TX Govt Code § 531.02164 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.02164. Medicaid Services Provided Through Home Telemonitoring Services

Sec. 531.02164.  MEDICAID SERVICES PROVIDED THROUGH HOME TELEMONITORING SERVICES.  (a)  In this section:(1)  "Home and community support services agency" means a person licensed under Chapter 142, Health and Safety Code, to provide home health, hospice, or personal assistance services as defined by Section 142.001, Health and Safety Code.(2)  "Hospital" means a hospital licensed under Chapter 241, Health and Safety Code.(b)  If the commission determines that establishing a statewide program that permits reimbursement under Medicaid for home telemonitoring services would be cost-effective and feasible, the executive commissioner by rule shall establish the program as provided under this section.(c)  The program required under this section must:(1)  provide that home telemonitoring services are available only to persons who:(A)  are diagnosed with one or more of the following conditions:(i)  pregnancy;(ii)  diabetes;(iii)  heart disease;(iv)  cancer;(v)  chronic obstructive pulmonary disease;(vi)  hypertension;(vii)  congestive heart failure;(viii)  mental illness or serious emotional disturbance;(ix)  asthma;(x)  myocardial infarction; or(xi)  stroke; and(B)  exhibit two or more of the following risk factors:(i)  two or more hospitalizations in the prior 12-month period;(ii)  frequent or recurrent emergency room admissions;(iii)  a documented history of poor adherence to ordered medication regimens;(iv)  a documented history of falls in the prior six-month period;(v)  limited or absent informal support systems;(vi)  living alone or being home alone for extended periods of time; and(vii)  a documented history of care access challenges;(2)  ensure that clinical information gathered by a home and community support services agency or hospital while providing home telemonitoring services is shared with the patient's physician; and(3)  ensure that the program does not duplicate disease management program services provided under Section 32.057, Human Resources Code.(c-1)  Notwithstanding Subsection (c)(1), the program required under this section must also provide that home telemonitoring services are available to pediatric persons who:(1)  are diagnosed with end-stage solid organ disease;(2)  have received an organ transplant; or(3)  require mechanical ventilation.(d)  If, after implementation, the commission determines that the program established under this section is not cost-effective, the commission may discontinue the program and stop providing reimbursement under Medicaid for home telemonitoring services, notwithstanding Section 531.0216 or any other law.(e)  The commission shall determine whether the provision of home telemonitoring services to persons who are eligible to receive benefits under both Medicaid and the Medicare program achieves cost savings for the Medicare program.(f)  To comply with state and federal requirements to provide access to medically necessary services under the Medicaid managed care program, a Medicaid managed care organization may reimburse providers for home telemonitoring services provided to persons who have conditions and exhibit risk factors other than those expressly authorized by this section.  In determining whether the managed care organization should provide reimbursement for services under this subsection, the organization shall consider whether reimbursement for the service is cost-effective and providing the service is clinically effective.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1205 (S.B. 293), Sec. 5, eff. September 1, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.033, eff. April 2, 2015.Acts 2019, 86th Leg., R.S., Ch. 1061 (H.B. 1063), Sec. 2, eff. September 1, 2019.Acts 2021, 87th Leg., R.S., Ch. 624 (H.B. 4), Sec. 3, eff. June 15, 2021.|