Page 171 State Telehealth Laws and Reimbursement Policies A Comprehensive Scan of the 50 States and District of Columbia

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

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