reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter D. Provision of and Reimbursement for Teledentistry Dental Services in General › Section 548.0151. Medicaid Reimbursement Requirements

Text of section effective on April 01, 2025
Sec. 548.0151.  MEDICAID REIMBURSEMENT REQUIREMENTS.  (a) The executive commissioner by rule shall require each health and human services agency that administers a part of Medicaid to provide Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in this state.
(b)  The commission shall require reimbursement for a teledentistry dental service at the same rate as the Medicaid program reimburses for the same in-person dental service.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter D. Provision of and Reimbursement for Teledentistry Dental Services in General › Section 548.0152. Dentist's Choice of Platform

Text of section effective on April 01, 2025
Sec. 548.0152.  DENTIST'S CHOICE OF PLATFORM.  The commission may not limit a dentist's choice of platform for providing a teledentistry dental service by requiring that the dentist use a particular platform to receive reimbursement for the service.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter D. Provision of and Reimbursement for Teledentistry Dental Services in General › Section 548.0153. Certain Teledentistry Dental Services Reimbursement Denials Prohibited

Text of section effective on April 01, 2025
Sec. 548.0153.  CERTAIN TELEDENTISTRY DENTAL SERVICES REIMBURSEMENT DENIALS PROHIBITED.  A request for reimbursement may not be denied solely because an in-person dental service between a dentist and a patient did not occur.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter D. Provision of and Reimbursement for Teledentistry Dental Services in General › Section 548.0154. State Board of Dental Examiners Rules

Text of section effective on April 01, 2025
Sec. 548.0154.  STATE BOARD OF DENTAL EXAMINERS RULES.  The State Board of Dental Examiners, in consultation with the commission and the commission's office of inspector general, as appropriate, may adopt rules as necessary to:
(1)  ensure that appropriate care, including quality of care, is provided to patients who receive teledentistry dental services; and
(2)  prevent abuse and fraud through the use of teledentistry dental services, including rules relating to filing claims and the records required to be maintained in connection with teledentistry dental services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter E. Reimbursement for Telemedicine Medical, Teledentistry Dental, and Telehealth Services Provided to Certain Children › Section 548.0201. Reimbursement for Telemedicine Medical, Teledentistry Dental, and Telehealth Services Provided to Children With Special Health Care Needs

Text of section effective on April 01, 2025
Sec. 548.0201.  REIMBURSEMENT FOR TELEMEDICINE MEDICAL, TELEDENTISTRY DENTAL, AND TELEHEALTH SERVICES PROVIDED TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.  (a)  In this section, "child with special health care needs" has the meaning assigned by Section 35.0022, Health and Safety Code.
(b)  The executive commissioner by rule shall establish policies that permit reimbursement under Medicaid and the child health plan program for services provided through telemedicine medical services, teledentistry dental services, and telehealth services to children with special health care needs.
(c)  The policies required under this section must:
(1)  be designed to:
(A)  prevent unnecessary travel and encourage efficient use of telemedicine medical services, teledentistry dental services, and telehealth services for children with special health care needs in all suitable circumstances; and
(B)  ensure in a cost-effective manner the availability to a child with special health care needs of services appropriately performed using telemedicine medical services, teledentistry dental services, and telehealth services that are comparable to the same types of services available to that child without using telemedicine medical services, teledentistry dental services, and telehealth services; and
(2)  provide for reimbursement of multiple providers of different services who participate in a single session of telemedicine medical services, teledentistry dental services, telehealth services, or any combination of those services for a child with special health care needs, if the commission determines that reimbursing each provider for the session is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without using telemedicine medical services, teledentistry dental services, and telehealth services, including the costs of transportation and lodging and other direct costs.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter E. Reimbursement for Telemedicine Medical, Teledentistry Dental, and Telehealth Services Provided to Certain Children › Section 548.0202. Medicaid Reimbursement for Telemedicine Medical Services Provided in School-Based Setting

