Page 73 50 State Telemedicine Gaps Analysis Coverage and Reimbursement
P. 73
50 State Telemedicine Gaps Analysis: Coverage & Reimbursement
Telemedicine in
Texas
PARITY:
Private Insurance A TX private insurance parity law
Medicaid B enacted in 1997 and also includes
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State Employee Health Plan A coverage for state employee health
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MEDICAID SERVICE plans.
COVERAGE & CONDITIONS
OF PAYMENT: Medicaid
Patient Setting A Two distinct definitions of
Eligible Technologies B telemedicine vs. telehealth.
Distance or Geography A Originating site includes established
Restrictions medical health site and state mental
Eligible Providers C health facility, which excludes the
Physician-provided B home.
Services Patients must receive an in-person
Mental/behavioral Health B evaluation for the same diagnosis or
Services condition being rendered via
Rehabilitation F telemedicine. Patients with mental
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Home Health F health diagnoses or conditions are
exempt from this requirement if the
Informed Consent B purpose of telemedicine is to screen
Telepresenter C and refer for additional services. In
INNOVATIVE PAYMENT order to continue receiving
OR SERVICE DELIVERY telemedicine services, the patient
MODELS: must have an in-person evaluation at
State-wide Network least once within the 12 months
Medicaid Managed Care before receiving telemedicine.
Medicare-Medicaid Dual Coverage for interactive audio-video
Eligibles only and RPM for home health
Health Home agencies and hospitals. Set to expire
HCBS Waiver September 2015.
Corrections ✔ Requires written informed consent
Other and a telepresenter during the
telemedicine encounter.
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American Telemedicine Association
2015
