1 TAC §355.7001
The Health and Human Services Commission proposes new §355.7001,
concerning the reimbursement for telemedicine services for the Medicaid Program.
House Bill 2386 and House Bill 2017 directed the Health and Human Services
Commission to establish a system for reimbursing providers of services performed
using telemedicine. The new Subchapter G, which contains the new section
§355.7001, sets forth definitions related to telemedicine in §355.7001(a).
The new §355.7001(b) establishes reimbursement for the attending provider
for evaluation and management services and for the consulting provider for
consultation services in accordance with existing Medicaid reimbursement
methodology. It also stipulates that providers seeking reimbursement for
telemedicine services must adhere to reimbursement and medical policies adopted
by the Texas Department of Health for telemedicine services. This new section
provides definitions,
a description of services approved for reimbursement, and requirements of
providers claiming reimbursement for services performed using telemedicine.
Mr. Steve Svadlenak, Director of Medicaid Reimbursement, has determined
that for the first five-year period the section is in effect, there will be
no net fiscal implications as a result of administering the new section. The
use of telemedicine will result in an increase in expenditures due to the
reimbursement for attending providers but will also result in a decrease in
expenditures for medical transportation costs. Savings may also result because
of earlier interventions that telemedicine may effectively provide by allowing
clients in rural and medically underserved areas to access services more quickly
and conveniently. The anticipated use of telemedicine is unknown; telemedicine
networks are only beginning to be developed in the state. Providers must also
cover hardware, software, and transmission costs. There will be no fiscal
impact for local governments.
Mr. Svadlenak has also determined that for the first five-year period the
section is in effect, the public benefit anticipated as a result of enforcing
the section will be improved access to health care services for eligible recipients.
There will be no costs to small businesses or persons complying with the section
as proposed. There will be no impact on local employment.
Comments may be submitted to Linda K. Wertz at the Texas Health and Human
Services Commission, 4900 North Lamar Boulevard, Austin, Texas 78751, (512)
424-6517. Comments will be accepted for 30 days following publication of this
proposal in the
Texas Register
. In addition,
a public hearing on the proposed sections will be held at 9:00 A.M. on February
19, 1998, in the HHSC Public Hearing Room located in the Brown Heatley Building
at 4900 North Lamar Boulevard, Austin, Texas. Parking will be available at
the Texas Department of Human Services complex, 701 West 51st Street.
The new rule is proposed under the Texas Government Code, Chapter
531, §531.033, which authorizes the Commissioner of Health and Human
Services to adopt rules necessary to carry out the Health and Human Services
Commissioner's duties under Chapter 531; and under Texas Government Code,
§531.021, which provides the commission with the authority to administer
federal medical assistance funds.
The new rule implements Government Code, §531.021 and Human Resources
Code, §§32.001-32.047.
§355.7001.Telemedicine Services.
(a)
Definitions. The following words and terms, when used
in this chapter, will have the following meanings, unless the context clearly
indicates otherwise.
(1)
Telemedicine - A method of health care service delivery
used to facilitate medical consultations by physicians to health care providers
in rural or underserved areas for purposes of patient diagnosis or treatment
that require advanced telecommunications technologies, including interactive
video consultation, teleradiology, and telepathology.
(2)
Rural - Area defined as a county with a population
of less than 50,000.
(3)
Underserved - Area that meets the definition of Medically
Underserved Area (MUA) or Medically Underserved Population (MUP) by the U.S.
Department of Health and Human Services.
(4)
Hub Site Provider - A physician at an accredited
medical school, or a physician at one of the following entities affiliated
with an accredited medical school: hospitals, teaching hospitals, tertiary
centers, or health clinics. The hub site physician will provide consultation
and diagnosis, and may develop the patient's plan of care and treatment.
(5)
Remote Site Provider - A health professional, such
as a physician or advanced nurse practitioner, that is able to independently
bill the Medicaid Program, or a Federally Qualified Health Center or Rural
Health Clinic. Remote site providers must be located in rural or underserved
areas. The remote site provider is responsible for carrying out or coordinating
the plan of care and treatment after consulting with the hub site provider.
(b)
Reimbursement for Services Performed Using Telemedicine
(1)
Hub site providers can bill for consultation services
provided using telemedicine. Remote site providers can bill for evaluation
and management services provided using telemedicine.
(2)
Telemedicine services are reimbursed in accordance
with the existing Medicaid reimbursement methodology.
(3)
Providers seeking reimbursement for telemedicine
services must provide and bill for the service in the manner prescribed by
the Texas Department of Health.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
January 26, 1998.
TRD-9801122
Marina Henderson
Executive Deputy Commissioner
Health and Human Services Commission
Earliest possible date of adoption: March 9, 1998
For further information, please call: (512) 424-6576