Text of section effective on April 01, 2025
Sec. 548.0202.  MEDICAID REIMBURSEMENT FOR TELEMEDICINE MEDICAL SERVICES PROVIDED IN SCHOOL-BASED SETTING.  (a)  In this section, "physician" means an individual licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.
(b)  The commission shall ensure that Medicaid reimbursement is provided to a physician for a telemedicine medical service provided by the physician, even if the physician is not the patient's primary care physician or provider, if:
(1)  the physician is an authorized Medicaid health care provider;
(2)  the patient is a child who receives the service in a primary or secondary school-based setting; and
(3)  the parent or legal guardian of the patient provides consent before the service is provided.
(c)  In the case of a telemedicine medical service provided to a child in a school-based setting as described by Subsection (b), the notification under Section 548.0106, if any, must include a summary of the service, including exam findings, prescribed or administered medications, and patient instructions.
(d)  If a patient receiving a telemedicine medical service in a school-based setting as described by Subsection (b) does not have a primary care physician or provider, the commission shall require that the patient's parent or legal guardian receive:
(1)  the notification required under Section 548.0106; and
(2)  a list of primary care physicians or providers from which the patient may select the patient's primary care physician or provider.
(e)  The commission in consultation with the Texas Medical Board shall monitor and regulate the use of telemedicine medical services to ensure compliance with this section.  In addition to any other method of enforcement, the commission may use a corrective action plan to ensure compliance with this section.
(f)  The Texas Medical Board, in consultation with the commission, as appropriate, may adopt rules as necessary to:
(1)  ensure that appropriate care, including quality of care, is provided to patients who receive telemedicine medical services; and
(2)  prevent abuse and fraud through the use of telemedicine medical services, including rules relating to filing of claims and records required to be maintained in connection with telemedicine.
(g)  This section does not affect any requirement relating to:
(1)  a rural health clinic; or
(2)  physician delegation to an advanced practice nurse or physician assistant of the authority to carry out or sign prescription drug orders.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter E. Reimbursement for Telemedicine Medical, Teledentistry Dental, and Telehealth Services Provided to Certain Children › Section 548.0203. Medicaid Reimbursement for Telehealth Services Provided Through School District or Charter School

Text of section effective on April 01, 2025
Sec. 548.0203.  MEDICAID REIMBURSEMENT FOR TELEHEALTH SERVICES PROVIDED THROUGH SCHOOL DISTRICT OR CHARTER SCHOOL.  (a)  In this section, "health professional" means an individual who is:
(1)  licensed, registered, certified, or otherwise authorized by this state to practice as a social worker, occupational therapist, or speech-language pathologist;
(2)  a licensed professional counselor;
(3)  a licensed marriage and family therapist; or
(4)  a licensed specialist in school psychology.
(b)  The commission shall ensure that Medicaid reimbursement is provided to a school district or open-enrollment charter school for telehealth services provided through the school district or charter school by a health professional, even if the health professional is not the patient's primary care provider, if:
(1)  the school district or charter school is an authorized Medicaid health care provider; and
(2)  the parent or legal guardian of the patient provides consent before the service is provided.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0251. Definitions

Text of section effective on April 01, 2025
Sec. 548.0251.  DEFINITIONS.  In this subchapter:
(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 those terms are defined by Section 142.001, Health and Safety Code.
(2)  "Hospital" means a hospital licensed under Chapter 241, Health and Safety Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0252. Medicaid Reimbursement Program for Home Telemonitoring Services Authorized

Text of section effective on April 01, 2025
Sec. 548.0252.  MEDICAID REIMBURSEMENT PROGRAM FOR HOME TELEMONITORING SERVICES AUTHORIZED.  If the commission determines that establishing a statewide program that permits Medicaid reimbursement for home telemonitoring services would be cost-effective and feasible, the executive commissioner by rule shall establish the program as provided by this subchapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0253. Reimbursement Program Requirements

Text of section effective on April 01, 2025
Sec. 548.0253.  REIMBURSEMENT PROGRAM REQUIREMENTS.  (a)  A program established under this subchapter must:
(1)  provide that home telemonitoring services are available only to an individual who:
(A)  is 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)  exhibits 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; 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.
(b)  Notwithstanding Subsection (a)(1), a program established under this subchapter must also provide that home telemonitoring services are available to pediatric individuals who:
(1)  are diagnosed with end-stage solid organ disease;
(2)  have received an organ transplant; or
(3)  require mechanical ventilation.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0254. Discontinuation of Reimbursement Program Under Certain Circumstances

