1 Tex. Admin. Code § 355.7001 - Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services
(a) Eligible
providers performing telemedicine medical, telehealth, or home telemonitoring
services are defined in §
354.1430 of this title (relating to
Definitions), §
354.1432 of this title (relating to
Telemedicine and Telehealth Benefits and Limitations), and §
354.1434 of this title (relating to
Home Telemonitoring Benefits and Limitations).
(b) The Health and Human Services Commission
(HHSC) reimburses eligible distant site professionals providing telemedicine
medical services as follows:
(1) Physicians
are reimbursed for their Medicaid telemedicine medical services in the same
manner as their other professional services in accordance with §
355.8085 of this title (relating to
Reimbursement Methodology for Physicians and Other Practitioners).
(2) Physician assistants are reimbursed for
their Medicaid telemedicine medical services in the same manner as their other
professional services in accordance with §
355.8093 of this title (relating to
Reimbursement Methodology for Physician Assistants).
(3) Advanced Practice Registered Nurses
(APRNs) are reimbursed for their Medicaid telemedicine medical services in the
same manner as their other professional services in accordance with §
355.8281 of this title (relating to
Reimbursement Methodology for Nurse Practitioners and Clinical Nurse
Specialists).
(4) Certified nurse
midwives are reimbursed for their Medicaid telemedicine medical services in the
same manner as their other professional services in accordance with §
355.8161 of this title (relating to
Reimbursement Methodology for Midwife Services).
(c) HHSC reimburses eligible distant site
professionals providing telehealth services as follows:
(1) Licensed professional counselors,
including licensed marriage and family therapists, and licensed clinical social
workers (including Comprehensive Care Program social workers) are reimbursed
for their Medicaid telehealth services in the same manner as their other
professional services in accordance with §
355.8091 of this title (relating to
Reimbursement to Licensed Professional Counselors, Licensed Clinical Social
Workers, and Licensed Marriage and Family Therapists).
(2) Licensed psychologists (including
licensed psychological associates) and psychology groups are reimbursed for
their Medicaid telehealth services in the same manner as their other
professional services in accordance with §
355.8085 of this title.
(3) Durable medical equipment suppliers are
reimbursed for their Medicaid telehealth services in the same manner as their
other professional services in accordance with §
355.8023 of this title (relating to
Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS)).
(d) Telemedicine and telehealth patient site
locations, as defined in §
354.1430 and §
354.1432 of this title, are
reimbursed a facility fee determined by HHSC.
(e) HHSC reimburses eligible providers
performing home telemonitoring services in the same manner as their other
professional services described in §
355.8021 of this title (relating to
Reimbursement Methodology for Home Health Services).
(f) Telemedicine medical services provided in
a school-based setting by a physician, even if the physician is not the
patient's primary care physician, will be reimbursed in accordance with the
applicable methodologies described in subsection (b)(1) of this section and
§
355.8443 of this title (relating to
Reimbursement Methodology for School Health and Related Services (SHARS)) if
the following conditions are met:
(1) the
physician is an authorized health care provider under Medicaid;
(2) the patient is a child who receives the
service in a primary or secondary school-based setting;
(3) the parent or legal guardian of the
patient provides consent before the service is provided; and
(4) a health professional as defined by Texas
Government Code §
548.0101 is present
with the patient during the treatment.
(g) Fees for telemedicine, telehealth, and
home telemonitoring services are adjusted within available funding as described
in §
355.201 of this title (relating to
Establishment and Adjustment of Reimbursement Rates by the Health and Human
Services Commission).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.