FEATURED, FROM LEFT: Rep. Tom Oliverson, R-Houston, Rep. Four Price, R-Amarillo, and Rep. Trent Ashby, R-Lufkin, participate in a news conference in the Speakers Committee Room at the Texas Capitol on Wednesday, April 7, 2021. Price was the author of House Bill 4, which will provide delivery of health care services under Medicaid and other public benefit programs by using telecommunication or information technology. Rio Grande Valley lawmakers were part of the leadership team which helped Price pass House Bill 4 into law. DHR Health, headquartered in Edinburg, supported House Bill 4.
Photograph By HOUSE PHOTOGRAPHY
Telemedicine bill to improve access to health care – authored by Rep. Guillén, coauthored by Rep. Canales, Rep. Guerra, and Rep. Martínez, cosponsored by Sen. Hinojosa and supported by DHR Health – signed into law by Gov. Abbott
House Bill 4, authored by Rep. Four Price, R-Amarillo – whose leadership team on the legislation included Rio Grande Valley state lawmakers – will 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.
The legislation, which was signed into law by Gov. Greg Abbott on Tuesday, June 15, 2021, also was supported by DHR Health. The law went into effect on Tuesday, June 15, 2021.
Legislation is a proposed or enacted law or group of laws.
Telemedicine is a general term that covers all of the ways a person and their 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”).
Telemedicine is the use of telecommunications technology and information technologies to provide remote clinical services to patients. Physicians use telemedicine for the transmission of digital imaging, video consultations, and remote medical diagnosis.
Telehealth is the utilization of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health education, public health and health administration.”
Unlike telemedicine, telehealth also covers non-clinical events like administrative meetings, continuing medical education (CME), and physician training. Telehealth is not a specific service, but a collection of methods to improve patient care and education delivery.
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.
“Healthcare matters regardless of where one resides in Texas. Improving the health outcomes of Texans is always one of my top legislative priorities,” said Price. “It is a privilege to continue to work on practical solutions to better the health of Texas patients.”
As a result of House Bill 4, the state will be able to provide delivery of health care services under Medicaid and other public benefit programs by using telecommunication or information technology.
“Now we are extending the benefits to rural health clinics as well. So, whether you’re a rural health clinic, FQHC (Federally Qualified Health Center), a private provider, Medicaid, we really extended the benefits of TeleMedicine and TeleHealth and through this bill and through bills we’ve previously passed,” said Price.
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.
As the primary author of House Bill 4, Price was the legislator who filed the bill and guided 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 Guillén, D-Rio Grande City, was one of four joint authors 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, Rep. R.D. “Bobby” Guerra, D-McAllen, who also serves as Vice-Chair, House Committee on Public Health, and Rep. Armando Martínez, D-Weslaco, were coauthors of House Bill 4.
“This leveraging of technology has the potential of continuing to improve patient outcomes by having the patient seen and receive treatment in a more timely manner,” said Canales. “Also, the utilization of telemedicine provides greater access to medical specialists statewide that who don’t necessarily exist in our local communities.”
As coauthors, Canales, Guerra and Martínez were legislators who authorized Price to join in the authorship of the measure. A coauthor must be a member of the chamber in which the bill was filed.
Sen. Juan “Chuy” Hinojosa, D-McAllen, was a cosponsor of House Bill 4.
As a cosponsor, Hinojosa was the legislator who joined with the primary sponsor – Sen. Dawn Buckingham MD, R-Lakeway – to help guide House Bill 4 through the legislative process in the Senate.
As a sponsor of the bill, Buckingham was the primary senator who guided House Bill 4 through the Senate after House Bill 4 had passed the House of Representatives.
Telemedicine is a subject that Price said that he and his staff have worked on for several legislative sessions and gained much in popularity with patients and physicians and other healthcare professionals, especially since the onset of COVID-19.
House Bill 4 makes permanent several key state waivers, authorized by Abbott during the pandemic last year, that will continue to allow medical services to be provided by existing Texas Health and Human Services Commission programs 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, according to supporters of House Bill 4.
A waiver is when a person, government, or organization agrees to give up a right or says that people do not have to obey a particular rule or law.
Additionally, House Bill 4 addresses gaps related to the use of technology in delivering services and information to many Texas patients.
A more detailed version of House Bill 4’s requirements is included in a bill analysis produced by the House Research Organization, which is the nonpartisan research arm of the House of Representatives.
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.
Highlights of the House Research Organization’s bill analysis on House Bill 4 follow:
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.
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.
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 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).
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.
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.
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).