Text of section effective on April 01, 2025
Sec. 548.0254.  DISCONTINUATION OF REIMBURSEMENT PROGRAM UNDER CERTAIN CIRCUMSTANCES.  If, after implementation, the commission determines that the program established under this subchapter is not cost-effective, the commission may discontinue the program and stop providing Medicaid reimbursement for home telemonitoring services, notwithstanding Subchapter B or any other law.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0255. Determination of Cost Savings for Medicare Program

Text of section effective on April 01, 2025
Sec. 548.0255.  DETERMINATION OF COST SAVINGS FOR MEDICARE PROGRAM.  The commission shall determine whether providing home telemonitoring services to individuals who are eligible to receive benefits under both Medicaid and the Medicare program achieves cost savings for the Medicare program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter F. Medicaid Reimbursement for Home Telemonitoring Services › Section 548.0256. Reimbursement for Other Conditions and Risk Factors

Text of section effective on April 01, 2025
Sec. 548.0256.  REIMBURSEMENT FOR OTHER CONDITIONS AND RISK FACTORS.  (a) 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 individuals who have conditions and exhibit risk factors other than those expressly authorized by this subchapter.
(b)  In determining whether the Medicaid managed care organization should provide reimbursement for services under this section, the organization shall consider whether reimbursement for the service is cost-effective and providing the service is clinically effective.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter G. Medicaid Reimbursement for Internet Medical Consultations › Section 548.0301. Definition

Text of section effective on April 01, 2025
Sec. 548.0301.  DEFINITION.  In this subchapter, "physician" means an individual licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter G. Medicaid Reimbursement for Internet Medical Consultations › Section 548.0302. Medicaid Reimbursement for Internet Medical Consultation Authorized

Text of section effective on April 01, 2025
Sec. 548.0302.  MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL CONSULTATION AUTHORIZED.  (a)  The executive commissioner by rule may require the commission and each health and human services agency that administers a part of Medicaid to provide Medicaid reimbursement for a medical consultation that a physician or other health care professional provides using the Internet as a cost-effective alternative to an in-person consultation.
(b)  The executive commissioner may require the commission or a health and human services agency to provide the reimbursement described by this section only if the Centers for Medicare and Medicaid Services develops an appropriate Current Procedural Terminology code for medical services provided using the Internet.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter G. Medicaid Reimbursement for Internet Medical Consultations › Section 548.0303. Pilot Program for Medicaid Reimbursement for Internet Medical Consultation

Text of section effective on April 01, 2025
Sec. 548.0303.  PILOT PROGRAM FOR MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL CONSULTATION.  (a)  The executive commissioner may develop and implement a pilot program in one or more sites the executive commissioner chooses under which Medicaid reimbursements are paid for medical consultations provided by physicians or other health care professionals using the Internet.  The pilot program must be designed to test whether an Internet medical consultation is a cost-effective alternative to an in-person consultation under Medicaid.
(b)  The executive commissioner may modify the pilot program as necessary throughout the program's implementation to maximize the potential cost-effectiveness of Internet medical consultations.
(c)  If the executive commissioner determines from the pilot program that Internet medical consultations are cost-effective, the executive commissioner may expand the pilot program to additional sites or implement Medicaid reimbursements for Internet medical consultations statewide.
(d)  The executive commissioner is not required to implement the pilot program authorized under Subsection (a) as a prerequisite to providing Medicaid reimbursement authorized by Section 548.0302 on a statewide basis.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0351. Definitions

Text of section effective on April 01, 2025
Sec. 548.0351.  DEFINITIONS.  In this subchapter:
(1)  "Nonurban health care facility" means a hospital licensed under Chapter 241, Health and Safety Code, or other licensed health care facility in this state that is located in a rural area as defined by Section 845.002, Insurance Code.
(2)  "Pediatric specialist" means a physician who is certified in general pediatrics by the American Board of Pediatrics or American Osteopathic Board of Pediatrics.
(3)  "Pediatric subspecialist" means a physician who is certified in a pediatric subspecialty by a member board of the American Board of Medical Specialties or American Osteopathic Board of Pediatrics.
(4)  "Pediatric tele-specialty provider" means a pediatric health care facility in this state that offers continuous access to telemedicine medical services provided by pediatric subspecialists.
(5)  "Physician" means an individual licensed to practice medicine in this state.
(6)  "Program" means the pediatric tele-connectivity resource program for rural Texas established under this subchapter.
(7)  Notwithstanding Section 521.0001, "telemedicine medical service" means a health care service delivered to a patient:
(A)  by a physician acting within the scope of the physician's license or a health professional acting under the delegation and supervision of a physician and within the scope of the health professional's license;
(B)  from a physical location that is different from the patient's location; and
(C)  using telecommunications or information technology.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0352. Establishment of Pediatric Tele-Connectivity Resource Program for Rural Texas

