state, or a
health professional acting under the delegation and
supervision of a physician licensed in this state, and
acting within the scope of the physician’s or health
professional’s license to a patient at a different physical
location than the physician or health professional using
telecommunications or information technology.
Source: TX Occupations Code 111.001 (SB 1107 – 2017)

Live Video Reimbursement

TX Medicaid required to reimburse school districts or open enrollment charter schools for telehealth services delivered by a health professional even if the specialist is not the patient’s primary care provider if the school district or charter school is an authorized health care provider under Medicaid and the parent or guardian of the patient consents.

A health professional is defined as:

Licensed social worker, occupational therapist or

Texas Medicaid reimburses for live video for the following services:

Consultations;

Office or other outpatient visits;

Psychiatric diagnostic interviews;

Pharmacologic management;

Psychotherapy

Data transmission

Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Govt. Code Sec. 531.0216. (2016).

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speech language pathologist
Telemedicine eligible distant site providers:
Licensed professional counselor
Licensed marriage and family therapist Physician
Licensed specialist in school psychology. Certified Nutrition Specialist
Source: TX Government Code Sec. 531.02171. Nurse Practitioner
Physician Assistant
Certified Nurse Midwife
A distant site provider is the physician, or PA, NP or CNS
who is supervised by and has delegated authority from a
licensed Texas physician who uses telemedicine to
provide health care services in Texas. Hospitals may also
serve as the distant site provider.
Source: TX Medicaid Telecommunication Services Handbook, pg.
5, (Oct. 2017). (Accessed Mar. 2017).
Telehealth eligible distant site providers
Licensed professional counselors
Licensed marriage and family therapist
Licensed clinical social worker
Psychologist
Licensed psychological associate
Provisionally licensed psychologist
Licensed dietician
Source: TX Medicaid Telecommunication Services Handbook, pg.
7, (Oct. 2017).
Eligible originating sites (Telecommunication):
Established medical site
State mental health facility
State supported living center
Source: TX Medicaid Telecommunication Services Handbook. P. 5-
6 (Oct. 2017).
Telemedicine eligible originating (patient) site providers:
Physicians;
Physician assistants;
Nurse practitioners;
Clinical nurse specialists;
Outpatient providers
Source: TX Admin Code. Title 1, Sec. 355.7001 and TX Medicaid
Telecommunication Services Handbook, pg. 6 (Oct. 2017).
Telehealth eligible originating site presenter:
An individual who is licensed or certified in Texas
to perform health care services
A qualified mental health professional
A telepresenter is required at the originating site for both
telemedicine and telehealth, unless the services relate to
mental health. In that situation a patient-site presenter
does not have to be readily available unless the client is
in a danger to himself/herself or others.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: TX Medicaid Telecommunication Services Handbook, pg. 8

(July. 2016).

More than one medically necessary telemedicine or

telehealth service may be reimbursed for the same date
and same place of service if the services are billed by
providers of different specialties.

Source: TX Medicaid Telecommunication Services Handbook, pg.

4, (Oct. 2017).

There is distant-site physician reimbursement for

assessment and evaluation office visit if:

A health professional under the physician’s

supervision is present with the patient for the
visit;

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 visit.

Source: TX Govt. Code Sec. 531.0217.

Provider reimbursement must be the same as in-person

services.

Source: TX Admin. Code, Title 1 Sec. 355.7001.

Telemedicine services are not required if an in-person

consultation with a physician is reasonably available
where the patient resides or works.

Telemedicine providers must 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.

With patient consent, the primary care provider must be

notified of the telemedicine medical service for the
purpose of sharing medical information.

Source: TX Govt. Code Sec. 531.0217.

Before receiving a telehealth service, the patient must

receive an initial evaluation for the same diagnosis or
condition by a physician or other qualified healthcare
professional licensed in Texas which can be performed
in-person or as a telemedicine visit that conforms to 22
TAC Ch. 174. A patient receiving telehealth services
must be evaluated annually by a physician or other
healthcare professional (in person or via a telemedicine

visit) to determine if the patient has a continued need for
the service. Exception for mental health diagnosis or
condition.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Medicaid
Telecommunication Services Handbook, pg. 6 (Oct. 2017).
See provider manual for special rules for Texas Health
Steps program.
Source: TX Medicaid Telecommunication Services Handbook, pg. 6
(Oct. 2017).
Telemedicine: For new conditions, the patient site
presenter must be readily available (in the same room or
in close proximity) on site at the established medical site
to assist with care. Patient site presenter not required for
mental health services (except in cases of behavioral
emergencies).
Telehealth: Before receiving telehealth services, the
client must receive an initial evaluation for the same
diagnosis performed in person or via telemedicine, except
for mental health. Clients receiving telehealth services
must be evaluated at least annually by a physician or
health care professional in person or via telemedicine,
except for mental health services.

