Telemedicine medical services and telehealth services are a
benefit under the Texas Medicaid program as provided in this section
and are subject to the specifications, conditions, limitations, and
requirements established by the Texas Health and Human Services Commission
or its designee (HHSC).
(1) Conditions for reimbursement applicable to telemedicine
medical services.
(A) The telemedicine medical services must be designated
for reimbursement by HHSC. Telemedicine medical services designated
for reimbursement include:
(i) consultations;
(ii) office or other outpatient visits;
(iii) psychiatric diagnostic interviews;
(iv) pharmacologic management;
(v) psychotherapy; and
(vi) data transmission.
(B) The services must be provided in compliance with
22 TAC Chapter 174 (relating to Telemedicine).
(C) The patient site must be:
(i) an established medical site;
(ii) a state mental health facility; or
(iii) a state supported living center.
(D) For a child receiving telemedicine medical services
in a primary or secondary school-based setting, advance parent or
legal guardian consent for a telemedicine medical service must be
obtained.
(E) The patient's primary care physician or provider
must be notified of a telemedicine medical service, unless the patient
does not have a primary care physician or provider.
(i) The patient receiving the telemedicine medical
service, or the patient's parent or legal guardian, must consent to
the notification.
(ii) For a telemedicine medical service provided to
a child in a primary or secondary school-based setting, the notification
must include a summary of the service, including:
(I) exam findings;
(II) prescribed or administered medications; and
(III) patient instructions.
(F) If a child receiving a telemedicine medical service
in a primary or secondary school-based setting does not have a primary
care physician or provider, the child's parent or legal guardian must
be offered:
(i) the information in subparagraph (E)(ii) of this
paragraph; and
(ii) a list of primary care physicians or providers
from which to select the child's primary care physician or provider.
(G) Telemedicine medical services provided in a school-based
setting by a physician, even if the physician is not the patient's
primary care physician or provider, are reimbursed if:
(i) the physician is enrolled as a Medicaid provider;
(ii) the patient is a child who receives the service
in a primary or secondary school-based setting;
(iii) the parent or legal guardian of the patient provides
consent before the service is provided; and
(iv) a health professional as defined by Texas Government
Code §531.0217(a)(1) is present with the patient during the treatment.
(2) Conditions for reimbursement applicable to telehealth
services.
(A) The telehealth services must be designated for
reimbursement by HHSC. Designated telehealth services will be listed
in the Texas Medicaid Provider Procedures Manual.
(B) The services must be provided in compliance with
standards established by the respective licensing or certifying board
of the professional providing the services.
(C) The patient site must be:
(i) an established health site;
(ii) a state mental health facility; or
(iii) a state supported living center.
(D) The patient site presenter must be readily available
for telehealth services. However, if the telehealth services relate
only to mental health, a patient site presenter does not have to be
readily available except when the patient may be a danger to himself
or to others.
(E) Before receiving a telehealth service, the patient
must receive an initial evaluation for the same diagnosis or condition
by a physician or other qualified healthcare professional licensed
in Texas.
(i) A required initial evaluation must be performed
in-person or as a telemedicine visit that conforms to 22 TAC Chapter
174 (relating to Telemedicine).
(ii) If the patient is receiving the telehealth services
to treat a mental health diagnosis or condition, the patient is not
required to receive an initial evaluation.
(F) A patient receiving telehealth services must be
evaluated at least annually by a physician or other healthcare professional
licensed in Texas and qualified to determine if the patient has a
continued need for services.
(i) The evaluation must be performed in-person or as
a telemedicine visit that conforms to 22 TAC Chapter 174.
(ii) This evaluation requirement does not apply to
a patient receiving telehealth services for the treatment of a mental
health diagnosis or condition from a qualified behavioral health provider
licensed in Texas.
(G) Both the distant site provider and the patient
site presenter must maintain the records created at each site unless
the distant site provider maintains the records in an electronic health
record format.
(H) Written telehealth policies and procedures must
be maintained and evaluated at least annually by both the distant
site provider and the patient site presenter and must address:
(i) patient privacy to assure confidentiality and integrity
of patient telehealth services;
(ii) archival and retrieval of patient service records;
and
(iii) quality oversight mechanisms.
(3) Conditions for reimbursement applicable to both
telemedicine medical services and telehealth services.
(A) Preventive health visits under Texas Health Steps
(THSteps), also known as Early and Periodic Screening, Diagnosis and
Treatment program, are not reimbursed if performed using telemedicine
medical services or telehealth services. Health care or treatment
provided using telemedicine medical services or telehealth services
after a THSteps preventive health visit for conditions identified
during a THSteps preventive health visit may be reimbursed.
(B) Documentation in the patient's medical record for
a telemedicine medical service or a telehealth service must be the
same as for a comparable in-person evaluation.
(C) Providers of telemedicine medical services and
telehealth services must maintain confidentiality of protected health
information (PHI) as required by 42 CFR Part 2, 45 CFR Parts 160 and
164, chapters 111 and 159 of the Occupations Code, and other applicable
federal and state law.
(D) Providers of telemedicine medical services and
telehealth services must comply with the requirements for authorized
disclosure of PHI relating to patients in state mental health facilities
and residents in state supported living centers, which are included
in, but not limited to, 42 CFR Part 2, 45 CFR Parts 160 and 164, Health
and Safety Code §611.004, and other applicable federal and state
law.
(E) Telemedicine medical services and telehealth services
are reimbursed in accordance with Chapter 355 of this title (relating
to Reimbursement Rates).
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| Source Note: The provisions of this §354.1432 adopted to be effective May 1, 2013, 38 TexReg 1871; amended to be effective May 15, 2016, 41 TexReg 2737; amended to be effective March 21, 2017, 42 TexReg 1245 |
