1 Tex. Admin. Code § 354.1432 - Telemedicine and Telehealth Benefits and Limitations
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).
Notes
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