Store and Forward Reimbursement

(see Medicaid column) TX Medicaid Manual states that telemedicine and
telehealth services only “involve direct face-to-face
interactive video communication between the client and
the distant-site provider.”
Source: TX Medicaid Telecommunication Services Handbook, pg.
4, (Oct. 2017).
TX Government Code includes a definition of
“Telemedicine Medical Service” and “Telehealth Services”
which encompasses Store and Forward, stating that it
includes “clinical data transmission using computer
imaging by way of still-image capture and store and
forward”.
Source: TX Government Code, Sec. 531.001.

Remote Patient Monitoring Reimbursement

No reference found. Texas Medicaid will reimburse for home telemonitoring
in the same manner as their other professional services
provided by a home health agency.
Source: TX Admin Code, Title 1, Sec. 355.7001.
Online evaluation and management for home
telemonitoring services is a benefit in the office or
outpatient hospital setting when services are provided
by a nurse practitioner, clinical nurse specialist,
physician assistant or physician provider.
Data must be reviewed by a registered nurse, nurse

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STATE LAW/REGULATIONS MEDICAID PROGRAM

practitioner, clinical nurse specialist, or physician
assistant who is responsible for reporting data to the
prescribing physician in the event of a measurement
outside the established parameters.
The procedure code is limited to once per seven days.
Scheduled periodic reporting of client data to the
physician is required.
Setup and daily monitoring is reimbursed when provided
by a home health agency or outpatient hospital.
There must be prior authorization from TX Medicaid for
home telemonitoring. Clients must be diagnosed with
diabetes or hypertension and exhibit two or more risk
factors (see regulations).
Source: TX Medicaid Telecommunication Services Handbook, pg.
8-9, (Oct. 2017).
Home Telemonitoring is available only to patients who:
Are diagnosed with diabetes, hypertension; or
When it is determined by Texas Health and
Human Services Commission to be cost
effective and feasible the following conditions
are also included: pregnancy, heart disease,
cancer, chronic obstructive pulmonary disease,
congestive heart failure, mental illness, asthma,
myocardial infarction or stroke.
Patients that meet the above criteria must exhibit two or
more of the following risk factors:
Two or more hospitalizations in the prior 12
month period
Frequent or recurrent emergency room
admissions
A documented history of poor adherence to
ordered medication regimens
A documented history of falls in the prior six
month period
Limited or absent informal support system
Living alone or being home alone for extended
periods of time; and
A documented history of care access challenges
Providers must be enrolled and approved as home
telemonitoring services providers.
The home health agency must maintain extensive
documentation in the patient’s medical record.
Source: TX Admin Code. Title 1, Sec. 354.1434 & TX Medicaid
Telecommunication Services Handbook, pg. 9, (Oct. 2017).

Email/Phone/FAX

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Recently Passed Legislation (Effective Jan. 1, 2018) No reimbursement for email.
A health plan is not required to provide coverage for No reimbursement for telephone.
No reimbursement for FAX.
services provided by only synchronous or asynchronous No reimbursement for chart review.
audio interaction including audio-only telephone; email
or facsimile. Source: TX Medicaid Telecommunication Services Handbook, pg.
4, (Oct. 2017).
Source: TX Insurance Code 1455.004 & .005 (SB 1107 – 2017)
For speech-language pathology and audiology, no
reimbursement for correspondence only, e.g.,
telephone, email, or FAX, although they may be
adjuncts to tele-practice.
Source: TX Admin. Code, Title 22, Sec. 741.214. TX Admin. Code,
Ch. 112, Sec.112.150. (2016).

