2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter A. General Provisions › Section 533.039. Delivery of Benefits Using Telecommunications and Information Technology

Text of section effective until April 01, 2025
Sec. 533.039.  DELIVERY OF BENEFITS USING TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY.  (a)  The commission shall establish policies and procedures to improve access to care under the Medicaid managed care program by encouraging the use of telehealth services, telemedicine medical services, home telemonitoring services, and other telecommunications or information technology under the program.
(b)  To the extent permitted by federal law, the executive commissioner by rule shall establish policies and procedures that allow a Medicaid managed care organization to conduct assessments and provide care coordination services using telecommunications or information technology.  In establishing the policies and procedures, the executive commissioner shall consider:
(1)  the extent to which a managed care organization determines using the telecommunications or information technology is appropriate;
(2)  whether the recipient requests that the assessment or service be provided using telecommunications or information technology;
(3)  whether the recipient consents to receiving the assessment or service using telecommunications or information technology;
(4)  whether conducting the assessment, including an assessment for an initial waiver eligibility determination, or providing the service in person is not feasible because of the existence of an emergency or state of disaster, including a public health emergency or natural disaster; and
(5)  whether the commission determines using the telecommunications or information technology is appropriate under the circumstances.
(c)  If a Medicaid managed care organization conducts an assessment of or provides care coordination services to a recipient using telecommunications or information technology, the managed care organization shall:
(1)  monitor the health care services provided to the recipient for evidence of fraud, waste, and abuse; and
(2)  determine whether additional social services or supports are needed.
(d)  To the extent permitted by federal law, the commission shall allow a recipient who is assessed or provided with care coordination services by a Medicaid managed care organization using telecommunications or information technology to provide consent or other authorizations to receive services verbally instead of in writing.
(e)  The commission shall determine categories of recipients of home and community-based services who must receive in-person visits.  Except during circumstances described by Subsection (b)(4), a Medicaid managed care organization shall, for a recipient of home and community-based services for which the commission requires in-person visits, conduct:
(1)  at least one in-person visit with the recipient to make an initial waiver eligibility determination; and
(2)  additional in-person visits with the recipient if necessary, as determined by the managed care organization.
(f)  Notwithstanding the provisions of this section, the commission may, on a case-by-case basis, require a Medicaid managed care organization to discontinue the use of telecommunications or information technology for assessment or service coordination services if the commission determines that the discontinuation is in the best interest of the recipient.
Added by Acts 2021, 87th Leg., R.S., Ch. 624 (H.B. 4), Sec. 6, eff. June 15, 2021.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.