Texas House Bill HB-3740 would create exciting opportunities for
Medicaid beneficiaries and providers.

On May 24, 2021 Texas House Bill HB-3740 passed through the Texas House of Representatives, was then sent on to the Senate, and finally the bill landed with Texas Health and Human Services.

Texas House Bill HB-3740 correlates to the provision of the Texas Medicaid Home Telemonitoring Program which has been enacted since 2014. The significance of this bill, if passed, would be drastic expansion of diagnoses that would qualify Medicaid beneficiaries for home telemonitoring.

Medicaid beneficiaries who are diagnosed with one or more of the following diagnoses and meet certain risk criteria would become eligible:

  • Pregnancy
  • Diabetes
  • Heart disease
  • Cancer
  • Chronic obstructive pulmonary disease
  • Hypertension
  • Congestive heart failure
  • Mental illness or serious emotional disturbance
  • Asthma
  • Myocardia infraction
  • Stroke

Since the program’s inception, the Texas state telemonitoring program has only benefited those who have been diagnosed with hypertension and/or diabetes.

In October 2020, TMHP (Texas Medicaid & Healthcare Partnership) announced that they had expanded the benefit under the CHSCN (Children with Special Health Care Needs) program to benefit pediatric Medicaid beneficiaries with three new conditions: required mechanical ventilation; organ transplant; and end-stage solid organ disease. TMHP made no mention of expanding qualified diagnosis for beneficiaries 21 and older.

Since 2018, adoption rates for the Texas Home Telemonitoring program have risen. This is most likely related to the unbundling of Medicare CPT code 99091 that also occurred in 2018, and hence drove exposure to telehealth and remote patient monitoring.

In addition to the October 2020 qualifying diagnosis expansions, TMHP also notified providers that prior authorizations could now be authorized for 180 days vs. the original 60 days, lifting a heavy administrative burden off Home and Community Support Services Agencies or Hospitals.

In the same update, TMHP announced that RN, NP, CNS, or PA’s may sign prior authorization requests on behalf of the client’s physician when the physician delegates this authority. This was another significant update for Home and Community Support Services Agencies or Hospitals that assisted in expediting their orders management process for the program.

Surprisingly, home telemonitoring provider adoption rates remain low. According to a 2020 report from Texas Health and Human Services, 402 providers were rendering telemonitoring services at the end of FY 2019. Clients receiving home telemonitoring services between January and May 2020 was only 13,941. Many factors contribute to the lack of provider adoption. However, it is most likely attributed to the lack of information, education, and provider notification surrounding the home telemonitoring program.

Key takeaways for Home and Community Support Services Agencies or Hospitals

Post-acute providers and especially home health agencies across the United States have made an outcry to CMS to reimburse for the use of telehealth and remote patient monitoring. Nothing has come to fruition to date, other than The HEAT Act which would only allow reimbursement to home health agencies during a pandemic state.

Texas home health agencies and outpatient hospitals have a unique opportunity allowing them to adopt telehealth and remote patient monitoring technology and unlike agencies in other states, receive reimbursement to do so.

Even if Medicare were to begin reimbursing home health agencies for the use of telehealth and remote patient monitoring, most HHAs have never utilized remote care technology and do not have policies, procedures, processes, or technology in place to do so.
Texas post-acute providers should look at the current state telemonitoring program reimbursement and the likely additions coming from House Bill-3740 as an opportunity to be early adopters of remote care, and to establish a program and effective process to track its performance.

Key takeaways for Physicians, Nurse Practitioners, Physician Assistants, and other qualified healthcare providers

Medicare and some secondary payers have been reimbursing physicians, nurse practitioners, physician assistants, and other qualified healthcare providers for remote patient monitoring since the early 2000s. Adoption rates began to rise when CMS unbundled CPT code 99091 and increased the reimbursement amount for providing services.

A unique aspect of home telemonitoring in Texas vs. Medicare’s remote patient monitoring program is the incorporation of the home health agency or outpatient hospital. Two of the most common reasons for practices and providers lack of adoption is the inability or difficulty in administering equipment and monitoring patient engagement. The Texas Medicaid program has split responsibilities between the prescribing provider and the outpatient providers. Home and Community Support Services Agencies or Hospitals are responsible for the provision and maintenance of telemonitoring equipment, monitoring patient engagement and responding to out of parameter readings. The prescribing provider is responsible for care plan oversight and coordinating care with the HHA they refer that patient to.
HMOs like Molina, Superior, Amerigroup, Cigna and others pay for home telemonitoring services as well. Dual eligible patients are billed to TMHP or Medicare first, and traditional Medicare patients are billed to their appropriate HMO.

This presents a unique opportunity for providers who may already provide RPM services through the Medicare RPM program but have limited scalability due to staffing or program costs. Providers can refer their Medicaid or MQMB patients to a qualified Home and Community Support Services Agency or Hospital who will be responsible for educating and training the patient on their telemonitoring equipment, ensuring the patient participates, and coordinating with the prescribing provider when out of parameter readings occur.

How to get started?

Telos Health Solutions offers intuitive remote patient monitoring and virtual care solutions. Telos solutions are designed to improve care coordination, increase access to care, and reduce avoidable hospitalizations.

If you would like to learn more and find out how your agency or practice can start providing home telemonitoring or remote patient monitoring services, please reach out to us and one of our experts will be happy to assist you.

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