What are the laws governing Texas telehealth solutions?
Texas telehealth solutions are governed by the Texas Telehealth Act, which was passed in 2017. The act allows for the provision of telemedicine services in a variety of settings, including hospitals, clinics, and patients' homes. The act also sets forth certain requirements for Texas telehealth solutions, such as the need for providers to be licensed in the state and the need for patients to provide consent for the services.
Medicaid Telehealth Reimbursement
Summary
Texas Medicaid reimburses for live video and store-and-forward in some circumstances. Home telemonitoring is reimbursable for some conditions when a provider is approved to deliver those services.
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Definitions
"Telehealth service" means a health service, other than a telemedicine medical service, that is delivered by a licensed or certified health professional acting within the scope of the health professional's license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology.
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Live Video
Policy
Synchronous audiovisual interaction is reimbursable under Texas Medicaid.
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Eligible Services/Specialties
Click for a list of reimbursable services.
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Eligible Providers
Click for a list of eligible distant site providers.
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Eligible Sites
Click for a list of eligible originating sites.
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Facility/Transmission Fee
Patient-site providers that are enrolled in Texas Medicaid may only be reimbursed for the facility fee using procedure code Q3014. Procedure code Q3014 is payable to NP, CNS, PA, physicians, and outpatient hospital providers. Charges for other services that are performed at the patient site may be submitted separately. Procedure code Q3014 is not a benefit if the patient site is the client’s home.
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Store-and-Forward
Policy
Asynchronous store and forward technology, including asynchronous store and forward technology in conjunction with synchronous audio interaction between the distant site provider and the patient in another location is reimbursable under Texas Medicaid.
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Eligible Services/Specialties
Remote Patient Monitoring
Policy
Texas Medicaid will reimburse for home telemonitoring in the same manner as their other professional services provided by a home health agency.
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Conditions
Click to see list of patient eligibility.
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Provider Limitations
Providers must be enrolled and approved as home telemonitoring services providers.
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Other Restrictions
Patients that meet the condition criteria must exhibit two or more of certain risk factors. Click to view the risk factors.
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Click to see a list of risk factor criteria.
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Email/Phone/Fax
No reimbursement for audio-only telephone consultation.
No reimbursement for text-only email message.
No reimbursement for facsimile transmission.
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Consent
Written or verbal consent must be obtained to allow any other individual (besides the distant site provider, patient site presenter or representative) to be present during a telemedicine or telehealth visit.
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Out of State Providers
An out-of-state physician who is a distant site provider may provide episodic telemedicine medical services without a Texas medical license as outlined in Texas Statute and Regulation.
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Miscellaneous
Click for a list of miscellaneous requirements for Texas Medicaid.
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Private Payer Laws
Definitions
"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.
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Requirements
Each issuer of a health benefit plan must adopt and display in a conspicuous manner on their website the policies and payment practices for telemedicine medical services and telehealth services. They, however, are not required to list payment rates.
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Parity
Prohibits a health benefit plan from excluding from coverage a service delivered as a telemedicine medical service or a telehealth service solely because the service is not provided in-person. A health plan is not required to provide coverage for services provided by only synchronous or asynchronous audio interaction including audio-only telephone; email or facsimile.
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Professional Regulation/Health & Safety
Definitions
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.
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Consent
Consent required prior to telemedicine or telehealth services.
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Online Prescribing
A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service and a patient receiving the telemedicine medical service as long as the practitioner complies with the same standard of care as would apply in an in-person setting, and complies with specified standards.
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Cross State Licensing
A telemedicine license may be issued for out of state providers.
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Miscellaneous
Click for additional professional and health & safety requirements.
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Source: Center for Connected Health Policy
https://www.cchpca.org