Text of section effective on April 01, 2025
Sec. 548.0352.  ESTABLISHMENT OF PEDIATRIC TELE-CONNECTIVITY RESOURCE PROGRAM FOR RURAL TEXAS.  The commission with any necessary assistance of pediatric tele-specialty providers shall establish a pediatric tele-connectivity resource program for rural Texas to award grants to nonurban health care facilities to connect the facilities with pediatric specialists and pediatric subspecialists who provide telemedicine medical services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0353. Use of Program Grant

Text of section effective on April 01, 2025
Sec. 548.0353.  USE OF PROGRAM GRANT.  A nonurban health care facility awarded a grant under this subchapter may use grant money to:
(1)  purchase equipment necessary for implementing a telemedicine medical service;
(2)  modernize the facility's information technology infrastructure and secure information technology support to ensure an uninterrupted two-way video signal that is compliant with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191);
(3)  pay a service fee to a pediatric tele-specialty provider under an annual contract with the provider; or
(4)  pay for other activities, services, supplies, facilities, resources, and equipment the commission determines necessary for the facility to use a telemedicine medical service.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0354. Selection of Program Grant Recipients

Text of section effective on April 01, 2025
Sec. 548.0354.  SELECTION OF PROGRAM GRANT RECIPIENTS.  (a)  The commission with any necessary assistance of pediatric tele-specialty providers may select an eligible nonurban health care facility to receive a grant under this subchapter.
(b)  To be eligible for a grant, a nonurban health care facility must have:
(1)  a quality assurance program that measures the compliance of the facility's health care providers with the facility's medical protocols;
(2)  on staff at least one full-time equivalent physician who has training and experience in pediatrics and one individual who is responsible for ongoing nursery and neonatal support and care;
(3)  a designated neonatal intensive care unit or an emergency department;
(4)  a commitment to obtaining neonatal or pediatric education from a tertiary facility to expand the facility's depth and breadth of telemedicine medical service capabilities; and
(5)  the capability of maintaining records and producing reports that measure the effectiveness of the grant the facility would receive.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0355. Gifts, Grants, and Donations

Text of section effective on April 01, 2025
Sec. 548.0355.  GIFTS, GRANTS, AND DONATIONS.  (a)  The commission may solicit and accept gifts, grants, and donations from any public or private source for the purposes of this subchapter.
(b)  A political subdivision that participates in the program may pay part of the costs of the program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0356. Work Group

Text of section effective on April 01, 2025
Sec. 548.0356.  WORK GROUP.  (a)  The commission may establish a program work group to:
(1)  assist the commission with developing, implementing, or evaluating the program; and
(2)  prepare a report on the results and outcomes of the grants awarded under this subchapter.
(b)  A program work group member is not entitled to compensation for serving on the program work group and may not be reimbursed for travel or other expenses incurred while conducting the business of the program work group.
(c)  A program work group is not subject to Chapter 2110.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0357. Biennial Report

Text of section effective on April 01, 2025
Sec. 548.0357.  BIENNIAL REPORT.  Not later than December 1 of each even-numbered year, the commission shall submit a report to the governor and members of the legislature regarding the activities of the program and grant recipients under the program, including the results and outcomes of grants awarded under this subchapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0358. Rules

Text of section effective on April 01, 2025
Sec. 548.0358.  RULES.  The executive commissioner may adopt rules necessary to implement this subchapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter H. Pediatric Tele-Connectivity Resource Program for Rural Texas › Section 548.0359. Appropriation Required

