Section 354.1432 - Telemedicine and Telehealth Benefits and LimitationsTelemedicine medical services and telehealth services are authorized service delivery methods for Texas Medicaid covered services as provided in this section. All telemedicine medical services and telehealth services are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.
(1) A client must not be required to receive a covered service as a telemedicine medical service or telehealth service except in the event of an active declaration of state of disaster and at the direction of HHSC.(2) In the event of a declaration of state of disaster, HHSC may issue direction to providers regarding the use of telemedicine medical services and telehealth services, including the use of an audio-only platform, to provide covered services to clients who reside in the area subject to the declaration of state of disaster.(3) HHSC considers the following criteria when determining whether a covered service may be delivered as telemedicine medical service or telehealth service, including via an audio-only platform: (A) clinical effectiveness;(D) patient choice and access to care; and(E) other criteria specific to the service.(4) Conditions for reimbursement applicable to telemedicine medical services. (A) The provider must be enrolled in Texas Medicaid.(B) The covered services must be provided in compliance with Texas Occupations Code Chapter 111 and Title 22 Texas Administrative Code Chapter 174 (relating to Telemedicine).(C) A telemedicine medical service must be designated for reimbursement by HHSC. Telemedicine medical services designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with paragraph (3) of this section. Covered services that HHSC has determined are clinically effective and cost-effective when provided as a telemedicine medical service can be found in the Texas Medicaid Provider Procedures Manual (TMPPM).(5) Conditions for telemedicine medical services provided in a primary or secondary school-based setting.(A) For a child receiving telemedicine medical services in a primary or secondary school-based setting, advance parent or legal guardian consent for a telemedicine medical service must be obtained.(B) The patient's primary care physician or provider must be notified of a telemedicine medical service, unless the patient does not have a primary care physician or provider.(i) The patient receiving the telemedicine medical service, or the patient's parent or legal guardian, must consent to the notification.(ii) For a telemedicine medical service provided to a child in a primary or secondary school-based setting, the notification must include a summary of the service, including:(II) prescribed or administered medications; and(III) patient instructions.(C) If a child receiving a telemedicine medical service in a primary or secondary school-based setting does not have a primary care physician or provider, the child's parent or legal guardian must be offered:(i) the information in subparagraph (B)(ii) of this paragraph; and(ii) a list of primary care physicians or providers from which to select the child's primary care physician or provider.(D) Telemedicine medical services provided in a school-based setting by a physician, even if the physician is not the patient's primary care physician or provider, are reimbursed if:(i) the physician is enrolled as a Medicaid provider;(ii) the patient is a child who receives the service in a primary or secondary school-based setting; and(iii) the parent or legal guardian of the patient provides consent before the service is provided.(6) Conditions for reimbursement applicable to telehealth services.(A) The provider must be enrolled in Texas Medicaid.(B) The covered services must be provided in compliance with Texas Occupations Code Chapter 111 and standards established by the respective licensing or certifying board of the professional providing the telehealth service.(C) Telehealth services must be designated for reimbursement by HHSC. Telehealth services designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with paragraph (3) of this section. Covered services that HHSC has determined are clinically effective and cost-effective when provided as a telehealth service can be found in the TMPPM.(7) Conditions for reimbursement applicable to both telemedicine medical services and telehealth services.(A) Preventive health visits under Texas Health Steps (THSteps), also known as Early and Periodic Screening, Diagnosis and Treatment program, are not reimbursed if performed using telemedicine medical services or telehealth services. Health care or treatment provided using telemedicine medical services or telehealth services after a THSteps preventive health visit for conditions identified during a THSteps preventive health visit may be reimbursed.(B) Documentation in the patient's medical record for a telemedicine medical service or a telehealth service must be the same as for a comparable in-person evaluation.(C) Providers of telemedicine medical services and telehealth services must maintain confidentiality of protected health information (PHI) as required by Title 42 Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, Texas Occupations Code Chapters 111 and 159, and other applicable federal and state law.(D) Providers of telemedicine medical services and telehealth services must comply with the requirements for authorized disclosure of PHI relating to patients in state mental health facilities and residents in state supported living centers, which are included in, but not limited to, 42 CFR Part 2, 45 CFR Parts 160 and 164, Texas Health and Safety Code § 611.004, and other applicable federal and state law.(E) Telemedicine medical services and telehealth services are reimbursed in accordance with Chapter 355 of this title (relating to Reimbursement Rates).1 Tex. Admin. Code § 354.1432
The provisions of this §354.1432 adopted to be effective May 1, 2013, 38 TexReg 1871; amended to be effective May 15, 2016, 41 TexReg 2737; amended by Texas Register, Volume 42, Number 11, March 17, 2017, TexReg 1245, eff. 3/21/2017; Amended by Texas Register, Volume 48, Number 03, January 20, 2023, TexReg 0210, eff. 1/23/2023