Online Prescribing

Recently Passed Legislation (Now Effective) Telemedicine medical services provided at an
A valid practitioner-patient relationship is present established medical site may be used for all client visits,
between a practitioner providing a telemedicine medical including the establishment of a defined physician-client
service and a patient receiving the telemedicine medical relationship between a distant site provider and a client.
service as long as the practitioner complies with the
same standard of care as would apply in an in-person Source: TX Medicaid Telecommunication Services Handbook, pg. 7, (Oct.
setting, and complies with one of the following 2017).
scenarios:
Has a preexisting practitioner-patient
relationship with the patient established;
Communicates with the patient pursuant to a
call coverage agreement established in
accordance with Texas Medical Board rules with
a physician requesting coverage of medical care
for the patient; or
Provides the telemedicine medical services
through the use of one of the following methods,
as long as the practitioner complies with follow-
up requirements and the method allows the
practitioner to have access to the relevant
clinical information that would be required to
meet the standard of care.
Synchronous audiovisual interaction
Asynchronous store and forward
technology as long as practitioner uses
relevant clinical information
Another form of audiovisual
telecommunication technology that
allows the practitioner to comply with the
appropriate standard of care
A practitioner who provides telemedicine medical
services to a patient shall provide the patient with
guidance on appropriate follow up care and with the
patient’s consent, forward the report of the encounter to
the patient’s primary care physician within 72 hours.
A practitioner-patient relationship is not present for

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STATE LAW/REGULATIONS MEDICAID PROGRAM

purposes of prescribing an abortifacient or other drug or

device to terminate a pregnancy.

The Texas Medical Board, Texas Board of Nursing,

Texas Physician Assistant Board and the Texas
Pharmacy Board are required to adopt joint rules that
establish the determination of a valid prescription, which
must allow for the establishment of the practitioner-
patient relationship through telemedicine if it meets the
standards outlined above.

This section does not apply to mental health services.

Source: TX Occupations Code 111.005-.008 (SB 1107 – 2017)

Treatment and consultation recommendations made in

an online setting, including issuing a prescription via
electronic means, will be held to the same standards of
appropriate practice as those in traditional in-person
clinical settings.

Online or telephone evaluations solely by questionnaire

are prohibited.

Source: TX Admin. Code, Title 22, Sec. 174.8.

A physician-patient relationship (needed to prescribe

any dangerous drug or controlled substance) requires
either an in-person exam or the patient to be located at
an Established Medical Site. This does not apply for
mental health services, except in cases of behavioral
emergencies.

Source: TX Admin. Code, Title 22, Part 9, Ch. 190 (Expected to be

revised based on passage of SB 1107).

Consent

Consent required prior to telemedicine or telehealth Written or verbal consent must be obtained to allow any
services. other individual (besides the distant site provider, patient
Either originating or distant site health professionals site presenter or representative) to be present during a
telemedicine or telehealth visit.
shall obtain this consent. A good faith effort must be made to obtain written

For a child receiving telemedicine services in a primary acknowledgement of notification of privacy practices,
school based setting, advance parent or legal guardian when communicating via email or other electronic
consent must be obtained. method.
Source: TX Occupational Code Sec. 111.002. TX Admin. Code, Signed and dated informed consent required before
Title 1, Sec. 354.1432. (2016). providing services via telemedicine.
Source: TX Medicaid Telecommunication Services Handbook, pg.
5 (Oct. 2017).

Location

An established medical site may include the patient’s Telemedicine/Telehealth eligible originating (patient)
home, including a group or institutional setting, for the sites:

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STATE LAW/REGULATIONS MEDICAID PROGRAM

delivery of mental health services. If for other medical
services other than mental health services, the patient’s An established medical site
home or group or institutional setting may be an A state mental health facility
established medical site if: State supported living centers.
A patient site presenter is present; A patient’s home is not an established medical site,
There is a defined physician-patient relationship except when services are limited to mental health
The patient site presenter has sufficient services. For medical services the following
communication and remote medical diagnostic requirements must be met to be provided in the clients’
technology to allow the physician to carry out an home:
adequate physical examination appropriate for A patient site presenter is present
the patient’s presenting condition while seeing There is a defined physician-client relationship
and hearing the patient in real time. The technology is adequate to allow for a real
Source: TX Administrative Code Sec. Title 22 Section 174.6. time physical exam
The physical exam is held to the same
(See Medicaid column) standards as in the traditional medical setting.

