Texas May 2019 Fact Sheet

SB670 was reintroduced to improve upon telemedicine laws for Medicaid originally enacted in 2017 and is effective as of September 1, 2019.  This law aims to reduce costs, improve access, and eliminate restrictions that plague Texas.

Service Parity
  • “The commission shall ensure a managed care organization that contracts with the commission under Chapter 533 to provide health care services to Medicaid recipients does not deny reimbursement for a covered health care service or procedure delivered by a health care provider with whom the managed care organization contracts to a recipient as a telemedicine medical service or a telehealth service solely because the covered service or procedure is not provided through an in-person consultation.”
  • Service parity is implemented for Medicaid participants to receive telemedicine services
Payment Parity
  • “The commission shall ensure that Medicaid reimbursement is provided to a physician for a telemedicine medical service provided by the physician, even if the physician is not the patient’s primary care physician or provider…”
  • Pending certain requirements being met, this provision mandates payment parity.
Increasing Access
  • “The commission shall: explore opportunities to increase STAR Health program providers’ use of telemedicine medical services in medically underserved areas of this state.”
  • Historically medically underserved areas will be required to have the opportunity for telemedicine services to be explored.
Increased Technology Permissions
  • “The commission may not limit a physician ’s choice of platform for providing a telemedicine medical service or telehealth service by requiring that the physician use a particular platform to receive reimbursement for the service.”
  • Allows providers the opportunity to explore a variety of platforms and technologies including remote patient monitoring and store-and-forward.
Existing Laws – Private Payors

Currently, private payors in Texas cover patient service parity and include a general definition of the originating site. The law leaves it open for insurance companies to dictate their own policies regarding payment and therefore, payment parity currently is not required. Information regarding an insurance company’s individual policies may be found on their website, and possibly specific to certain types of plans. For more information on telemedicine reimbursement, including Medicare and private payors, please reference the Texas State Reimbursement Map.

Categories
Tags