(a) Home telemonitoring services are a benefit of 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 (HHSC) or its designee.
(b) Home telemonitoring services require scheduled
remote monitoring of data related to a patient's health and transmission
of the data to a licensed home health agency or a hospital, as those
terms are defined by Texas Government Code §531.02164(a).
(c) Home telemonitoring service providers must:
(1) comply with all applicable federal, state, and
local laws and regulations;
(2) be enrolled and approved for participation in the
Texas Medicaid Program as home telemonitoring service providers;
(3) bill for services covered under the Texas Medicaid
Program in the manner and format prescribed by HHSC;
(4) share clinical information gathered while providing
home telemonitoring services with the patient's physician; and
(5) not duplicate disease management program services
provided under Human Resources Code §32.057 and further described
in Division 32 of this subchapter (relating to Texas Medicaid Wellness
Program).
(d) Home telemonitoring services are available only
to Texas Medicaid clients who:
(1) are diagnosed with diabetes, hypertension, or any
other conditions allowed by Texas Government Code §531.02164
and determined by HHSC to be cost effective and feasible; and
(2) exhibit two or more of the following risk factors:
(A) two or more hospitalizations in the prior 12-month
period;
(B) frequent or recurrent emergency room admissions;
(C) a documented history of poor adherence to ordered
medication regimens;
(D) a documented history of falls in the prior six-month
period;
(E) limited or absent informal support systems;
(F) living alone or being home alone for extended periods
of time; and
(G) a documented history of care access challenges.
(e) Home telemonitoring services are reimbursed in
accordance with Chapter 355 of this title (relating to Reimbursement
Rates).
(f) Home telemonitoring services are available to Texas
Medicaid clients who are 20 years of age and younger, with one or
more of the following conditions:
(1) end-stage solid organ disease;
(2) organ transplant recipient; or
(3) requiring mechanical ventilation.
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