Source: TX Medicaid Telecommunication Services Handbook, pg.
5-8, (Oct. 2017). TX Admin. Code, Title 1, Sec. 354.1432.
Services may take place in a school-based setting if:
The physician is an authorized health care
provider under Medicaid;
The patient is a child who receives the service in
A primary or secondary school-based setting;
The parent or legal guardian of the patient
provides consent before the service is provided;
and
A health professional is present with the patient
during treatment.
There must be a patient site presenter, with the
exception of mental health services.
Source: TX Bill HB 1878(2015); 1 TAC Sec. 355.7001; & TAC
354.1432.
Other Sites
For telemedicine medical services that are provided at a
site other than an established medical site, the following
apply:
Patient-site presenters are not required for pre-
existing conditions previously diagnosed by a
physician through a face to face visit
All clients must be seen by a physician for an in-
person evaluation at least once a year
Telemedicine medical services may be used to
treat chronic pain with scheduled drugs
A distant site provider may treat an established client’s
new symptoms, however the client must be advised to
see a physician face to face within 72 hours. They
cannot continue to be treated if they have not seen a
physician within 72 hours.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

A distant site provider who provides telemedicine
services at a site other than an established medical site
for a previously diagnosed medical condition must:
See the client one time in a face to face visit
before providing telemedicine medical care
See the client without an initial face to face visit
as long as the client has received an in-person
evaluation by another physician who has
referred the client for additional care and the
referral is documented in the medical record.
Source: TX Medicaid Telecommunication Services Handbook, pg.
5-8, (Oct. 2017).

Cross-State Licensing

A telemedicine license may be issued for out of state No reference found.
providers.
Source: TX Admin. Code, Title 22, Sec. 172.12 & TX Occupation
Code Section 151.056.

Private Payers

Recently Passed Legislation (Effective Jan. 1, 2018) No reference found.
Prohibits a health benefit plan from excluding from
coverage a service delivered as a telemedicine medical
service or a telehealth service solely because the
service is not provided in-person. A health plan is not
required to provide coverage for services provided by
only synchronous or asynchronous audio interaction
including audio-only telephone; email or facsimile.
Each issuer of a health benefit plan must adopt and
display in a conspicuous manner on their website the
policies and payment practices for telemedicine medical
services and telehealth services. They, however, are
not required to list payment rates.
Source: TX Insurance Code 1455.004 & .005 (SB 1107 – 2017)
Requires coverage of telemedicine services, subject to
contract terms and conditions.
Source: TX Insurance Code Sec. 1455.004 (valid until Dec. 31,
2017).

Site/Transmission Fee

(see Medicaid column) Telemedicine patient site locations are reimbursed a
facility fee. It is not a benefit if the patient is the client’s
home.
Source: TX Admin. Code, Title 1 Sec. 355.7001 & TX Medicaid
Telecommunication Services Handbook, pg. 6 (Oct. 2017).

Miscellaneous

Children’s Health Insurance Program

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Allows reimbursement for live video telemedicine and
telehealth services to children with special health care
needs.
Source: TX Govt. Code Sec. 531.02162
Must use the “95” modifier for telemedicine/telehealth
services (except for services that already indicate
remote delivery in the description). See manual for
codes that can be billed with the 95 modifier.
Source: TX Medicaid Telecommunication Services Handbook, pg.
5 (Oct. 2017).
The software system used by the distant site and
originating site (when patient presenter is used) must
allow secure authentication of the distant site provider
and the client.
See provider manual for other information security and
documentation requirements.
Source: TX Medicaid Telecommunication Services Handbook, pg.
5 (Oct. 2017).

Comments: Professional Board Telehealth-Specific Regulations

TX Medical Board (Source: TX Admin. Code, Title 22, Part 9, Ch. 190)

TX Board of Speech Pathology and Audiology Source: TX Admin. Code, Ch. 112, Sec.112.150.

TX Board of Occupational Therapy Examiners (Source: TX Admin. Code, Title 3, Subtitle H, Ch. 372.1)

Legislation established a pilot project to provide emergency medical services instruction and emergency prehospital care instruction through a telemedicine medical service provided by regional trauma resource centers to:

Health care providers in rural area trauma facilities and

Emergency medical services providers in rural areas.

Source: TX Bill HB 479 (2015)).

An e-Health Advisory Committee was established under TX Government Code Section 531.012 and is comprised of 15 members, including:

At least one expert on telemedicine

At least one expert on home telemonitoring services

At least one representative of consumers of health services provided through telemedicine.

Source: TX Admin. Code, Ch. 112, Sec.351.801. (2016).

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