In Texas, where 200 counties are considered medically underserved and more than a dozen have only one primary care doctor, there is an important role for telemedicine. The Texas Medical Board (TMB) recently introduced a new set of regulations in an attempt to balance the need to expand access to healthcare and the need to ensure quality patient outcomes. However, Teladoc, a well-known telemedicine platform, has filed a lawsuit to prevent the regulations, which they claim are too restrictive and violate federal antitrust laws, from going into effect.
Keeping up with changing telemedicine regulations can be a chore. To help, we’ve pulled together nine frequently asked questions about the new and current telemedicine regulations in Texas.
What do the new regulations change?
For the purposes of telemedicine, the new regulations stipulate that the patient-physician relationship can be established in the following ways:
- Via an in-person physical exam that is repeated annually
- Through telemedicine if the patient is at an established medical site
- Through telemedicine if the patient is referred to physician by another provider that established a patient-physician relationship
This differs from the current regulations under which providers are permitted to evaluate and treat patients without conducting an in-person physical examination, or otherwise having another health care worker in the same location as the patient.
Are the new regulations currently in effect?
No. Although the rule was set to go into effect on June 3, Judge Robert Pitman granted an injunction to Teladoc. The injunction will continue until the federal antitrust law of Teladoc against the TMB is resolved.
Who can provide care via telemedicine?
The following practitioners can legally provide care via telemedicine in Texas:
- Clinical Nurse Specialists
- Nurse Practitioners
- Physicians Assistants
- Certified Nurse Midwifes
- Licensed Professional Counselors
- Licensed Marriage and Family Therapists
- Licensed Clinical Social Workers
- Licensed Psychological Associates
- Provisionally Licensed Psychologists
- Licensed Dieticians
If practitioners are providing remote care to patients through the new Medicare Chronic Care Management Program, additional providers like Registered Nurses and MAs may also provide care.
Who can receive care via telemedicine?
A patient can receive care via telemedicine if any of the following apply:
- The patient is at a qualified medical site
- The patient is located at home if the appropriate physician-patient relationship has been established
If no physician-patient relationship has been established, a patient may receive care from home if “sufficient diagnostic equipment and a trained medical professional,” are present.
What qualifies as “telemedicine”?
A “telemedicine medical service” as defined by the Texas Medical Board, requires providers to see and hear patients in real time in order to be reimbursed. Email, store-and-forward, phone calls and text communication do not qualify as telemedicine care and are therefore not reimbursable forms of communication.
Are there any care delivery limitations?
The board has specified only a few limitations on the type of care that can be delivered via telemedicine. Practitioners may not:
- Provide a diagnosis to a new patient unless an appropriate patient-physician relationship has been established
- Provide ongoing medical treatment to a patient with a new chronic condition unless a timely in-person evaluation is conducted after initial diagnosis
- Prescribe scheduled drugs for chronic pain treatment
Are private payers required to reimburse for telemedicine?
Yes. Texas is progressive when it comes to private payer reimbursement. As outlined in Chapter 1455 of the Texas Statutes Insurance Code, private payers are mandated to reimburse for telemedicine appointments. (The exact legislation can be found here.)
Can Medicare & Medicaid patients be treated via telemedicine?
Currently, Centers for Medicare & Medicaid Services (CMS) does not reimburse for telemedicine if the patient is at home unless a patient is being seen through the new Medicare Chronic Care Management Program. Patients must be at the following locations in order for physicians to receive reimbursement:
- Established Medical Site
- State Mental Health Facility
- State-Supported Living Center
What are the requirements to receive reimbursement?
There are, of course, a few requirements that must be met in order to be fully reimbursable by either CMS or private payers.
- Real-time video and audio must be included
- HIPAA standards must be met
- Audio and video quality must be similar to in-person
- Archival and retrieval of client records must be possible
We’ll keep an eye on the litigation regarding the new telemedicine regulations in Texas and let you know if they are allowed to go into effect. Meanwhile, for the average practitioner who has established patients, telemedicine is a viable option for providing convenient, remote follow-up care in Texas.