Text of section effective on April 01, 2025
Sec. 548.0359.  APPROPRIATION REQUIRED.  The commission may not spend state funds to accomplish the purposes of this subchapter and is not required to award a grant under this subchapter unless money is appropriated for the purposes of this subchapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 548 - Health Care Services Provided Through Tele-Connective Means › Subchapter I. Telehealth Treatment Program for Substance Use Disorders › Section 548.0401. Telehealth Treatment Program for Substance Use Disorders

Text of section effective on April 01, 2025
Sec. 548.0401.  TELEHEALTH TREATMENT PROGRAM FOR SUBSTANCE USE DISORDERS.  The executive commissioner by rule shall establish a program to increase opportunities and expand access to telehealth treatment for substance use disorders in this state.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter A. General Provisions Applicable to Provision of Drugs Under Vendor Drug Program and Certain Other Programs › Section 549.0001. Bulk Purchasing With Another State of Prescription Drugs and Other Medications

Text of section effective on April 01, 2025
Sec. 549.0001.  BULK PURCHASING WITH ANOTHER STATE OF PRESCRIPTION DRUGS AND OTHER MEDICATIONS.  (a)  Subject to Subsection (b), the commission and each health and human services agency the executive commissioner authorizes may enter into an agreement with one or more other states for the joint bulk purchasing of prescription drugs and other medications to be used in Medicaid, the child health plan program, or another program under the commission's authority.
(b)  A joint bulk purchasing agreement may not be entered into until:
(1)  the commission determines that entering into the agreement would be feasible and cost-effective; and
(2)  if appropriated money would be spent under the proposed agreement, the governor and the Legislative Budget Board grant prior approval to spend appropriated money under the proposed agreement.
(c)  In determining the feasibility and cost-effectiveness of entering into a joint bulk purchasing agreement, the commission shall identify:
(1)  the most cost-effective existing joint bulk purchasing agreement; and
(2)  any potential groups of states with which this state could enter into a new cost-effective joint bulk purchasing agreement.
(d)  If a joint bulk purchasing agreement is entered into, the commission shall adopt procedures applicable to an agreement and joint purchase described by this section.  The procedures must ensure that this state receives:
(1)  all prescription drugs and other medications purchased with money provided by this state; and
(2)  an equitable share of any price benefits resulting from the joint bulk purchase.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter A. General Provisions Applicable to Provision of Drugs Under Vendor Drug Program and Certain Other Programs › Section 549.0002. Value-Based Arrangement in Medicaid Vendor Drug Program

Text of section effective on April 01, 2025
Sec. 549.0002.  VALUE-BASED ARRANGEMENT IN MEDICAID VENDOR DRUG PROGRAM.  (a)  In this section, "manufacturer" has the meaning assigned by Section 549.0101.
(b)  Subject to Subchapter D, the commission may enter into a value-based arrangement for the Medicaid vendor drug program by written agreement with a manufacturer based on outcome data or other metrics to which this state and the manufacturer agree in writing.  The value-based arrangement may include a rebate, a discount, a price reduction, a contribution, risk sharing, a reimbursement, payment deferral or installment payments, a guarantee, patient care, shared savings payments, withholds, a bonus, or any other thing of value.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter A. General Provisions Applicable to Provision of Drugs Under Vendor Drug Program and Certain Other Programs › Section 549.0003. Period of Validity of Prescriptions Under Medicaid

Text of section effective on April 01, 2025
Sec. 549.0003.  PERIOD OF VALIDITY OF PRESCRIPTIONS UNDER MEDICAID.  (a)  This section does not apply to a prescription for a controlled substance, as defined by Chapter 481, Health and Safety Code.
(b)  In the rules and standards governing the vendor drug program, the executive commissioner, to the extent allowed by federal law and laws regulating the writing of prescriptions and dispensing of prescription medications, shall ensure that a prescription written by an authorized health care provider under Medicaid is valid for the lesser of:
(1)  the period for which the prescription is written; or
(2)  one year.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter A. General Provisions Applicable to Provision of Drugs Under Vendor Drug Program and Certain Other Programs › Section 549.0004. Certain Medications for Sex Offenders Prohibited

