By: Price, et al. (Senate Sponsor - Perry)	H.B. No. 2727
	(In the Senate - Received from the House May 1, 2023;
	May 2, 2023, read first time and referred to Committee on Health &
	Human Services; May 21, 2023, reported adversely, with favorable
	Committee Substitute by the following vote:  Yeas 9, Nays 0;
	May 21, 2023, sent to printer.)
Click here to see the committee vote
	COMMITTEE SUBSTITUTE FOR H.B. No. 2727	By:  Perry

	A BILL TO BE ENTITLED
	AN ACT
	relating to the provision of home telemonitoring services under
	Medicaid.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 531.001(4-a), Government Code, is
	amended to read as follows:
	(4-a)  "Home telemonitoring service" means a health
	service that requires scheduled remote monitoring of data related
	to a patient's health and transmission of the data to a licensed
	home and community support services agency, a federally qualified
	health center, a rural health clinic, or a hospital, as those terms
	are defined by Section 531.02164(a). The term is synonymous with
	"remote patient monitoring."
	SECTION 2.  Section 531.02164, Government Code, is amended
	by amending Subsections (a), (b), (c), (c-1), (d), and (f) and
	adding Subsections (c-2) and (c-3) to read as follows:
	(a)  In this section:
	(1)  "Federally qualified health center" has the
	meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
	(1-a)  "Home and community support services agency"
	means a person licensed under Chapter 142, Health and Safety Code,
	to provide home health, hospice, or personal assistance services as
	defined by Section 142.001, Health and Safety Code.
	(2)  "Hospital" means a hospital licensed under Chapter
	241, Health and Safety Code.
	(3)  "Rural health clinic" has the meaning assigned by
	42 U.S.C. Section 1396d(l)(1).
	(b)  The [If the commission determines that establishing a
	statewide program that permits reimbursement under Medicaid for
	home telemonitoring services would be cost-effective and feasible,
	the] executive commissioner [by rule] shall adopt rules for the
	provision and reimbursement of home telemonitoring services under
	Medicaid [establish the program] as provided under this section.
	(c)  For purposes of adopting rules [The program required]
	under this section, the commission shall [must]:
	(1)  identify and provide home telemonitoring services
	to persons diagnosed with conditions for which the commission
	determines the provision of home telemonitoring services would be
	cost-effective and clinically effective;
	(2)  consider providing home telemonitoring services
	under Subdivision (1) [provide that home telemonitoring services
	are available only] to Medicaid recipients [persons] who:
	(A)  are diagnosed with one or more of the
	following conditions:
	(i)  pregnancy;
	(ii)  diabetes;
	(iii)  heart disease;
	(iv)  cancer;
	(v)  chronic obstructive pulmonary disease;
	(vi)  hypertension;
	(vii)  congestive heart failure;
	(viii)  mental illness or serious emotional
	disturbance;
	(ix)  asthma;
	(x)  myocardial infarction; [or]
	(xi)  stroke;
	(xii)  end stage renal disease; or
	(xiii)  a condition that requires renal
	dialysis treatment; and
	(B)  exhibit at least one [two or more] of the
	following risk factors:
	(i)  two or more hospitalizations in the
	prior 12-month period;
	(ii)  frequent or recurrent emergency room
	admissions;
	(iii)  a documented history of poor
	adherence to ordered medication regimens;
	(iv)  a documented risk [history] of falls
	[in the prior six-month period]; and
	(v)  [limited or absent informal support
	systems;
	[(vi)  living alone or being home alone for
	extended periods of time; and
	[(vii)]  a documented history of care access
	challenges;
	(3) [(2)]  ensure that clinical information gathered
	by the following providers while providing home telemonitoring
	services is shared with the recipient's physician:
	(A)  a home and community support services agency;
	(B)  a federally qualified health center;
	(C)  a rural health clinic; or
	(D)  a hospital [while providing home
	telemonitoring services is shared with the patient's physician];
	[and]
	(4) [(3)]  ensure that the home telemonitoring
	services provided under this section do [program does] not
	duplicate disease management program services provided under
	Section 32.057, Human Resources Code; and
	(5)  require a provider to:
	(A)  establish a plan of care that includes
	outcome measures for each recipient who receives home
	telemonitoring services under this section; and
	(B)  share the plan and outcome measures with the
	recipient's physician.
