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Telemedicine bill to improve access to health care – authored by Rep. Guillén, coauthored by Rep. Canales, Rep. Guerra, and Rep. Martínez – and supported by DHR Health approved by House of Representatives - Titans of the Texas Legislature

FEATURED, FROM LEFT: Achael P. Patel, MD, Neuroscience, DHR Health; Gustavo Ramos, MD, Neuroscience, DHR Health; Rep. Terry Canales, D-Edinburg; Carlos Cárdenas, MD, Chair, Board of Managers, DHR Health, and Gastroenterology; Saroja Viswamitra, MD, DHR Health Rehabilitation Hospital; Juan Padilla, MD, Neuroscience, DHR Health; and Patrick T. Noonan, Jr., MD, Neurointerventional Radiology, DHR Health. This image was taken on February 1, 2020, at the DHR Health Neuroscience Institute.

Photograph Courtesy DHR HEALTH FACEBOOK

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Telemedicine bill to improve access to health care – authored by Rep. Guillén, coauthored by Rep. Canales, Rep. Guerra, and Rep. Martínez  – and supported by DHR Health approved by House of Representatives

By DAVID A. DÍAZ
[email protected]

Legislation that would improve access to health care for Texans, especially those in rural and medically underserved areas, by allowing multiple services to be provided through telemedicine, telehealth, telecommunications, or other information technology, on Thursday, April 15, 2021, was approved by the House of Representatives.

Rep. Four Price, R-Amarillo, is the author of House Bill 4.

Legislation is a proposed or enacted law or group of laws.

Telemedicine is a general term that covers all of the ways you and your doctor can use technology to communicate without being in the same room. It includes phone calls, video chats, emails, and text messages. People also call it telehealth, digital medicine, e-health, or m-health (for “mobile”).

https://www.webmd.com/lung/how-does-telemedicine-work#1

By increasing access to telemedicine and telehealth, the bill would ensure continuity of care and could generate cost-savings for families and the state. Providing telemedicine, telehealth, and telecommunication services could help families save time and money that they might otherwise spend traveling to appointments or finding child care. 

Elderly and medically fragile individuals, who often have limited mobility, also would benefit from virtual appointments. Allowing services like preventative health and wellness and care coordination to be provided through telemedicine and telehealth could help practitioners improve “no-show” appointment rates, identify patients’ health issues early, efficiently refer a patient to a specialist, and help decrease emergency room visits.

https://hro.house.texas.gov/pdf/ba87r/hb0004.pdf#navpanes=0

A bill is a type of legislative measure that requires passage by both chambers (House of Representatives and the Senate) of the Legislature and action by the governor in order to become effective. A bill is the primary means used to create and change the laws of the state. “Bill” types include Senate and House bills, Senate and House joint resolutions, Senate and House concurrent resolutions, and Senate and House resolutions.

“Healthcare matters to every person and their family regardless of where in Texas they reside. Improving the health outcomes of Texans is always one of my top legislative priorities. It is a privilege to continue to work on practical solutions to better the health of Texas patients,” said Price.

House Bill 4 is among a number of bills authored by Price in his continued legislative efforts to improve healthcare access and the delivery of medical services in Texas. Price’s healthcare bill package this legislative session also includes House Bill 2668 to ensure that patients are the ones who would continue to obtain the benefit from pharmaceutical coupons and House Bill 2595 to strengthen Texas’ mental health parity law.

As author of House Bill 4, Price is the legislator who filed the bill and is guiding it through the legislative process.

Filed is used to refer to a measure that has been introduced into the legislative process and given a number.

Rep. Ryan Guillen, D-Rio Grande City, is a joint author of House Bill 4.

In the House of Representatives, a joint author is a member authorized by the primary author of a bill or resolution to join in the authorship of the measure and have his or her name shown following the primary author’s name on official printings of the measure, on calendars, and in the journal. The primary author may authorize up to four joint authors.

Rep. Terry Canales, D-Edinburg, who also serves as Chair, House Committee on Transportation, and Rep. R.D. “Bobby” Guerra, D-McAllen, who also serves as Vice-Chair, House Committee on Public Health, and Rep. Armando “Mando” Martínez, D-Weslaco, are coauthors of Price’s bill.

As coauthors, Canales, Guerra, and Martínez are legislators authorized by the primary author of a bill or resolution to join in the authorship of the measure. A coauthor must be a member of the chamber in which the bill was filed

An identical bill, known as Senate Bill 412, authored by Sen. Dawn Buckingham, MD, R-Lakeway, features Sen. Juan “Chuy” Hinojosa, D-McAllen, as a coauthor.

Both House Bill 4  and Senate Bill 412 are waiting to be scheduled for a public hearing before the Senate Committee on Health and Human Services.

Roberto Haddad, Vice President and Counsel for Government Affairs and Policy, DHR Health, attended the public hearing on the legislation – House Bill 4 by Price – held on Wednesday, March 31, 2021, before the House Committee on Public Health, and registered his support for the measure on behalf of DHR Health. 

