TEXAS TELEMEDICINE LAW
Texas represents a glowing example of the tremendous potential telemedicine has in benefitting many more patients for far less cost. The popularity of telemedicine in Texas is commensurate to the growing shortage of health care providers as the state’s population continues to expand.
With such an accelerated growth, the telemedicine industry finds itself embroiled with the state medical board to redefine the boundaries of telemedicine. Currently the state medical board’s proposed restrictions have been halted by the Federal Appeals Court and the result of this lawsuit will have substantive implications on the future prospects of telemedicine in Texas.
Ready to find out more about Texas’s telemedicine policy? Keep on reading.
Parity Law
Texas enacted telehealth parity laws in 1997. A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services.
Type of Telemedicine Covered
Only those services that involve direct face-to-face interactive video communication between the client and the distant-site provider constitute a telemedicine or telehealth service. Telephone conversations, chart reviews, electronic mail messages, and fax transmissions alone do not constitute a telemedicine or telehealth interactive video service and will not be reimbursed as telemedicine or telehealth services.
Texas will cover telemedicine using store-and-forward technology as well as remote patient monitoring in a limited capacity.
Home Telemonitoring is available only to patients who are diagnosed with diabetes, hypertension; or when it is determined by Texas Health and Human Services Commission. The following conditions are also included: pregnancy, heart disease, cancer, chronic obstructive pulmonary disease, congestive heart failure, mental illness, asthma, myocardial infarction or stroke.
Patients that meet the above criteria must exhibit two or more of the following risk factors:
Two or more hospitalizations in the prior 12 month period
Frequent or recurrent emergency room admissions
A documented history of poor adherence to ordered medication regimens
A documented history of falls in the prior six month period
Limited or absent informal support system
Living alone or being home alone for extended periods of time; and
A documented history of care access challenges
Providers must be enrolled and approved as home Telemonitoring services providers
The home health agency must maintain extensive documentation in the patient’s medical record
Covered Health Services
Texas Medicaid reimburses for live video for the following services:
Consultations
Office or other outpatient visits
Psychiatric diagnostic interviews
Pharmacologic management
Psychotherapy
Data transmission
However, these community mental health services are ineligible:
Injectables
Nursing services
Crisis intervention
Individual, family, group and multiple family psychotherapy
Psychological testing which require “hands-on” encounters
Mental health assessment by non-physician
Service Plan Development
Billing Codes
In most cases, when you’re billing a telemedicine service through Texas Medicaid, you’ll need to include the appropriate covered CPT code along with the GT modifier. The GT modifier indicates that medical service was done via telemedicine.
Below is a list of example billing codes for telemedicine, taken straight from the Texas Medicaid telemedicine provider manual. Check the manual for more details!
Eligible Healthcare Providers
The following providers are eligible, as long as they are enrolled as a Texas Medicaid provider:
Physicians
Physician assistants
Nurse practitioners
Clinical nurse specialists
Outpatient hospitals
Licensed professional counselors
Licensed psychologists
Durable medical equipment suppliers
Licensed clinical social worker
Licensed psychological associate
Provisionally licensed psychologist
· Licensed dietician
Online Prescriptions
Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional in-person clinical settings. Online or telephone evaluations solely by questionnaire are prohibited.
Informed Patient Consent
Consent is required prior to telemedicine or telehealth services.
Either originating or distant site health professionals shall obtain this consent. The manner of obtaining is unspecified.
Cross-State Telemedicine Licensing
A telemedicine license may be issued for out-of-state providers.
Restrictions on Locations
Eligible originating (patient) sites include:
An established medical site
A Mental health facility
State supported living centers
Documenting Barriers to In-Person Care
Before receiving a telehealth service, the patient must receive an in-person evaluation for the same diagnosis or condition, with the exception of mental health conditions.
For continued services through telehealth, a patient must receive an in-person evaluation at least once during the previous 12 months.
A telepresenter is required at the originating site for both telemedicine and telehealth, unless the services relate to mental health. In that situation a patient-site presenter does not have to be readily available unless the client is in a danger to himself/herself or others.
Other Reimbursable Fees
More than one medically necessary telemedicine or telehealth service may be reimbursed for the same date and same place of service if the services are billed by providers of different specialties.
Additionally, telemedicine patient site locations are reimbursed a facility fee.
Reimbursement Rates
Provider reimbursement must be the same as in-person services.
Helpful Resources
Center for Connected Health Policy
The American Telemedicine Association State Policy Matrix
Texas Medicaid Telemedicine and Telehealth Services Handbook
The University of Texas Medical Branch Electronic Health Network