HBA-JEK C.S.H.B. 1615 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1615 By: Maxey Public Health 4/11/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Texas faces unique challenges with its health care system. The state has experienced a larger population increase than any other state in the nation in the past decade, especially in its Hispanic and aging babyboomer populations. Rural Texas has difficulty recruiting doctors, and several counties in Texas do not even have a physician. Telemedicine has the potential to bring health services to rural and underserved communities. C.S.H.B. 1615 provides for Medicaid and CHIP reimbursement and the regulation of telemedicine medical services in Texas. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 1 (Section 531.0216, Government Code), SECTION 2 (Section 531.02161, Government Code), SECTION 3 (Section 531.0217, Government Code), SECTION 14 (Section 57.0475, Utilities Code), and SECTION 17, to the Telecommunications Infrastructure Fund Board in SECTION 2 (Section 531.02161, Government Code) and SECTION 14 (Section 57.0475, Utilities Code), and to the Texas State Board of Medical Examiners in SECTION 3 (Section 531.0217, Government Code) and SECTION 9 (Section 6, Article 21.53F, Insurance Code) of this bill. ANALYSIS C.S.H.B. 1615 amends the Government Code to require the Health and Human Services Commission (HHSC) and the Telecommunications Infrastructure Fund Board (TIF board) by joint rule to establish and adopt minimum standards for an operating system used in the provision of telemedicine medical services (telemedicine) by a health care facility participating in the state Medicaid program no later than October 1, 2001. The bill sets forth requirements for minimum standards for the system (SECTIONS 2 and 16). The bill requires HHSC no later than January 1, 2002 to require by rule each human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for telemedicine that is initiated or provided by a physician (SECTIONS 3 and 17). C.S.H.B. 1615 prohibits HHSC from reimbursing a health care facility for telemedicine provided to a Medicaid recipient unless the facility complies with the minimum standards adopted by HHSC and the TIF board. The bill requires HHSC to consult with the Texas Department of Health (TDH) and the telemedicine advisory committee to develop a procedure to deny reimbursement for a health care service that, based on credible, clinical evidence, is shown to be medically inappropriate. C.S.H.B. 1615 requires HHSC to establish pilot programs in designated areas under which HHSC, in administering governmentfunded health programs, may reimburse a health professional participant in the pilot program for telehealth services and establish a separate provider identifier for telemedicine medical services providers. The bill requires HHSC to report to the speaker of the house of representatives and the lieutenant governor on the effects of telemedicine on the Medicaid program in the state no later than December 1 of each evennumbered year, and authorizes HHSC to adopt rules as necessary to implement provisions related to telemedicine reimbursement (SECTION 1). C.S.H.B. 1615 requires facilities and providers of telemedicine medical services to make a good faith effort to identify and coordinate with existing providers to preserve and protect existing health care systems and medical relationships in an area. The bill requires HHSC to require a patient's primary care physician to be notified of telemedicine for the purpose of sharing information if the patient consents to the notification. The bill requires HHSC in consultation with the Texas State Board of Medical Examiners (TSBME) to monitor and regulate the use of telemedicine to ensure compliance with these provisions, and authorizes HHSC to use a corrective action plan to ensure compliance (SECTION 3). C.S.H.B. 1615 amends the Government and Insurance codes to authorize TSBME to adopt rules as necessary to ensure the quality of care provided to patients who receive telemedicine, to ensure adequate supervision of health professionals who are not physicians and who provide telemedicine, to establish the maximum number of health professionals who are not physicians that a physician may supervise through telemedicine, and to require a face-to-face consultation between a patient and a physician providing a telemedicine medical service within a certain number of days following an initial telemedicine service only if the physician has never seen the patient (SECTIONS 3 and 9). The bill amends the Government Code to require the advisory committee established by HHSC to coordinate state telemedicine efforts and assist the commission in evaluating, monitoring, and coordinating telemedicine services and reimbursement. The bill provides that the telemedicine provisions do not affect any requirement relating to a federally qualified health center, a rural health clinic, or physician delegation of the authority to carry out or sign prescription drug orders to an advanced practice nurse or physician assistant (SECTION 3). C.S.H.B. 1615 amends the Health and Safety Code to provide that a health plan provider that is providing state child health plan (CHIP) covered benefits to a child must permit benefits to be provided through telemedicine in accordance with policies developed by HHSC. The bill sets forth benefits for which the policies must provide and requires HHSC to consult with the telemedicine advisory committee in developing the polices (SECTION 4). C.S.H.B. 1615 amends the Utilities Code to require the TIF board to use money in the qualifying entities account for funding an automated system to integrate client services and eligibility requirements for health and human services across agencies (SECTION 12). This provision expires September 1, 2003 (SECTION 18). The bill requires the TIF board and HHSC to jointly adopt rules prescribing the criteria that certain health care facilities must meet to be eligible to receive a grant from the TIF board and sets forth requirements regarding the criteria (SECTION 14). The bill provides that an electing company is not required to provide private network services to a project funded by the telecommunications infrastructure fund to the extent the project benefits a health care facility that is not supported by local or regional tax revenue, is not a certified nonprofit health corporation under federal law, or is not an ambulatory health care center (SECTION 15). EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1615 differs from the original bill by removing provisions related to the establishment of an assistance program to provide education concerning the telecommunications infrastructure fund. The substitute requires the Telecommunications Infrastructure Fund Board (TIF board) to use money in the qualifying entities account for funding an automated system to integrate client services and eligibility requirements for health and human services across agencies (SECTION 16). The substitute provides that the telemedicine provisions do not affect any requirement relating to a federally qualified health center (SECTION 3). The substitute removes provisions that required the Health and Human Services Commission (HHSC) to establish a pilot program under which certain Medicaid recipients would have received home health care services through telemedicine in addition to other home health care services. Instead, the substitute requires HHSC to establish pilot programs under which HHSC, in administering government-funded health programs, is authorized to reimburse a health professional participating in the pilot program for telehealth services (SECTION 1). The substitute requires facilities and providers of telemedicine medical services, rather than HHSC, to make a good faith effort to identify and coordinate with existing providers to preserve and protect existing health care systems and medical relationships in an area. The substitute adds that a telemedicine patient's consent is sufficient to require the patient's primary care physician to be notified of the telemedicine services provided to the patient (SECTION 3). The substitute authorizes the Texas State Board of Medical Examiners to adopt rules to require a face-to-face consultation between a patient and a physician providing telemedicine services only following an initial telemedicine service and only if the physician has never seen the patient (SECTION 3). C.S.H.B. 1615 requires HHSC to consult with the telemedicine advisory committee in developing polices regarding state child health plan (CHIP) covered benefits provided through telemedicine medical services (SECTION 4). The substitute removes the provision requiring HHSC to submit for approval a plan amendment relating to CHIP. The substitute sets forth that an electing company is not required to provide private network services to a project funded by the telecommunications infrastructure fund to the extent the project benefits a health care facility that is not supported by local or regional tax revenue, is not a certified nonprofit health corporation under federal law, or is not an ambulatory health care center (SECTION 15).