<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER APURCHASED HEALTH SERVICES
DIVISION 33ADVANCED TELECOMMUNICATIONS SERVICES
RULE §354.1432Telemedicine and Telehealth Benefits and Limitations

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).


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

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page