Texas § GV.548.0257 - REIMBURSEMENT FOR HIGH-RISK PREGNANCY

§ GV.548.0257. REIMBURSEMENT FOR HIGH-RISK PREGNANCY

REIMBURSEMENT FOR HIGH-RISK PREGNANCY. (a) In addition to determining whether to provide home telemonitoring services to Medicaid recipients with the conditions described by Section 548.0253 (a)(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 (b), 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 recipient's ongoing medical need; 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. (b) For purposes of Subsection (a), the commission shall require that: (1) a request for prior authorization under Subsection (a)(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 (a)(2)(C)(ii). Added by Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620 ), Sec. 8.047(a), eff. September 1, 2025. SUBCHAPTER G. MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL CONSULTATIONS