Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354.
MEDICAID HEALTH SERVICES
Subchapter A. PURCHASED HEALTH SERVICES
33.
TELEMEDICINE SERVICES
1 TAC §§354.1430, 354.1432, 354.1434
The Texas Health and Human Services Commission (HHSC or Commission)
proposes the following new rules for Telemedicine: §354.1430, Definitions
and §354.1432, Benefits and Limitations, and §354.1434, Requirements
for Providers.
Background and Justification
Section 531.02173 of the Government Code directs the Commission to align
the Medicaid telemedicine reimbursement policies with Medicare reimbursement
policies to the extent possible. To comply with the direction, HHSC proposes
to add three new rules regarding Telemedicine Services to its Texas Medicaid
Program rules. The new rules separate the benefits from reimbursement, update
terminology, and delineate the responsibilities for telemedicine providers.
Section-by-Section Summary
The information contained in the rules is outlined in this section. The
first new rule §354.1430, Definitions, defines the terms used within
Division 33, Telemedicine Services.
The second new rule, §354.1432, describes the telemedicine benefits
and limitations covered through the Texas Medicaid Program.
The third rule, §354.1434, explains who will be reimbursed for delivering
telemedicine services to Medicaid recipients and the requirements for telemedicine
providers.
Fiscal Note
Tom Suehs, Deputy Executive Commissioner for Financial Services, has determined
that during the first five-year period the proposed rules are in effect there
will be minimal fiscal impact to state government. The proposed rules will
not result in any fiscal implications for local health and human services
agencies. Local governments will not incur additional costs.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the proposal as they will not be required
to alter their business practices as a result of the rule. There are no anticipated
economic costs to persons who are required to comply with the proposed rule.
There is no anticipated negative impact on local employment.
Public Benefit
David Balland, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the sections are in effect, the
public will benefit from the adoption of the section. The anticipated public
benefit, as a result of enforcing the new sections, will be to align Medicaid
rules with Medicare to the extent possible and to provide clear information
related to the telemedicine benefits.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule"
as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environment exposure and
that may adversely affect, in a material way, the economy, a sector of the
economy, productivity, competition, jobs, the environment or the public health
and safety of a state or a sector of the state. This proposal is not specifically
intended to protect the environment or reduce risks to human health from environment
exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's
right to his or her property that would otherwise exist in the absence of
government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Arnulfo Gomez, at
Braker Center Bldg. H, 11209 Metric Blvd., Austin, Texas 78758, by fax to
(512) 491-1953 or by e-mail to arnulfo.gomez@hhsc.state.tx.us, within 30 days
of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for September 22, 2005 at 10:00 a.m. in the
Lone Star Room of Building H, Health and Human Services Commission, 11209
Metric Blvd., Austin, Texas 78758. Persons requiring further information,
special assistance, or accommodations should contact Carmen Capetillo at (512)
491-1104.
Statutory Authority
The new rules are proposed under the Texas Government Code, §531.033,
which provides the Commissioner of HHSC with broad rulemaking authority; the
Human Resources Code, §32.021 and the Texas Government Code, §531.021(a),
which provide HHSC with the authority to administer the federal medical assistance
(Medicaid) program in Texas; and the Texas Government Code, §531.021(b),
which provides HHSC with the authority to propose and adopt rules governing
the determination of Medicaid reimbursements).
The proposed new rules affect the Human Resources Code, Chapter 32, and
the Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by this proposal.
§354.1430.Definitions.
Definitions. The following words and terms, when used in this chapter,
have the following meanings.
(1)
Hub Site--A hub site is the location where the consulting
physician is physically located.
(2)
Hub Site Provider--A hub site provider must be a:
(A)
Physician at a rural health facility or an accredited medical
or osteopathic school located in Texas, or a physician at one of the following
entities affiliated through a written contract or agreement with a government
agency, accredited medical, or osteopathic school located in Texas:
(B)
Hospital;
(C)
Teaching hospital;
(D)
Tertiary center; or
(E)
Health clinic.
(3)
Remote Site--A remote site is where the Medicaid client
is physically located.
(4)
Remote Site Provider--A remote site provider is located
in rural or medically underserved areas and is limited to the following provider
types:
(A)
Physician;
(B)
Advanced practice nurse (APN);
(C)
Certified nurse midwife (CNM);
(D)
Hospital;
(E)
Federally qualified health center (FQHC);
(F)
Rural health clinic (RHC).
(5)
Rural area--A rural area is defined as a county with a
population of 50,000 or less or a county that was not designated as a metropolitan
area by the United States Bureau of the Census according to the most current
federal census and does not have within the boundaries of the county a hospital,
licensed under chapter 241, Health and Safety Code, with more than 100 beds.
(6)
Rural Health Facility--A rural health facility is located
in a rural county and is affiliated with an accredited medical school, teaching
hospital, or government agency through a written contract or agreement.
(7)
Telemedicine--Telemedicine is a method of health care service
delivery used to facilitate medical consultations by a physician to health
care providers in rural or underserved areas for purposes of patient diagnosis
or treatment that requires advanced telecommunications technologies.
(8)
Telepathology--Telepathology is the practice of pathology
(consultation, education and research) using telecommunications to transmit
data and images between two or more sites remotely located from each other.
(9)
Teleradiology--Teleradiology is a means of electronically
transmitting radiographic patient images and consultative text from one location
to another.
(10)
Underserved--An 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.
§354.1432.Benefits and Limitations.
(a)
Telemedicine services are a health care benefit of the
Texas Medicaid Program. Telemedicine services are described below.
(1)
Telemedicine services are direct "face-to-face" interactive
video communications with the client. Teleradiology and telepathology are
exceptions to the direct face-to-face requirement.
