Adopted Rules Title 1

TITLE 1. ADMINISTRATION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 354. MEDICAID HEALTH SERVICES

SUBCHAPTER A. PURCHASED HEALTH SERVICES

DIVISION 33. TELEMEDICINE SERVICES

The Texas Health and Human Services Commission (HHSC) adopts the repeal of 1 Texas Administrative Code (TAC) §354.1430, concerning Definitions, §354.1432, concerning Benefits and Limitations, and §354.1434, concerning Requirements for Telemedicine Providers, and new §354.1430, concerning Definitions, and §354.1432, concerning Benefits and Limitations. New §354.1430 is adopted with minor changes to the proposed text as published in the January 2, 2009, issue of the Texas Register (34 TexReg 9). The changes update incorrect citations. The repeal of §§354.1430, 354.1432, 354.1434 and new §354.1432 are adopted without changes and will not be republished.

Background and Justification

Senate Bill (SB) 24 and SB 760, 80th Legislature, Regular Session, 2007, required HHSC to make policy changes to the Medicaid telemedicine program. SB 24 instructs HHSC to add office visits as an additional telemedicine service for which distant site providers may receive reimbursement. This bill also directs HHSC to either: (1) allocate reimbursement between the distant site provider and the patient site provider; or (2) establish a facility fee that the distant site provider is required to pay the patient site provider. SB 760 changes the Medicaid telemedicine terminology and directs HHSC to encourage all health-care providers and health-care facilities to provide services via telemedicine.

In order to implement SB 24 and SB 760, and further align Texas Medicaid telemedicine policies with Medicare, thereby reducing provider confusion, HHSC proposed the repeal of §§354.1430, 354.1432, and 354.1434, related to Medicaid telemedicine, and their replacement with new §354.1430 and §354.1432. The proposed new rules implement the legislative requirements.

Comments

The 30-day comment period ended February 2, 2009. During this period, HHSC did not receive any comments regarding the proposed repeal and replacement of the rules.

1 TAC §§354.1430, 354.1432, 354.1434

Legal Authority

The repeals are adopted under Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 6, 2009.

TRD-200901726

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: May 26, 2009

Proposal publication date: January 2, 2009

For further information, please call: (512) 424-6900

1 TAC §354.1430, §354.1432

The new rules are adopted under Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.

§354.1430.Definitions.

The following words and terms, when used in this chapter, have the following meanings.

(1) Telemedicine--The practice of health care delivery, by a provider who is located at a site other than the site where the patient is located, for the purposes of evaluation, diagnosis, consultation, or treatment that requires the use of advanced telecommunications technology. Telephone conversations, chart reviews, electronic mail messages, and facsimile transmissions are not considered telemedicine.

(2) Distant site provider--The distant site provider uses telemedicine to provide health care services to the patient. The distant site provider must be a physician who is licensed to practice medicine in Texas under Subtitle B, Title 3, Occupations Code.

(3) Distant site location--The distant site location is where the distant site provider is physically located.

(4) Patient site presenter--The patient site presenter is the individual at the patient site who introduces the patient to the distant site provider for examination, and to whom the distant site provider may delegate tasks and activities in accordance with 22 TAC §174.6 (relating to Delegation to and Supervision of Patient Site Presenters). The patient site presenter must be:

(A) Licensed or certified in this state to perform health care services and must present and/or be delegated tasks and activities only within the scope of the individual's licensure or certification; and/or

(B) A qualified mental health professional (QMHP) as defined in 25 TAC §412.303(48) (relating to Definitions).

(5) Patient site location--The patient site location is where the client is physically located. It is limited to the following locations:

(A) State hospital;

(B) State school;

(i) Physician office;

(ii) Hospital;

(iii) Rural health clinic (RHC);

(iv) Federally qualified health center (FQHC);

(v) Intermediate care facility for persons with mental retardation (ICF/MR) that is not a state school;

(vi) Community center as defined in Health and Safety Code §534.001 or outreach site associated with a community center; or

(vii) Local health department established under Health and Safety Code §121.031, or public health district established under Health and Safety Code §121.041.

(6) State hospital--A state hospital is a hospital with an inpatient component and operated by the Department of State Health Services.

(7) State school--Also referred to as a "State MR Facility." A state school or state center with a mental retardation residential component as defined in 40 TAC §2.253(44) (relating to Definitions).

(8) Rural area--A rural area is defined as a county that is not included in a metropolitan statistical area as defined by the U.S. Office of Management and Budget (OMB) according to the most recent United States Census Bureau population estimates.

(9) Underserved area--An underserved area is an area that meets the current definition of a medically underserved area or medically underserved population (MUP) by the U.S. Department of Health and Human Services (DHHS), until DHHS adopts and implements the rule proposed in the Federal Register on February 29, 2008, that would revise and consolidate the criteria and processes for designating MUPs and health professional shortage areas. At that time, an underserved area will be defined as an area that meets the DHHS Index of Primary Care Underservice criteria.