2023 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 531.0217. Reimbursement for Certain Medical Consultations

Text of section effective until April 01, 2025
Sec. 531.0217.  REIMBURSEMENT FOR CERTAIN MEDICAL CONSULTATIONS.  (a)  In this section:
(1)  "Health professional" means:
(A)  a physician;
(B)  an individual who is:
(i)  licensed or certified in this state to perform health care services;  and
(ii)  authorized to assist a physician in providing telemedicine medical services that are delegated and supervised by the physician;  or
(C)  a licensed or certified health professional acting within the scope of the license or certification who does not perform a telemedicine medical service.
(2)  "Physician" means a person licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.
(3)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1205, Sec. 10(2), eff. September 1, 2011.
(4)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1205, Sec. 10(2), eff. September 1, 2011.
(b)  The executive commissioner by rule shall require each health and human services agency that administers a part of Medicaid to provide Medicaid reimbursement for a telemedicine medical service initiated or provided by a physician.
(c)  The commission shall ensure that reimbursement is provided only for a telemedicine medical service initiated or provided by a physician.
(c-1)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 6(3), eff. September 1, 2019.
(c-2)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 6(3), eff. September 1, 2019.
(c-3)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 6(3), eff. September 1, 2019.
(c-4)  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 health care provider under Medicaid;
(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.
(d)  The commission shall require reimbursement for a telemedicine medical service at the same rate as Medicaid reimburses for the same in-person medical service.  A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur.  The commission may not limit a physician's choice of platform for providing a telemedicine medical service or telehealth service by requiring that the physician use a particular platform to receive reimbursement for the service.
(e)  A health care facility that receives reimbursement under this section for a telemedicine medical service provided by a physician who practices in that facility or a health professional who participates in a telemedicine medical service under this section shall establish quality of care protocols and patient confidentiality guidelines to ensure that the telemedicine medical service meets legal requirements and acceptable patient care standards.
(f)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 6(3), eff. September 1, 2019.
(g)  If a patient receiving a telemedicine medical service has a primary care physician or provider and consents or, if appropriate, the patient's parent or legal guardian consents to the notification, the commission shall require that the primary care physician or provider be notified of the telemedicine medical service for the purpose of sharing medical information.  In the case of a service provided to a child in a school-based setting as described by Subsection (c-4), the notification, if any, must include a summary of the service, including exam findings, prescribed or administered medications, and patient instructions.
(g-1)  If a patient receiving a telemedicine medical service in a school-based setting as described by Subsection (c-4) 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 Subsection (g); and
(2)  a list of primary care physicians or providers from which the patient may select the patient's primary care physician or provider.
(h)  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.
(i)  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.
(i-1)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 205 (S.B. 1107), Sec. 12, eff. May 27, 2017.
(j)  Repealed by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.40(a)(1), and Ch. 946 (S.B. 277), Sec. 2.37(b)(1), eff. January 1, 2016.
(k)  This section does not affect any requirement relating to:
(1)  a rural health clinic; or
(2)  physician delegation of the authority to carry out or sign prescription drug orders to an advanced practice nurse or physician assistant.
Added by Acts 1997, 75th Leg., ch. 1251, Sec. 1, eff. Sept. 1, 1997.  Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.25, eff. Sept. 1, 1999.  Renumbered from Sec. 531.047 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(48), eff. Sept. 1, 1999;  Acts 2001, 77th Leg., ch. 661, Sec. 3, eff. June 13, 2001;  Acts 2001, 77th Leg., ch. 959, Sec. 10, eff. Sept. 1, 2001;  Acts 2001, 77th Leg., ch. 1255, Sec. 3, eff. June 15, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 370 (S.B. 1340), Sec. 3, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 1293 (S.B. 24), Sec. 1, eff. September 1, 2007.
Acts 2011, 82nd Leg., R.S., Ch. 1205 (S.B. 293), Sec. 10(2), eff. September 1, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.034, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 544 (H.B. 1878), Sec. 1, eff. September 1, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.40(a)(1), eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.37(b)(1), eff. January 1, 2016.
Acts 2017, 85th Leg., R.S., Ch. 205 (S.B. 1107), Sec. 10, eff. May 27, 2017.
Acts 2017, 85th Leg., R.S., Ch. 205 (S.B. 1107), Sec. 12, eff. May 27, 2017.
Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 3, eff. September 1, 2019.
Acts 2019, 86th Leg., R.S., Ch. 964 (S.B. 670), Sec. 6(3), eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.