Consent Requirements

A parent or legal guardian must provide written or verbal consent to the distant site provider to allow any other individual to be physically present in the distant or patient site environment during a telehealth or telemedicine service with a child.

An adult client must also provide written or verbal consent to the distant site provider to allow any other individual to be physically present in the distant or patient site environment during a telehealth or telemedicine service.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4-5, (Jan. 2026). (Accessed Jan. 2026).

A parent or responsible adult must provide written or verbal consent to the distant site provider to allow any other individual, other than the distant site provider, the patient site presenter, or a representative of the distant site provider or patient site presenter, to be physically present in the distant or patient site environment during the visit with a child.

An adult client must also provide written or verbal consent to the distant site provider to allow any other individual, other than the distant site provider, the patient site presenter, or a representative of the distant site provider or patient site presenter, to be physically present in the distant or patient site environment during the visit.

Documentation of the written or verbal consent must be maintained in the client’s medical record.

SOURCE:  TX Medicaid CSHCN Telecommunication Services Handbook, p. 4 (Dec. 2025) (Accessed Jan. 2026).

Provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral health service through a synchronous audio-only technology platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.

The distant site provider must obtain informed consent to treatment from the patient, patient’s parent, or the patient’s guardian prior to rendering a telemedicine medical service.

The distant site provider must obtain informed consent to treatment from the patient, patient’s parent or the patient’s legal guardian prior to rendering a telehealth service.

If a patient has a primary care provider who is not the distant site provider and the patient or their parent or legal guardian provides consent to a release of information, a distant site provider must provide the patient’s primary care provider with the following information:

• A medical record or report with an explanation of the treatment provided by the distant site provider
• The distant site provider’s evaluation, analysis, or diagnosis of the patient

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6, 8, 11 & 12 (Jan. 2026). (Accessed Jan. 2026).

School-Based Setting

The parent or legal guardian of the client provides consent before the service is provided.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10 (Jan. 2026). (Accessed Jan. 2026).

Conditions for telemedicine medical services provided in a primary or secondary school-based setting.

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.

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.

• The patient receiving the telemedicine medical service, or the patient’s parent or legal guardian, must consent to the notification.
• 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:
  • exam findings;
  • prescribed or administered medications; and
  • patient instructions.

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:

• the information in subparagraph (B)(ii) of this paragraph; and
• a list of primary care physicians or providers from which to select the child’s primary care physician or provider.

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:

• the physician is enrolled as a Medicaid provider;
• the patient is a child who receives the service in a primary or secondary school-based setting; and
• the parent or legal guardian of the patient provides consent before the service is provided.

SOURCE: TX Admin Code Title 1, Sec. 354.1432, (Accessed Aug. 2025).

Physical Therapy, Occupational Therapy, and Speech Therapy

The provider should obtain informed consent for treatment from the patient, patient’s parent, or the patient’s legal guardian prior to rendering a telehealth service. Verbal consent is permissible and should be documented in the client’s medical record.

SOURCE: TX Medicaid Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook pg. 9 (Aug. 2025). (Accessed Aug. 2025).

Managed Care (also applies to START Kids and STAR Health)

When an MCO conducts a change in condition assessment using audio-visual communication, verbal consent must be obtained and documented, and a HIPAA-compliant audio-visual communication product must be used.

If verbal consent for audio-visual communication is not received, the MCO must use in-person communication.

The MCO must inform members who utilize audio-visual communication for change in condition assessments that the member’s services will be subject to the following:

• The MCO must monitor services for fraud, waste, and abuse.
• The MCO must determine whether additional social services or supports are needed.
• The MCO must ensure that verbal consent to use telecommunications is documented in writing.

See rules Sec. 1604-1506 for additional requirements for each program.

SOURCE: TX Admin Code, Title 1, Part 15, Sec. 353.1503, (Accessed Jan. 2026).

Teledentistry

The client or parent/guardian must agree to receiving the teledentistry service.

Lidda Service Coordination

Audio-only–A synchronous interactive, two-way audio communication that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA). Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.

Audio-visual–A synchronous interactive, two-way audio and video communication that conforms to privacy requirements under HIPAA. Audio-visual does not include audio-only or in-person communication.

In-person (or in person)–Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.

A service coordinator may meet with an individual via audio-only or audio-visual communication for a comprehensive encounter:

• in a month when minimum in-person contact in accordance with subsection (h) of this section is not required; and
• if, before the service coordinator conducts the meeting using audio-only or audio-visual communication, the service coordinator obtains:
  • the written consent of the individual or LAR, which may only be effective for up to a year; or
  • the individual’s or LAR’s verbal consent, which may only be effective for that encounter, and documents the verbal consent in the individual’s record.

If a service coordinator does not obtain an individual’s or LAR’s written or verbal consent required by subsection (i)(2)(A) or (B) of this section respectively, the service coordinator must:

• • • document the individual’s or LAR’s refusal to receive a comprehensive encounter via audio-only or audio-visual communication in the individual’s record; and
    • conduct the comprehensive encounter in person.

SOURCE:  TX Admin Code, Title 26, Part 1, Sec. 331.5, (Accessed Jan. 2026).