	(c-1)  Notwithstanding any other provision of this section
	[Subsection (c)(1)], the commission shall ensure [the program
	required under this section must also provide] that home
	telemonitoring services are available to pediatric persons who:
	(1)  are diagnosed with end-stage solid organ disease;
	(2)  have received an organ transplant; or
	(3)  require mechanical ventilation.
	(c-2)  In addition to determining whether to provide home
	telemonitoring services to Medicaid recipients with the conditions
	described under Subsection (c)(2), the commission shall determine
	whether high-risk pregnancy is a condition for which the provision
	of home telemonitoring services is cost-effective and clinically
	effective. If the commission determines that high-risk pregnancy
	is a condition for which the provision of home telemonitoring
	services is cost-effective and clinically effective:
	(1)  the commission shall, to the extent permitted by
	state and federal law, provide recipients experiencing a high-risk
	pregnancy with clinically appropriate home telemonitoring services
	equipment for temporary use in the recipient's home; and
	(2)  the executive commissioner by rule shall:
	(A)  establish criteria to identify recipients
	experiencing a high-risk pregnancy who would benefit from access to
	home telemonitoring services equipment;
	(B)  ensure that, if cost-effective, feasible,
	and clinically appropriate, the home telemonitoring services
	equipment provided includes uterine remote monitoring services
	equipment and pregnancy-induced hypertension remote monitoring
	services equipment;
	(C)  subject to Subsection (c-3), require that a
	provider obtain:
	(i)  prior authorization from the commission
	before providing home telemonitoring services equipment to a
	recipient during the first month the equipment is provided to the
	recipient; and
	(ii)  an extension of the authorization
	under Subparagraph (i) from the commission before providing the
	equipment in a subsequent month based on the ongoing medical need of
	the recipient; and
	(D)  prohibit payment or reimbursement for home
	telemonitoring services equipment during any period that the
	equipment was not in use because the recipient was hospitalized or
	away from the recipient's home regardless of whether the equipment
	remained in the recipient's home while the recipient was
	hospitalized or away.
	(c-3)  For purposes of Subsection (c-2), the commission
	shall require that:
	(1)  a request for prior authorization under Subsection
	(c-2)(2)(C)(i) be based on an in-person assessment of the
	recipient; and
	(2)  documentation of the recipient's ongoing medical
	need for the equipment is provided to the commission before the
	commission grants an extension under Subsection (c-2)(2)(C)(ii).
	(d)  If, after implementation, the commission determines
	that a condition for which the commission has authorized the
	provision and reimbursement of home telemonitoring services under
	Medicaid [the program established] under this section is not
	cost-effective and clinically effective, the commission may
	discontinue the availability of home telemonitoring services for
	that condition [program] and stop providing reimbursement under
	Medicaid for home telemonitoring services for that condition,
	notwithstanding Section 531.0216 or any other law.
	(f)  To comply with state and federal requirements to provide
	access to medically necessary services under Medicaid, including
	the Medicaid managed care program, and if the commission determines
	it is cost-effective and clinically effective, the commission or a
	Medicaid managed care organization, as applicable, may reimburse
	providers for home telemonitoring services provided to persons who
	have conditions and exhibit risk factors other than those expressly
	authorized by this section. [In determining whether the managed
	care organization should provide reimbursement for services under
	this subsection, the organization shall consider whether
	reimbursement for the service is cost-effective and providing the
	service is clinically effective.]
	SECTION 3.  If before implementing any provision of this Act
	a state agency determines that a waiver or authorization from a
	federal agency is necessary for implementation of that provision,
	the agency affected by the provision shall request the waiver or
	authorization and may delay implementing that provision until the
	waiver or authorization is granted.
	SECTION 4.  This Act takes effect immediately if it receives
	a vote of two-thirds of all the members elected to each house, as
	provided by Section 39, Article III, Texas Constitution. If this
	Act does not receive the vote necessary for immediate effect, this
	Act takes effect September 1, 2023.
	* * * * *