﻿<?xml version="1.0" encoding="utf-8"?><Search><pages Count="7"><page Index="1"><![CDATA[



                                                                                 Center for Connected Health Policy

           Texas


           Medicaid Program:  Texas Medicaid

           Medicaid Program Administrator:  Texas Health and Human Services Commission

           Regional Telehealth Resource Center:
           TexLa Telehealth Resource Center
                 th
           3601 4  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   "Telehealth service" means a health service, other than a
            exchanged from one site to another via electronic   telemedicine medical service, that is delivered by a
            communications for the health and education of the   licensed or certified health professional acting within the
            individual or provider, and for the purpose of improving   scope of the health professional's license or certification
            patient care, treatment, and services.”            who does not perform a telemedicine medical service and
                                                               that requires the use of advanced telecommunications
            Source: TX Admin. Code, Title 25 Sec. 412.303.     technology, other than telephone or facsimile technology,
                                                               including:
            Speech-Language Pathology and Audiology
            Telehealth is “the use of telecommunications and       •   Compressed digital interactive video, audio, or
            information technologies for the exchange of information   data transmission;
            from one site to another for the provision of speech-  •   Clinical data transmission using computer
            language pathology or audiology services to an             imaging by way of still-image capture and store
            individual from a provider through hardwire or internet    and forward; and
            connection.”                                           •   Other technology that facilitates access to health
                                                                       care services or medical specialty expertise.
            Source: TX Admin. Code, Title 22 Sec. 741.1.
                                                               Source: TX Government Code, Sec. 531.001 &  TX Admin. Code,
            “Telemedicine medical service--A health care service,   Title 1 Sec. 354.1430 & TX Medicaid Telecommunication Services
            initiated by a physician who is licensed to practice   Handbook, pg. 9, (Jan. 2015).
            medicine in Texas under Title 3, Subtitle B of the
            Occupations Code or provided by a health professional   Telemedicine is defined as a health-care service that is
            acting under physician delegation and supervision, that   either initiated by a physician who is licensed to practice
            is provided for purposes of patient assessment by a   medicine in Texas or provided by a health professional
            health professional, diagnosis or consultation by a   who is acting under physician delegation and supervision.
            physician, or treatment, or for the transfer of medical   Telemedicine is provided for the purpose of the following:
            data, and that requires the use of advanced
            telecommunications technology, other than telephone or   •   Client assessment by a health professional
            facsimile technology, including:                       •   Diagnosis, consultation or treatment by a
                                                                       physician
               •   Compressed digital interactive video, audio, or   •   Transfer of medical data that requires the use of
                   data transmission;                                  advanced telecommunications technology, other
               •   Clinical data transmission using computer           than telephone or facsimile, including the
                   imaging by way of still-image capture and store     following: (1) Compressed digital interactive
                   and forward; and                                    video, audio or data transmission, (2) clinical data
               •   Other technology that facilitates access to         transmission using computer imaging by way of
                   health care services or medical specialty           still-image and store and forward; and (3) Other
                   expertise.”                                         technology that facilitates access to health-care
                                                                       services or medical specialty expertise.
            Source: TX Admin. Code, Title 1 Sec. 354.1430

                                                                                                                1
]]></page><page Index="2"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               7-8, (Jan. 2015).

                                                               "Telemedicine medical service" means a health care
                                                               service that is initiated by a physician 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 Government Code, Sec. 531.001.

                                                               Home telemonitoring is “a health service that requires
                                                               scheduled remote monitoring of data related to patient’s
                                                               health and transmission of the data to a licensed home
                                                               health agency or a hospital”.

                                                               Source: TX Government Code, Sec. 531.001.
            Live Video Reimbursement

            (see Medicaid column)                              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.

                                                               Telemedicine eligible distant site providers:
                                                                   •   Physician
                                                                   •   Certified Nutrition Specialist
                                                                   •   Nurse Practitioner
                                                                   •   Physician Assistant
                                                                   •   Certified Nurse Midwife

                                                               Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               8, (Jan. 2015).