Text of section effective on April 01, 2025
Sec. 549.0004.  CERTAIN MEDICATIONS FOR SEX OFFENDERS PROHIBITED.  (a)  To the maximum extent allowed under federal law, the commission may not provide a sexual performance enhancing medication under the vendor drug program or any other health and human services program to an individual required to register as a sex offender under Chapter 62, Code of Criminal Procedure.
(b)  The executive commissioner may adopt rules as necessary to implement this section.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter A. General Provisions Applicable to Provision of Drugs Under Vendor Drug Program and Certain Other Programs › Section 549.0005. Prior Approval of and Pharmacy Provider Access to Certain Communications With Certain Recipients and Enrollees

Text of section effective on April 01, 2025
Sec. 549.0005.  PRIOR APPROVAL OF AND PHARMACY PROVIDER ACCESS TO CERTAIN COMMUNICATIONS WITH CERTAIN RECIPIENTS AND ENROLLEES.  (a)  This section applies to:
(1)  the vendor drug program for Medicaid and the child health plan program;
(2)  the kidney health care program;
(3)  the children with special health care needs program; and
(4)  any other state program the commission administers that provides prescription drug benefits.
(b)  A managed care organization, including a health maintenance organization, or a pharmacy benefit manager, that administers claims for prescription drug benefits under a program to which this section applies shall, at least 10 days before the date the organization or pharmacy benefit manager intends to deliver a communication to recipients or enrollees collectively under a program:
(1)  submit a copy of the communication to the commission for approval; and
(2)  if applicable, allow the pharmacy providers of the recipients or enrollees who are to receive the communication access to the communication.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter B. Review and Analysis of Certain Prescription Drug Purchases and Patterns › Section 549.0051. Periodic Review of Vendor Drug Program Purchases

Text of section effective on April 01, 2025
Sec. 549.0051.  PERIODIC REVIEW OF VENDOR DRUG PROGRAM PURCHASES.  (a)  The commission shall periodically review all purchases made under the vendor drug program to determine the cost-effectiveness of including a component for prescription drug benefits in any capitation rate paid by this state under a Medicaid managed care program or the child health plan program.
(b)  In making the determination required by Subsection (a), the commission shall consider the value of any prescription drug rebates this state receives.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter B. Review and Analysis of Certain Prescription Drug Purchases and Patterns › Section 549.0052. Medicaid Prescription Drug Use and Expenditure Patterns

Text of section effective on April 01, 2025
Sec. 549.0052.  MEDICAID PRESCRIPTION DRUG USE AND EXPENDITURE PATTERNS.  The commission shall:
(1)  monitor and analyze Medicaid prescription drug use and expenditure patterns;
(2)  identify the therapeutic prescription drug classes and individual prescription drugs that are most often prescribed to patients or that represent the greatest expenditures; and
(3)  post the data the commission identifies under this section on the commission's Internet website and update the information on a quarterly basis.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0101. Definitions

Text of section effective on April 01, 2025
Sec. 549.0101.  DEFINITIONS.  In this subchapter:
(1)  "Labeler" means a person that:
(A)  has a labeler code from the United States Food and Drug Administration under 21 C.F.R. Section 207.33; and
(B)  receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale.
(2)  "Manufacturer" means a manufacturer of prescription drugs as defined by 42 U.S.C. Section 1396r-8(k)(5), including a subsidiary or affiliate of a manufacturer.
(3)  "Supplemental rebate" means a cash rebate a manufacturer pays to this state:
(A)  on the basis of appropriate quarterly health and human services program utilization data relating to the manufacturer's products; and
(B)  in accordance with a state supplemental rebate agreement negotiated with the manufacturer and, if necessary, approved by the federal government under 42 U.S.C. Section 1396r-8.
(4)  "Wholesaler" means a person licensed under Subchapter I, Chapter 431, Health and Safety Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0102. Requirement to Negotiate for Supplemental Rebates for Certain Programs

Text of section effective on April 01, 2025
Sec. 549.0102.  REQUIREMENT TO NEGOTIATE FOR SUPPLEMENTAL REBATES FOR CERTAIN PROGRAMS.  (a)  Subject to Subsection (b), the commission shall negotiate with manufacturers and labelers, including generic manufacturers and labelers, to obtain supplemental rebates for prescription drugs provided under:
(1)  the Medicaid vendor drug program in excess of the Medicaid rebates required by 42 U.S.C. Section 1396r-8;
(2)  the child health plan program; and
(3)  any other state program the commission or a health and human services agency administers, including a community mental health center or state mental health hospital.
(b)  The commission may by contract authorize a private entity to negotiate with manufacturers and labelers on the commission's behalf.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0103. Voluntary Negotiation for Manufacturer and Labeler Supplemental Rebates

