86R6128 MM-D
 
  By: Guillen H.B. No. 1738
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to telehealth and home telemonitoring services, including
  the provision of those services under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.02164, Government Code, is amended
  by adding Subsections (c-1), (c-2), and (f) to read as follows:
         (c-1)  Notwithstanding Subsection (c)(1), the program
  required under this section may also provide that home
  telemonitoring services are available to a pediatric patient with
  chronic or complex medical needs who:
               (1)  is being concurrently treated by at least three
  medical specialists;
               (2)  is diagnosed with end-stage solid organ disease;
               (3)  has received an organ transplant; or
               (4)  is diagnosed with severe asthma.
         (c-2)  For purposes of the program established under this
  section, the executive commissioner shall:
               (1)  establish an enhanced Medicaid reimbursement rate
  for home telemonitoring services related to management of a
  person's medication that is at least $6 per day more than the rate
  in effect on January 1, 2019;
               (2)  establish billing codes and a fee schedule for
  Medicaid reimbursement for home telemonitoring services provided
  by a federally-qualified health center, as defined by 42 U.S.C.
  Section 1396d(l)(2)(B), that are separate from other billing codes
  and fee schedules established for reimbursement for services
  provided by a federally-qualified health center;
               (3)  develop a process to prevent fraud and verify the
  success of a data transmission that includes validation of the data
  transmission by the service provider's data carrier; and
               (4)  allow for reimbursement for home telemonitoring
  services provided for a period of at least 120 days per episode.
         (f)  Each provider of home telemonitoring services under the
  program established under this section shall provide to the
  commission data regarding the services provided for analytical
  purposes.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02177 to read as follows:
         Sec. 531.02177.  STUDY CONCERNING HOME TELEMONITORING AND
  TELEHEALTH SERVICES FRAUD, WASTE, AND ABUSE. (a) Subject to the
  availability of funds, the commission shall conduct a study to
  identify patterns or instances of fraud, waste, or abuse committed
  by providers of Medicaid home telemonitoring services and
  telehealth services.
         (b)  Not later than September 1, 2020, the commission shall
  submit to the governor, the lieutenant governor, the speaker of the
  house of representatives, and each legislative standing committee
  with primary jurisdiction over Medicaid the results of the study
  conducted under this section and recommendations for legislative or
  other action.
         (c)  Based on the findings of the commission, the executive
  commissioner may adopt rules necessary to prevent or reduce fraud,
  waste, and abuse by providers of Medicaid home telemonitoring
  services and telehealth services.
         (d)  This section expires September 1, 2021.
         SECTION 3.  Section 111.001(3), Occupations Code, is amended
  to read as follows:
               (3)  "Telehealth service" means a health service, other
  than a telemedicine medical service, delivered by a health
  professional licensed, certified, or otherwise entitled to
  practice in this state and acting within the scope of the health
  professional's license, certification, or entitlement to a patient
  at a different physical location than the health professional using
  telecommunications or information technology. The term includes:
                     (A)  peer services provided by a certified mental
  health peer specialist or a certified substance use recovery
  specialist;
                     (B)  substance use counseling services; and
                     (C)  targeted case management services.
         SECTION 4.  The following sections of the Government Code
  are repealed:
               (1)  Section 531.02164(d); and
               (2)  Section 531.02176.
         SECTION 5.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules necessary to implement the
  changes in law made by this Act.
         SECTION 6.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 7.  This Act takes effect September 1, 2019.