                                                               Telehealth eligible distant site providers
                                                                   •   Licensed professional counselors
                                                                   •   Licensed marriage and family therapist

                                                                                                                2
]]></page><page Index="3"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   Licensed clinical social worker
                                                                   •   Psychologist
                                                                   •   Licensed psychological associate
                                                                   •   Provisionally licensed psychologist
                                                                   •   Licensed dietician

                                                               Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               9, (Jan. 2015).

                                                               Eligible originating sites (Telecommunication):
                                                                   •   Established medical site
                                                                   •   State mental health facility
                                                                   •   State supported living center

                                                               Source: TX Medicaid Telecommunication Services Handbook. P. 9
                                                               (Jan. 2015).

                                                               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. 9(Jan. 2015).

                                                               Telehealth eligible originating site providers:
                                                                   •   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.

                                                               Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               11 (Jan. 2015).

                                                               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.
                                                               7, (Jan. 2015).


                                                               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,


                                                                                                                3
]]></page><page Index="4"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                       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 in-person evaluation for the same diagnosis or
                                                               condition, with the exception of mental health conditions.

                                                               For continued services through telehealth, a patient must
                                                               receive an in-person evaluation at least once during the
                                                               previous 12 months.

                                                               Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Medicaid
                                                               Telecommunication Services Handbook, pg. 9 (Jan. 2015).
            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.
                                                               7, (Jan. 2015).

                                                               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

                                                                                                                4
]]></page><page Index="5"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               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
                                                               practitioner, clinical nurse specialist, physician assistant
                                                               or physician provider 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.

                                                               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.
                                                               12, (Jan. 2015).

                                                               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


                                                                                                                5
]]></page><page Index="6"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               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. 12, (Jan. 2015).
            Email/Phone/FAX

            For speech-language pathology and audiology, no    No reimbursement for email.
            reimbursement for correspondence only, e.g., mail,   No reimbursement for telephone.
            email, or FAX, although they may be adjuncts to tele-  No reimbursement for FAX.
            practice.                                          No reimbursement for chart review.

            Source: TX Admin. Code, Title 22, Sec. 741.214.    Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               8, (Jan. 2015).
            Online Prescribing
            Treatment and consultation recommendations made in   No reference found.
            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.

            Adopted Emergency Rule (Now Effective, Expires
            5/20/15)
            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.

            Source: TX Admin. Code, Title 22, Part 9, Ch. 190 (Injunction
            filed).
            Consent
            Consent required prior to telemedicine or telehealth   No reference found.
            services.

            Either originating or distant site health professionals
            shall obtain this consent.

            Source: TX Occupational Code Sec. 111.002.
            Location
            (see Medicaid column)                              Telemedicine/Telehealth eligible originating (patient)
                                                               sites:

                                                                   •   An established medical site
                                                                   •   A mental health facility


                                                                                                                6
]]></page><page Index="7"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   State supported living centers.

                                                               Source: TX Medicaid Telecommunication Services Handbook, pg.
                                                               8-10, (Jan. 2015).
            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
            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Source: TX Insurance Code Sec. 1455.004.
            Site/Transmission Fee
            (see Medicaid column)                              Telemedicine patient site locations are reimbursed a
                                                               facility fee.

                                                               Source: TX Admin. Code, Title 1 Sec. 355.7001 & TX Medicaid
                                                               Telecommunication Services Handbook, pg. 9 (Jan. 2015).
            Miscellaneous

                                                               Children’s Health Insurance Program
                                                               Allows reimbursement for live video telemedicine and
                                                               telehealth services to children with special health care
                                                               needs.

                                                               Source: TX Govt. Code Sec. 531.02162

           Comments:
                         New Regulations Passed
                             •  TX Medical Board (Source: TX Admin. Code, Title 22, Part 9, Ch. 190)
                             •  TX Board of Speech Pathology and Audiology (Source: TX Admin. Code, Title 22, Ch. 741)



























                                                                                                                7
]]></page></pages></Search>