Telemedicine medical services and telehealth services are authorized
service delivery methods for Texas Medicaid covered services as provided
in this section. All telemedicine medical services and telehealth
services are subject to the specifications, conditions, limitations,
and requirements established by the Texas Health and Human Services
Commission (HHSC) or its designee.
(1) A client must not be required to receive a covered
service as a telemedicine medical service or telehealth service except
in the event of an active declaration of state of disaster and at
the direction of HHSC.
(2) In the event of a declaration of state of disaster,
HHSC may issue direction to providers regarding the use of telemedicine
medical services and telehealth services, including the use of an
audio-only platform, to provide covered services to clients who reside
in the area subject to the declaration of state of disaster.
(3) HHSC considers the following criteria when determining
whether a covered service may be delivered as telemedicine medical
service or telehealth service, including via an audio-only platform:
(A) clinical effectiveness;
(B) cost effectiveness;
(C) health and safety;
(D) patient choice and access to care; and
(E) other criteria specific to the service.
(4) Conditions for reimbursement applicable to telemedicine
medical services.
(A) The provider must be enrolled in Texas Medicaid.
(B) The covered services must be provided in compliance
with Texas Occupations Code Chapter 111 and Title 22 Texas Administrative
Code Chapter 174 (relating to Telemedicine).
(C) A telemedicine medical service must be designated
for reimbursement by HHSC. Telemedicine medical services designated
for reimbursement are those that are clinically effective and cost-effective,
as determined by HHSC and in accordance with paragraph (3) of this
section. Covered services that HHSC has determined are clinically
effective and cost-effective when provided as a telemedicine medical
service can be found in the Texas Medicaid Provider Procedures Manual
(TMPPM).
(5) Conditions for telemedicine medical services provided
in a primary or secondary school-based setting.
(A) 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.
(B) 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.
(C) 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 (B)(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.
(D) 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; and
(iii) the parent or legal guardian of the patient provides
consent before the service is provided.
(6) Conditions for reimbursement applicable to telehealth
services.
(A) The provider must be enrolled in Texas Medicaid.
(B) The covered services must be provided in compliance
with Texas Occupations Code Chapter 111 and standards established
by the respective licensing or certifying board of the professional
providing the telehealth service.
(C) Telehealth services must be designated for reimbursement
by HHSC. Telehealth services designated for reimbursement are those
that are clinically effective and cost-effective, as determined by
HHSC and in accordance with paragraph (3) of this section. Covered
services that HHSC has determined are clinically effective and cost-effective
when provided as a telehealth service can be found in the TMPPM.
(7) 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 Title 42 Code of Federal Regulations
(CFR) Part 2, 45 CFR Parts 160 and 164, Texas Occupations Code Chapters
111 and 159, 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, Texas
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; amended to be effective January 23, 2023, 48 TexReg 209 |
