Some telehealth regulations waived for COVID-19 response

Gov. Abbott earlier this month announced temporary waivers of certain telehealth regulations for physicians, speech language pathologists, and audiologists to increase Texans’ access to care during the COVID-19 pandemic. The waivers expanded on a March 17 directive to the Texas Department of Insurance (TDI) to adopt an emergency rule for health professionals providing telemedicine under certain health insurance plans.

Texas is one of several states that have implemented temporary measures to expand telehealth services. These measures generally have allowed the doctor-patient relationship to be established using telephone calls and allowed health providers to be reimbursed for more services provided through telehealth and telemedicine.

Telehealth and telemedicine are defined in Occupations Code sec. 111.001 as health care provided through telecommunication technology by a practitioner in a different location from the patient receiving the care. In telemedicine the practitioner in charge of delivering the care is a physician, while in telehealth it is another health professional, such as a chiropractor, not under a physician’s supervision.

Speech pathologists and audiologists. The Texas Department of Licensing and Regulation on April 9 temporarily suspended certain requirements for speech language pathologists and audiologists. The suspensions allow speech-language pathology interns to receive all direct and indirect supervision hours through telehealth. Audiology assistants and interns also may be supervised for all assigned tasks through telehealth.

With the suspension, speech-language pathology licensees who are approved to provide telehealth services may use certain devices not otherwise on the list of approved technology, including a smart phone or any audio-visual, real-time, or two-way interactive communication system. Audiologists and audiology interns who fit and dispense hearing instruments through telehealth are not required under the suspension to first meet the client in person at the same physical location.

Telemedicine services and reimbursement. The Texas Medical Board (TMB) on March 14 temporarily suspended certain requirements for establishing the doctor-patient relationship. The suspension allows a doctor-patient relationship to be established via telephone (audio-only) consultations, rather than requiring audiovisual interaction between the physician and patient. Under the suspension, telemedicine, including telephone calls, also may be used for diagnosis, treatment, ordering of tests, and prescribing for all conditions.

Prescriptions. Gov. Abbott on April 9 extended until May 8 a previously issued waiver to allow telephone refills of a valid prescription for treatment of chronic pain by a physician with an existing chronic pain patient. Health providers are being encouraged by TMB to visit the U.S. Drug Enforcement Administration’s website for additional guidance when prescribing controlled substances during the COVID-19 pandemic.

Provider reimbursement. TDI on March 17 adopted an emergency rule to ensure payment parity for providers offering telemedicine to patients and to ensure that health benefit plans offer telemedicine coverage on the same basis as in-person visits. Under the rule, a health plan must reimburse a preferred or contracted health professional for providing a telemedicine service to a covered patient on the same basis and at least at the same rate as for in-person visits. The rule applies to a health plan offered by a health maintenance organization, a group hospital service corporation, and a nonprofit health corporation holding a certificate of authority, among several other plans, as specified under Insurance Code secs. 1455.002 and 1455.003.

Medicaid. The Health and Human Services Commission on March 20 authorized Medicaid providers to submit claims dated March 20 through April 30 to receive reimbursement for certain behavioral health services delivered through telephone (audio-only), including substance use disorder services, mental health rehabilitation, and psychotherapy.

For more background on telehealth and telemedicine, see the House Research Organization’s 2017 focus report, Emerging issues in Texas telemedicine regulation.

By Alison Hern

UPDATE: On September 25, Governor Abbott announced Texas’ major health insurers have agreed to continue reimbursing network health care providers for telehealth appointments at the same rate which they pay for office visits through the end of 2020. While the agreement applies only to state-regulated plans, both the Employee Retirement System and the Teacher Retirement System will continue telehealth payment parity through the end of the year as well.

On August 7, the Health and Human Services Commission extended until October 23 the time during which Medicaid providers may submit claims to receive reimbursement for certain behavioral health services delivered by telephone (audio-only).

On June 24, the Texas Department of Insurance extended until September 12 an emergency rule temporarily requiring that health professionals’ reimbursement rates for telemedicine-based services be at least the same as those for in-person services and that health benefit plans offer telemedicine coverage on the same basis as in-person visits.

On June 5, the Texas Medical Board adopted an emergency rule temporarily allowing physicians of established chronic pain patients to telephonically refill existing prescriptions of scheduled drugs if deemed necessary due to the COVID-19 pandemic. On July 1, the emergency rule was extended until September 2 or during the period of the governor’s disaster declaration, whichever is shorter.

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