The commission in coordination with the department and single source continuum contractors shall establish guidelines in the STAR Health program to improve the use of telehealth services to provide and enhance mental health and behavioral health care for children placed in the managing conservatorship of the state.
SOURCE: Human Resources Code Title 2, Section D, Chapter 42, 42.260. (Accessed Dec. 2022).
Children’s Health Insurance Program
Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.
SOURCE: TX Govt. Code Sec. 531.02162, (Accessed Dec. 2022).
Procedure codes that are benefits for distant site providers when billed with the 95 modifier (synchronous audiovisual technology) are included in the individual TMPPM handbooks. Procedure codes that indicate remote (telehealth service) delivery in the description do not need to be billed with the 95 modifier.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 and 12 (Dec. 2022). (Accessed Dec. 2022).
Providers of telehealth or telemedicine must maintain the confidentiality of protected health information (PHI) as required by Federal Register 42, Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, Chapters 111 and 159 of the Texas Occupations Code, and other applicable federal and state law.
See provider manual for other information security and documentation requirements.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4. (Dec. 2022). (Accessed Dec. 2022).
Fees for telemedicine, telehealth and home telemonitoring services are adjusted within available funding.
SOURCE: TX Admin Code. 355.7001(g). (Accessed Dec. 2022).
A valid practitioner-patient relationship must exist between the distant site provider and the patient receiving telemedicine services. A valid practitioner-patient relationship exists between the distant site provider and the patient if:
The distant site provider meets the same standard of care required for and in-person service.
The relationship can be established through:
- A prior in-person service.
- A prior telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).
- The current telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).
The valid practitioner-patient relationship can be established through a call coverage agreement established in accordance with Texas Medical Board (TMB) administrative rules in 22 TAC §177.20.
A distant site provider should provide patients who receive a telemedicine service with guidance on the appropriate follow-up care.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Dec. 2022). (Accessed Dec. 2022).
Prescriptions Generated from a Telemedicine Medical Service
A distant site provider may issue a valid prescription as part of a telemedicine service. An electronic prescription (e-script) may be used as permitted by applicable federal and state statues and rules.
The same standards that apply for the issuance of a prescription during an in-person setting apply to prescriptions issued by a distant site provider.. The prescribing physician must be licensed in Texas. If the prescription is for a controlled substance, the prescribing physician must have a current valid U.S. Drug Enforcement Administration (DEA) registration number.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9 (Dec. 2022). (Accessed Dec. 2022).
Radiation Therapy Services
Teletherapy is covered by Texas Medicaid once per day in an outpatient hospital setting.
SOURCE: TX Medicaid Inpatient and Outpatient Hospital Services Handbook, p. 61 (Dec. 2022). (Accessed Dec. 2022).
All client health information generated or utilized during a telehealth or telemedicine service must be stored by the distant site provider in a client health record. If the distant site provider stores the patient health information in an electronic health record, the provider should use software that complies with Health Insurance Portability and Accountability Act (HIPAA) confidentiality and data encryption requirements, as well as with the United States Department of Health and Human Services (HHS) rules implementing HIPAA.
Medical records must be maintained for all telemedicine services.
Documentation for a service provided via telemedicine must be the same as for a comparable in-person 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
Unless the telemedicine services are rendered to a child in a school-based setting, distant site providers of mental health services are not required to provide the patient’s primary care provider with a treatment summary. For telemedicine provided to a child in a school-based setting, a notification provided by the telemedicine physician to the child’s primary care provider must include a summary of the service, exam findings, prescribed or administered medications, and patient instructions.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5 & 11. (Dec. 2022). (Accessed Dec. 2022).
Screening activities for crisis stabilization units, including triage and determining if the individual’s need is urgent can be conducted in person or through telehealth.
SOURCE: TX Admin Code, Title 26, Part 1, Ch. 306, Subchapter B, Sec. 306.45, (Accessed Dec. 2022).
A patient can be admitted on a voluntary admission only if a physician has conducted or consulted with a physician who has conducted, either in person or through telemedicine medical services, an admission examination within 72 hours before or 24 hours after admission.
SOURCE: TX Admin Code, Title 26, Part 1, Ch. 568, Subchapter B, Sec. 568.22, (Accessed Dec. 2022).
The commission shall establish policies and procedures to improve 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 under the program.
To the extent permitted by federal law, the executive commissioner by rule shall establish policies and procedures that allow a Medicaid managed care organization to conduct assessments and provide care coordination services using telecommunications or information technology. See rule for details.
SOURCE: TX Statute Sec. 533.039, (Accessed Dec. 2022).
In the event of a state of disaster declared pursuant to Texas Government Code §418.014 for statewide disasters or limited areas subject to the declaration, the flexibilities listed under subsection (c) of this section will be available until the state of disaster is terminated. Telehealth and telemedicine have the same meaning as the terms telehealth services and telemedicine medical services defined in §111.001 of the Texas Occupations Code (relating to Definitions).
See rule for additional details.
SOURCE: TX Admin Code Title 26, Part 1, Ch. 306, Subchapter X, 306.1251. (Accessed Dec 2022).