Anchored in southwest Edinburg, with a growing presence in neighboring McAllen, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.

DHR Health is the flagship teaching hospital for the University of Texas Rio Grande Valley School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 70 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.

Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV  Med”) own and operate a 519 licensed bed general acute care hospital located at 5501 South McColl in Edinburg. The facility is one of the largest physician-owned facilities in the United States that began as an ambulatory surgery center in 1997.

DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing presence in McAllen, including its South Campus located immediately across Owassa Road in northeast McAllen.

More details are provided in a bill analysis of House Bill 4.

A  bill analysis is a document prepared for all bills and joint resolutions reported out of committee. A bill analysis may include background information on the measure, a statement of purpose or intent, and an analysis of the content of the measure.

According to the bill analysis of House Bill 4:

• The State of Texas, at the beginning of the COVID-19 pandemic, temporarily granted waivers to allow medical services provided by existing Texas Health and Human Services Commission programs to be delivered to patients via telemedicine/telehealth;

• These waivers proved beneficial to patients in the delivery of timely healthcare and have also shown to be a cost-effective tool in the delivery of healthcare. This leveraging of technology has the potential of continuing to improve patient outcomes by having the patient seen and receiving treatment in a timelier manner. Also, the utilization of telemedicine provides greater access to medical specialists statewide; and

• However, the waivers are set to soon expire. House Bill 4 seeks to make the waivers permanent. Additionally, House Bill 4 addresses gaps related to the use of technology in delivering services and information to patients. 

House Bill 4 proposes to make permanent the emergency waivers that have been temporarily granted during the COVID-19 pandemic for the delivery of certain established adult and child healthcare programs by healthcare providers. 

These waivers proved beneficial to patients in the delivery of timely healthcare and have also shown to be a cost-effective tool in the delivery of healthcare. This leveraging of technology has the potential of continuing to improve patient outcomes by having the patient seen and receiving treatment in a timelier manner. Also, the utilization of telemedicine provides greater access to medical specialists statewide. 

However, the waivers are set to soon expire. House Bill 4 seeks to make the waivers permanent. Additionally, House Bill 4 addresses gaps related to the use of technology in delivering services and information to patients. 

A more detailed version of the bill analysis is included in a report produced by the House Research Organization, which is the nonpartisan research arm of the House of Representatives.

https://hro.house.texas.gov/About.aspx#about

Highlights of the House Research Organization’s report on House Bill 4 follow:

Background

Occupations Code sec. 111.001 defines “telehealth service” and “telemedicine medical service” as health care provided through telecommunication technology by a practitioner in a different location from the patient receiving the care. In telemedicine, the practitioner in charge of delivering the care is a physician, while in telehealth it is another health professional who is not under a physician’s supervision or delegation authority.

Government Code sec. 531.02164 limits home telemonitoring services under Medicaid only to persons who are diagnosed with at least one specified health condition, including pregnancy, diabetes, heart disease, cancer, and mental illness, and who exhibit at least two specified risk factors.

Sec. 533.0061 establishes minimum standards to ensure a managed care organization provides Medicaid recipients sufficient access to certain services, such as primary and specialty care and nursing and therapy services, among others.

Sec. 531.0216(i) authorizes a federally qualified health center to be reimbursed for the originating site facility fee and/or the distant site practitioner fee for a covered telemedicine or telehealth service provided to a Medicaid recipient. This requirement applies only if the Legislature appropriates money for this purpose. Otherwise, the executive commissioner of the Health and Human Services Commission may implement this provision using other available funds appropriated for that purpose.

Health and Safety Code sec. 62.1571 requires a Children’s Health Insurance Program health plan provider to allow a child’s covered benefits to be provided through telemedicine medical services.

House Bill 4 would require the executive commissioner of the Health and Human Services Commission (HHSC) to establish policies, procedures, and otherwise ensure certain health care services could be provided through telehealth, telemedicine, telecommunications, or other information technology.
Telehealth and telemedicine services. 

By January 1, 2022, the Health and Human Services Commission would have to ensure that enrollees in Medicaid, the Children’s Health Insurance Program (CHIP), and other specified public benefits programs had the option to receive certain services as telemedicine or telehealth services, or otherwise use telecommunications or information technology, regardless of whether the services were provided through managed care or another delivery model. 

This provision would apply to the following services:

• Preventative health and wellness;
• Case management, including targeted case management;
• Certain behavioral health services;
• Occupational, physical, and speech therapy;
• Nutritional counseling; and
• Assessments, including nursing assessments under certain Section 1915(c) home and community-based services waiver programs.

The Health and Human Services Commission would have to ensure the required service options were provided only if permitted by federal law and if the commission determined it was cost-effective and clinically effective.

Audio-only services 

Under House Bill 4, the Health and Human Services Commission by rule would have to develop and implement a system to ensure behavioral health services could be provided using audio-only technology to enrollees in Medicaid, CHIP, and other specified public benefits programs. The executive commissioner of the Health and Human Services Commission by rule could provide audio-only technology through non-behavioral health services if the executive commissioner determined that using that technology would be cost-effective and clinically effective.