Text of section effective on April 01, 2025
Sec. 549.0103.  VOLUNTARY NEGOTIATION FOR MANUFACTURER AND LABELER SUPPLEMENTAL REBATES.  A manufacturer or labeler that sells prescription drugs in this state may voluntarily negotiate with the commission and enter into an agreement to provide supplemental rebates for prescription drugs provided under:
(1)  the Medicaid vendor drug program in excess of the Medicaid rebates required by 42 U.S.C. Section 1396r-8;
(2)  the child health plan program; and
(3)  any other state program the commission or a health and human services agency administers, including a community mental health center or state mental health hospital.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0104. Considerations in Supplemental Rebate Negotiations

Text of section effective on April 01, 2025
Sec. 549.0104.  CONSIDERATIONS IN SUPPLEMENTAL REBATE NEGOTIATIONS.  (a)  In negotiating terms for a supplemental rebate amount, the commission shall consider:
(1)  rebates calculated under the Medicaid rebate program in accordance with 42 U.S.C. Section 1396r-8;
(2)  any other available information on prescription drug prices or rebates; and
(3)  other program benefits as specified in Section 549.0106(b).
(b)  In negotiating terms for a supplemental rebate, the commission shall use the average manufacturer price as defined in 42 U.S.C. Section 1396r-8(k)(1) as the cost basis for the product.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0105. Required Disclosures in Negotiations for Supplemental Rebates

Text of section effective on April 01, 2025
Sec. 549.0105.  REQUIRED DISCLOSURES IN NEGOTIATIONS FOR SUPPLEMENTAL REBATES.  Before or during supplemental rebate agreement negotiations for a prescription drug being considered for the preferred drug list, the commission shall disclose to pharmaceutical manufacturers any clinical edits or clinical protocols that may be imposed on drugs within a particular drug category that are placed on the preferred drug list during the contract period.  Clinical edits may not be imposed for a preferred drug during the contract period unless the disclosure is made.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 549 - Provision of Drugs and Drug Information › Subchapter C. Supplemental Rebates or Program Benefits for Prescription Drugs › Section 549.0106. Program Benefits Instead of Supplemental Rebates; Monetary Contribution or Donation

Text of section effective on April 01, 2025
Sec. 549.0106.  PROGRAM BENEFITS INSTEAD OF SUPPLEMENTAL REBATES; MONETARY CONTRIBUTION OR DONATION.  (a)  For purposes of this section, a program benefit may mean a disease management program authorized under this title, a drug product donation program, a drug utilization control program, prescriber and beneficiary counseling and education, a fraud or abuse initiative, and another service or administrative investment with guaranteed savings to a program a health and human services agency operates.
(b)  The commission may enter into a written agreement with a manufacturer to accept a program benefit instead of a supplemental rebate only if:
(1)  the program benefit yields savings that are at least equal to the amount the manufacturer would have provided under a state supplemental rebate agreement during the current biennium as determined by the written agreement;
(2)  the manufacturer:
(A)  posts a performance bond guaranteeing savings to this state; and
(B)  agrees that if the savings are not achieved in accordance with the written agreement, the manufacturer will forfeit the bond to this state, less any savings that were achieved; and
(3)  the program benefit is in addition to other program benefits the manufacturer currently offers to recipients of Medicaid or related programs.
(c)  For purposes of this subchapter, the commission may consider a monetary contribution or donation to the arrangements described in Subsection (b) for the purpose of offsetting expenditures to other state health care programs, but that funding may not be used to offset expenditures for covered outpatient drugs as defined by 42 U.S.C. Section 1396r-8(k)(2) under the vendor drug program.  An arrangement under this subsection may not yield less than the amount this state would have benefited under a supplemental rebate.  The commission may consider an arrangement under this subchapter as satisfying the requirements of Section 549.0204(a).
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.