Texas § GV.548.0253 - REIMBURSEMENT REQUIREMENTS

§ GV.548.0253. REIMBURSEMENT REQUIREMENTS

REIMBURSEMENT REQUIREMENTS. (a) For purposes of adopting rules under this subchapter, the commission shall: (1) identify and provide home telemonitoring services to individuals 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) to a Medicaid recipient who: (A) is 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; (xi) stroke; (xii) end stage renal disease; or (xiii) a condition that requires renal dialysis treatment; and (B) exhibits at least one 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 of falls; and (v) a documented history of care access challenges; (3) 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; (4) ensure that the home telemonitoring services provided under this subchapter do 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 subchapter; and (B) share the plan and outcome measures with the recipient's physician. (b) Notwithstanding any other provision of this subchapter, the commission shall ensure that home telemonitoring services are available to pediatric individuals who: (1) are diagnosed with end-stage solid organ disease; (2) have received an organ transplant; or (3) require mechanical ventilation. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025. Amended by: Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620 ), Sec. 8.047(a), eff. September 1, 2025.