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Telemedicine regulations in Texas

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Telemedicine just makes sense in Texas.

With a large rural population and a shortage of providers across a range of specialties, legislators have looked to telehealth to close the gap in access to care. Texas now has among the most detailed regulation for telemedicine in the country – and the majority of it is quite favorable for healthcare providers looking to offer remote care to their patients.

Telemedicine regulations in Texas

Overview

It is important to note that telemedicine is simply another mode of delivering care to patients. It is not intended to replace in-person care but is instead used to optimize the use of provider resources in order to increase patient access to care. Physicians and other healthcare providers practicing telemedicine should be held to the same legal guidelines as when providing in-person care.

Establishing a patient-physician relationship

This is currently being highly debated by the Texas Medical Board and a telemedicine service, Teledoc. As it stands, a patient-physician relationship may be established through telemedicine without a prior in-person physical examination. However, this may soon change.

Eligible providers

According to Tile 1 of the Texas Administrative Code, all healthcare professionals that are licensed to practice medicine in Texas under Title 3, Subtitle B of the Occupations Code are permitted to provide telemedicine services. Furthermore, healthcare professionals acting under physician delegation and supervision may also practice telemedicine.

Patient eligibility

There are three things that determine who is eligible to receive telehealth care: 1) the physician must determine that a patient is eligible for this form of care by justifying that a physical exam is not necessary; 2) the patient must provide either verbal or written consent to receive care; 3) the patient must be at an eligible originating site if being reimbursed through Medicaid.

Prescribing limitations

According to Title 22 of the Texas Administrative Code, scheduled drugs may not be prescribed over telemedicine in Texas. Currently, the Texas Medical Board is determining whether an in-person patient relationship must be established prior to prescribing drugs over telemedicine. As of June 16, 2015, an initial in-person visit is not necessary.

Getting Reimbursed for Telemedicine in Texas

Private payer reimbursement for telemedicine in Texas

“Telemedicine” definition

Telemedicine is “the use of health care information exchanged from one site to another via electronic communications … for the purpose of improving patient care, treatment, and services.”

“Telemedicine medical service” definition

A service that “requires the use of advanced telecommunications technology, other than telephone or facsimile technology.”

Live video reimbursement

Section 1455 of the Texas Insurance Code requires that private payers reimburse physicians for telemedicine services, including live video conferencing.

Store-and-forward reimbursement

Because store-and-forward falls under the definition of “telemedicine medical services,” in Texas, private payers must reimburse for it.

Phone and fax reimbursement

Currently, no legislation exists regarding the reimbursement of care delivered by email, phone or fax. Insurance plans may reimburse for this form of care delivery, but it is not mandated.

Medicaid reimbursement for telemedicine in Texas

Videoconferencing reimbursement

Reimbursement is available for consultations, office or outpatient visits, psychiatric diagnostic interviews, pharmacologic management, and psychotherapy.

Store-and-forward reimbursement

Texas Medicaid excludes store-and-forward from the definition of telehealth services. It is therefore not reimbursable through Medicaid.

Remote patient monitoring

Texas Medicaid will reimburse for home tele-monitoring in the same manner as other services provided by a home health agency.

Reimbursement for phone and fax

Texas Medicaid provides no reimbursement for care delivered over the phone or through fax. It also does not reimburse for email communication or chart review.

Site / transmission fee

Medicaid reimburses a facility fee to the qualified originating site where the remote patient is located.

Eligible providers

Eligible distant site providers are as follows: Physicians, Certified Nurse Specialists, Nurse Practitioners, Physician Assistants and Certified Nurse Midwives.

Originating (patient) site requirements

Eligible originating (patient) sites are as follows: established medical sites, mental health facilities, and state supported living centers.

Frequently Asked Questions (FAQ)

As of today, providers are able to deliver telemedicine services to patients they have not previously seen in person. However, there is an ongoing debate between the Texas Medical Board and the telehealth community as to whether or not this physician-patient relationship should be able to be established remotely. Stay tuned!

According to the Texas Medical Board, patients must be seen in person at least once per year if they are going to receive ongoing remote care via telemedicine.

Yes, the Texas Medical Board holds providers to the same standard of care for remote consultations as it does for in-person visits.

Yes! The Medicare Chronic Care Management (CCM) program reimburses providers $42 per month for delivering remote care to patients with two or more chronic conditions

Medicaid reimburses the same amount for telemedicine services as it does when the service is delivered in person. Private payers vary with respect to reimbursement rates, but we have seen the vast majority reimbursement at equivalent rates to in-person visits as well.

Check out our telemedicine product page. There you’ll learn about the different features of telehealth software and solutions

Telehealth terms to know

Store-and-forward

Store-and-forward refers to the electronic transmission of medical information, such as digital images, documents, and pre-recorded videos through secure messaging.

mHealth

mHealth stands for mobile health. mHealth involves transmitting digital health information from patient to provider or vice versa. It typically involves the use of smartphones or tablets and downloadable health apps.

Cross-state licensing

Cross-state licensing refers legislation that allows physicians who aren’t fully licensed in a neighboring state to provide telemedicine care to patients in that neighboring state.

Originating site

Originating site refers to the location of the patient during a telemedicine encounter. This site can be the patient’s home for private payer reimbursement, but must be a qualified healthcare facility for Texas Medicaid reimbursement.

Distant site

Distant site refers to the location of the healthcare provider during a telemedicine encounter. As long as the provider is licensed in the State of Texas, they may be physically located anywhere in the world!

Remote patient monitoring

Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from individuals. It is then electronically transmitted to a health care provider in a different location for assessment.

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