Texas HHSC provides update on telehealth expansion under HB 4


Boram Kim


The Texas Health and Human Services Commission (HHSC) presented on Tuesday an update on its implementation of House Bill 4, which requires the agency to deliver more telehealth and telemedicine services on a permanent and cost-effective basis. 


Stay one step ahead. Join our email list for the latest news.



After engaging stakeholders for most of 2022, HHSC posted in July a draft of its Medicaid Medical and Dental Policy under HB 4 for public comment. Changes to the fee-for-service (FFS) policy were issued to providers in a final notice over the summer. 

The total number of Medicaid telehealth visits in Texas jumped from 72,490 in 2019 to 1.15 million in 2021. These remote visits ranged from physician care to psychotherapy. 

The legislation is intended to maintain support for remote services after PHE funding ends and primarily impacts Medicaid and other health and human services programs. It also expands teleservices to Medicaid managed care organizations (MCOs). 

The FFS policy changes updates reimbursement rules for remote delivery of Medicaid services in the following areas:

  • Behavioral health
  • Intellectual and developmental disabilities (IDD)
  • Chemical dependency
  • Rural medicine
  • Managed care (policy under development)

Behavioral health

FFS policy now requires the provision of “clinically appropriate and safe” behavioral health teleservices that defer to the patient’s needs and are driven by member choice and consent. Behavioral health teleservices are also required to be accessible, centered around the patient and family, and align with state regulations. 

The policy also outlined new scenarios where audio-visual and audio-only services were allowed. The allowances include home and community-based services (HCBS), mental health screenings, brief intervention, treatment referrals, substance use disorder (SUD) counseling, along with other assessment and intervention services. 

Intellectual and developmental disabilities (IDD)

Teleservices will now encompass IDD-targeted case management; several physical, occupational, and speech therapy services; renewal assessments; focused nursing assessments in HCBS, Texas Home Living, and community living assistance and support services (CLASS); and specialized therapies. 

Chemical dependency

Licensed chemical dependency treatment facilities (CDTF) are now permitted to provide virtual outpatient services. HHSC has already trained its compliance staff on the new CDTF’s teleservices regulations surrounding screening and assessment procedures, which took effect in March. 

Rural medicine

Changes to how rural health clinics (RHCs) bill and are reimbursed for telemedicine and telehealth services were implemented in April. Rural health clinics must designate the provision of remote services as a “distant site” to process an originating site facility fee. Providers who provide telehealth in a facility are eligible to receive facility fees from CMS. The same facility rates applied to federally qualified health centers (FQHC) will now apply to RHCs for reimbursement. 

Managed care

HHSC is currently in the process of assessing and coordinating the utilization of teleservices in managed care. The agency plans to release the timeline for adopting and publishing the final rules this winter. Those rules will provide guidance to MCOs on member communications, home telemonitoring, and network adequacy.