Texas House votes to expand virtual access to care for Medicaid recipients

The Texas House of Representatives passed a Senate bill this week aimed at ensuring patients and providers in the Texas Medicaid program can access “a full array of choices when participating in virtual health care,” according to the author’s statement of intent.  

SB 670, authored by Sen. Dawn Buckingham, repeals and amends several regulatory requirements surrounding telehealth and telemedicine. It also directs the Health and Human Services Commission (HHSC) to — among other tasks — ensure Medicaid managed care organizations don’t deny reimbursement for a covered service solely because that service was provided virtually, instead of in-person.

“The goal of this language is to avoid having to go service by service through all the Medicaid services that are possible and add them to telemedicine/telehealth reimbursement one at a time,” the original bill analysis reads.

This session’s SB 670 follows in the footsteps of telemedicine/telehealth laws signed into law last session, in 2017.

While Texas Medicaid began providing reimbursement for telemedicine services in 1997, SB 1107 established statewide standards and expectations for the practitioners who provide those services in 2017, according to HHSC (see page 4 of this report). One major change made by that bill was getting rid of the requirement for an in-person consult with a physician before such services could be provided.

Another law established in 2017, SB 922, requires HHSC to provide Medicaid reimbursement to a broader range of practitioners, including social workers, physical therapists, and counselors.

HHSC wrote in a December 2018 report that the number of people using Texas Medicaid telemedicine, telehealth, and home telemonitoring services grew by 30 percent from fiscal year 2016 to fiscal year 2017, and that the number of providers who offer the services increased by 32 percent.

The number of services available for Medicaid reimbursement, HHSC reported, increased by 22 percent in fiscal year 2017.

Image: HHSC

 

“While utilization has increased, the proportion of Medicaid services delivered remotely is still relatively small and there is opportunity to continue to expand the use of telemedicine, telehealth, and home telemonitoring services,” HHSC wrote.

Changes to current regulations in this session’s SB 670 include:

  • Repealing several provisions of the Government Code that set requirements for participation and reimbursement of telemedicine and telehealth services for providers under Medicaid, like a prohibition on Medicaid reimbursement for facilities that don’t use certain minimum standards for technology;
  • Removing and changing language around the requirement for HHSC to encourage providers to provide telemedicine and telehealth services; and
  • Removing a requirement for the HHSC to encourage STAR Health program providers to use telemedicine medical services as appropriate, leaving the requirement that HHSC should “explore opportunities” to increase those providers’ use of telemedicine medical services in underserved areas.

Beyond directing HHSC to make sure MCOs aren’t denying reimbursement based on the fact that services are provided virtually, it also directs HHSC to:

  • Ensure MCOs don’t limit, deny, or reduce reimbursement due to a provider’s choice of platform for providing virtual services;
  • Ensure MCOs are ensuring that the use of telemedicine or telehealth services “promotes and supports patient-centered medical homes;”
  • Develop a monitoring process for MCOs;
  • Require reimbursement for telemedicine services at the same (rather than a comparable) rate as Medicaid reimburses the same in-person services; and
  • Ensure that federally qualified health centers can be reimbursed for certain fees for covered telemedicine/telehealth services provided to Medicaid recipients — pending appropriation.

In a public hearing in the Senate Committee on Health and Human Services earlier this session, HHSC Medicaid Chief Medical Officer Dr. Ryan Van Ramshorst said the bill doesn’t necessarily create any new benefits, when he testified as a resource witness.

“As I read the bill, I don’t think this creates any new benefit, it simply offers benefits that are already part of the Medicaid state plan through telemedicine or telehealth — through that mechanism,” he said.

The bill passed unanimously out of the Senate earlier this session, and now returns to the chamber after amendments in the House.

The House made two amendments to the bill: One, from Rep. Matt Schaefer, adds telemedicine and telehealth services to the definition of “direct primary care” services; the other, from Rep. Tom Oliverson, adds federally qualified health centers to the types of facilities at which a telepharmacy system can be located.