(2)
Telemedicine hub site providers may be reimbursed only
for consultation or interpretation using interactive video as defined by Medicaid
telemedicine medical policy and as currently reimbursed under the Texas Medicaid
Program.
(3)
Telemedicine remote sites may be reimbursed for services
when any one of the following places of service are utilized and billed:
(A)
Practitioner's office;
(B)
Rural Health Clinic;
(C)
Federally Qualified Health Clinic;
(D)
Inpatient hospital;
(E)
Outpatient hospital;
(F)
Emergency room;
(G)
ICR-MR facility.
(4)
Telephone conversations, chart reviews, electronic mail
messages and facsimile transmissions do not constitute a telemedicine interactive
video consultation, and will not be reimbursed as telemedicine service.
(5)
Texas Health Steps (THSteps), also known as Early and Periodic
Screening, Diagnosis and Treatment, preventive health visits are not reimbursed
if performed via telemedicine. Health care or treatment provided for conditions
identified during these preventive health visits may be reimbursed if the
health care is provided via telemedicine.
(6)
Nursing facilities, skilled nursing facilities, and client
homes are not approved places of service as remote sites for telemedicine
services.
(b)
Reimbursement for Services Performed Using Telemedicine.
(1)
Providers seeking reimbursement for telemedicine services
must provide and bill for the service in the manner prescribed by the Texas
Medicaid Program.
(2)
Telemedicine services are reimbursed in accordance with
the existing Medicaid reimbursement methodology as defined in §355.7001
of this title (relating to Telemedicine Services Reimbursement).
§354.1434.Requirements for Telemedicine Providers.
Providers of telemedicine services must adhere to the requirements
listed in this section.
(1)
Must be enrolled in the Texas Medicaid Program to be eligible
for reimbursement.
(2)
The hub site provider's findings must be documented in
writing in the recipient's medical records at the remote site.
(3)
The remote site provider must be present with the client
during the interactive video telemedicine visit.
(4)
The remote site provider is responsible for providing or
coordinating the plan of care and treatment after consulting with the hub
site provider.
(5)
Information about the diagnosis, evaluation, or treatment
of a client with Medicaid coverage by a person licensed or certified to perform
the diagnosis, evaluation or treatment of any medical, mental or emotional
disorder, or drug abuse, is confidential information that the provider may
disclose only to authorized people. Only the client may give written permission
for release of any pertinent information before client information can be
released, and confidentiality must be maintained in all other aspects. The
signed consent form or documentation of consent for release of information
is to become part of the medical record at the remote site.
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 August 9, 2005.
TRD-200503298
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: September 25, 2005
For further information, please call: (512) 424-6900
Subchapter G. TELEMEDICINE SERVICES AND OTHER COMMUNITY-BASED SERVICES
The Texas Health and Human Services Commission (HHSC) proposes to
repeal and replace the following rule: §355.7001, Telemedicine Reimbursement
Services under Chapter 355, Subchapter G.
Background and Justification
Section 531.02173 of the Government Code directs HHSC to align the Medicaid
telemedicine reimbursement policies with Medicare reimbursement policies.
In accordance with this directive, HHSC proposes to repeal the following rule: §355.7001,
Telemedicine Services, because HHSC is proposing to replace it with a new
rule §355.7001, to be titled Telemedicine Services Reimbursement. The
purpose of the repeal is to update terminology and to reorganize the rule
content to identify and clearly delineate those responsibilities that are
reimbursement and program activities.
Section-by-Section Summary
Repeal §355.7001, "Telemedicine Services" and submit as §355.7001,
"Telemedicine Services Reimbursement" in order to clarify and distinguish
those activities that are considered reimbursement apart from definitions
and program benefits and limitations. The submitted §355.7001, identifies
those services provided by government-funded health program, e.g., Federally
Qualified Health Clinics (FQHC's) and Rural Health Clinics (RHC's). The list
of Telemedicine definitions in §355.7001, are removed and placed in the
new §354.1430, "Definitions," and the new §354.1432, "Benefits and
Limitations" is added to better define program benefits and limitations apart
from reimbursement activities.
Fiscal Note
Tom Suehs, Deputy Executive Commissioner for Financial Services, has determined
that during the first five-year period the proposed rules are in effect there
will be minimal fiscal impact to state government. The proposed rules will
not result in any fiscal implications for local health and human services
agencies. Local governments will not incur additional costs.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the proposal, as they will not be required
to alter their business practices as a result of the rule. There are no anticipated
economic costs to persons who are required to comply with the proposed rules.
There is no anticipated negative impact on local employment.
Public Benefit
David Balland, Associate Commissioner for Medicaid and Children's Health
Insurance Program (CHIP), has determined that for each year of the first five
years the proposed rules are in effect, the public will benefit from the adoption
of the proposed rules. The anticipated public benefit, as a result of enforcing
the proposed rules, will be the consistency of information to providers of
Telemedicine services.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule"
as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risks to human health from environmental exposure
and that may adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, or the public health
and safety of a state or a sector of the state. This proposal is not specifically
intended to protect the environment or reduce risks to human health from environmental
exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's
right to his or her property that would otherwise exist in the absence of
government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Arnulfo Gomez, at
H-600, 1100 W. 49th St., Austin, Texas 78756, by fax to (512) 491-1953, or
by e-mail to arnulfo.gomez@hhsc.state.tx.us within 30 days of publication
of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for September 22, 2005 at 10:00 a.m. in the
Lone Star Room of Building H, Health and Human Services Commission, 11209
Metric Blvd., Austin, Texas 78758. Persons requiring further information,
special assistance, or accommodations should contact Carmen Capetillo at (512)
491-1104.
Chapter 355.
REIMBURSEMENT RATES