The Health and Human Services Commission would have to implement these audio-only provisions by January 1, 2022.

Medicaid managed care

House Bill 4 would require the Health and Human Services Commission to establish policies and procedures for improving access to care under the Medicaid managed care program by encouraging the use of telehealth services, telemedicine medical services, home telemonitoring services, and other telecommunications or information technology.

Reimbursement for home telemonitoring services

House Bill 4 would allow a Medicaid managed care organization (MCO) to reimburse providers for home telemonitoring services provided to persons and in circumstances other than those specified in Government Code sec. 531.02164. The MCO would have to consider whether the reimbursement for the service would be cost-effective and providing the service would be clinically effective.

Text messaging 

By January 1, 2022, the executive commissioner would have to adopt and publish guidelines for MCOs on how they could communicate by text message with enrollees, which would include standardized consent language.

Home and community-based services

To the extent permitted by federal law, the Health and Human Services Commission would have to establish policies and procedures that allowed a Medicaid MCO to conduct assessments of and provide care coordination services to recipients receiving home and community-based services using other telecommunication or technology if those methods were deemed appropriate by the MCO or the Health and Human Services Commission. 

House Bill 4 also would permit telecommunication and information technology for the assessments and care coordination services if requested by the recipient, or if an in-person assessment or activity would not be feasible because of an emergency or state of disaster, including a public health emergency or natural disaster.

The Health and Human Services Commission would be required to determine categories of recipients of home and community-based services who must receive in-person visits. Except when not feasible due to a public health emergency or disaster, the bill would require an MCO to conduct for a recipient of home and community-based services at least one in-person visit with the recipient, and additional visits if necessary, as determined by the MCO.

If an MCO assessed or provided care coordination services to a recipient using telecommunications or information technology, the MCO would have to monitor the provided health care services for evidence of fraud, waste, and abuse and determine whether additional social services or supports were needed. The Health and Human Services Commission would have to allow a recipient receiving certain services using telecommunication and information technology to consent verbally instead of in writing.

Provider access standards 

House Bill 4 would require provider access standards for Medicaid managed care to include consideration of and the availability of telehealth and telemedicine services within an MCO’s provider network.

Reimbursement for rural health clinics 

House Bill 4 would establish that a rural health clinic as defined by 42 U.S.C. sec. 1396d(l)(1) was eligible for reimbursement for certain fees under Government Code sec. 531.0216(i).

Other provisions 

House Bill 4 would make conforming changes under Health and Safety Code sec. 62.1571 by requiring telehealth services also be offered as covered benefits to CHIP enrollees.

House Bill 4 would take immediate effect if finally passed by a two-thirds record vote of the membership of each house. Otherwise, it would take effect September 1, 2021.

Supporters say

House Bill 4 would improve access to health care for Texans, especially those in rural and medically underserved areas, by allowing multiple services to be provided through telemedicine, telehealth, telecommunications, or other information technology.

During the COVID-19 pandemic, demand for telehealth and telemedicine services increased due to heightened mental health needs exacerbated by illness, fear, and social and economic hardship. In response, many health care providers quickly shifted from providing in-person visits to using telehealth and telemedicine and other remote technology tools. 

House Bill 4 would preserve telehealth and telemedicine efforts made in the pandemic to address provider shortages and provide Texans access to virtual health care services beyond the public health emergency. House Bill 4 also would establish sufficient protections for Texans by requiring the Health and Human Services Commission to determine whether providing virtual services would be cost-effective and clinically effective.

By increasing access to telemedicine and telehealth, the bill would ensure continuity of care and could generate cost-savings for families and the state. Providing telemedicine, telehealth, and telecommunication services could help families save time and money that they might otherwise spend traveling to appointments or finding child care. 

Elderly and medically fragile individuals, who often have limited mobility, also would benefit from virtual appointments. Allowing services like preventative health and wellness and care coordination to be provided through telemedicine and telehealth could help practitioners improve “no-show” appointment rates, identify patients’ health issues early, efficiently refer a patient to a specialist, and help decrease emergency room visits.

Allowing audio-only benefits for behavioral health services would address a gap in health care services and create flexibility for patients and providers. Many Texans do not have internet access or smartphones, making audio-only their most viable option. Additionally, an audio-only option could help reduce stigma for patients seeking mental health and substance use disorder services.

Critics say

House Bill 4 could reduce the quality of health care by allowing audio-only benefits to be provided for certain behavioral health services. A health practitioner may not be able to accurately assess a patient through audio-only technology.

While House Bill 4 makes significant strides to advance telehealth and telemedicine services for Texans beyond the pandemic, the bill should require health care professionals’ reimbursement rates for telemedicine and telehealth services to be the same rate as those for in-person services. Providing payment parity would help encourage more providers to use telehealth and telemedicine services.

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For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).

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