Tex.
Gov't Code Section 548.0055
Promotion and Support of Medical Home and Care Coordination
(a)
The commission shall ensure that a Medicaid managed care organization ensures that using telemedicine medical services, teledentistry dental services, or telehealth services promotes and supports patient-centered medical homes by allowing a Medicaid recipient to receive a telemedicine medical service, teledentistry dental service, or telehealth service from a provider other than the recipient’s primary care physician or provider, except as provided by Section 548.0202 (Medicaid Reimbursement for Telemedicine Medical Services Provided in School-based Setting)(b), only if:(1)
the service is provided in accordance with the law and contract requirements applicable to providing the same health care service in an in-person setting, including requirements regarding care coordination; and(2)
subject to Subsection (b), the provider of the service gives notice to the Medicaid recipient’s primary care physician or provider regarding the service, including a summary of the service, exam findings, a list of prescribed or administered medications, and patient instructions, for the purpose of sharing medical information.(b)
A provider of a telemedicine medical service, teledentistry dental service, or telehealth service is required to provide notice under Subsection (a)(2) only if:(1)
the recipient has a primary care physician or provider; and(2)
the recipient or, if appropriate, the recipient’s parent or legal guardian, consents to the notice.(c)
The commission shall develop, document, and implement a monitoring process to ensure that a Medicaid managed care organization ensures that using telemedicine medical services, teledentistry dental services, or telehealth services promotes and supports patient-centered medical homes and care coordination in accordance with Subsection (a). The process must include monitoring of the rate at which a telemedicine medical service, teledentistry dental service, or telehealth service provider gives notice in accordance with Subsection (a)(2).
Source:
Section 548.0055 — Promotion and Support of Medical Home and Care Coordination, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.548.htm#548.0055 (accessed Jun. 5, 2024).
