In December, Texas Governor Rick Perry issued a statement on the “Future of Medicaid” in the state and reported, “The current Medicaid system is financially unsustainable and now requires innovative ideas to meet the challenging needs of Medicaid.” To help meet the needs of Medicaid, Armando Martinex a member of the Texas legislature introduced HB 70 and State Senator Kirk Watson introduced a similar bill SB 293 to help provide telemedicine telehealth medical and home telemonitoring services to certain Medicaid recipients.
The legislation would enable the Texas Department of Health and Human Services Commission (HHSC) to encourage healthcare providers and healthcare facilities to participate as telemedicine/telehealth service providers. However, the legislation does not require that service be provided to a patient through a telecommunications system when the service could be reasonably provided by a physician through a face-to-face consultation.
In developing the system, programs and pilot projects in other states would have to be reviewed to determine the most effective method for reimbursement, identify clinical evidence that supports the delivery of healthcare using a telecommunications system, and establish pilot studies for telemedicine and telehealth service delivery.
The legislation would establish pilot studies in designated areas of the state and participating health professionals would be reimbursed for participating in the pilot program. The pilot studies would examine new clinical findings to determine whether reimbursement for particular services should be denied or authorized.
The pilot program would need support from the local communities, to provide health screenings, prenatal care, medical or surgical follow-up visits, periodic consultations with specialists regarding chronic disorders, provide triage and pre-transfer arrangements, transmit diagnostic images and data, and monitor chronic conditions.
The pilot would also need to establish quantifiable measures and expected health outcomes for telecommunications services and consider additional applications for telemedicine/telehealth, to provide care to diabetics, persons with heart disease, cancer, COPD, hypertension, and CHF.
Further activities would need to be undertaken by the HHSC to:
• Provide for an approval process before a provider can receive reimbursement for services
• Establish a separate provider identifier for telemedicine/telehealth, and home telemonitoring service providers
• Have the HHSC and the Telecommunications Infrastructure Fund Board establish and adopt minimum standards for the operating the system, including standards for electronic transmission, software, and hardware
A program would be put in place to provide home telemonitoring service to only persons who are diagnosed with one or more conditions but also have other risk factors, such as:
• 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 systems
• Being alone for extended periods of time
• A documented history of care access challenges
Every two years, the HHSC would have to report to the state Speaker of the House of Representatives, and the Lieutenant Governor on how the program is operating. Information will need to be submitted on the geographic and demographic disposition of physicians and health professionals providing services, the number of patient receiving services, the types of services being provided, and the cost for use of the services.
Go to www.legis.state.tx.us/tlodocs/82Rbilltext/html/HB00070I.htm to review the legislation.