The commission and executive commissioner must set policies for Medicaid managed care to use telehealth and related technology, and managed care organizations must follow certain monitoring and in-person visit rules.
Sec. 540.0711. DELIVERY OF BENEFITS USING TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a) The commission shall establish policies and procedures to improve access to care under the Medicaid managed care program by encouraging the use under the program of: (1) telehealth services; (2) telemedicine medical services; (3) home telemonitoring services; and (4) other telecommunications or information technology. (b) To the extent allowed by federal law, the executive commissioner by rule shall establish policies and procedures that allow a Medicaid managed care organization to conduct assessments and provide care coordination services using telecommunications or information technology. In establishing the policies and procedures, the executive commissioner shall consider: (1) the extent to which a Medicaid managed care organization determines using the telecommunications or information technology is appropriate; (2) whether the recipient requests that the assessment or service be provided using telecommunications or information technology; (3) whether the recipient consents to receiving the assessment or service using telecommunications or information technology; (4) whether conducting the assessment, including an assessment for an initial waiver eligibility determination, or providing the service in person is not feasible because of the existence of an emergency or state of disaster, including a public health emergency or natural disaster; and (5) whether the commission determines using the telecommunications or information technology is appropriate under the circumstances. (c) If a Medicaid managed care organization conducts an assessment of or provides care coordination services to a recipient using telecommunications or information technology, the organization shall: (1) monitor the health care services provided to the recipient for evidence of fraud, waste, and abuse; and (2) determine whether additional social services or supports are needed. (d) To the extent allowed by federal law, the commission shall allow a recipient who is assessed or provided with care coordination services by a Medicaid managed care organization using telecommunications or information technology to provide consent or other authorizations to receive services verbally instead of in writing. (e) The commission shall determine categories of recipients of home and community-based services who must receive in-person visits. Except during circumstances described by Subsection (b)(4), a Medicaid managed care organization shall, for a recipient of home and community-based services for which the commission requires in-person visits, conduct: (1) at least one in-person visit with the recipient to make an initial waiver eligibility determination; and (2) additional in-person visits with the recipient if necessary, as determined by the organization. (f) Notwithstanding this section, the commission may, on a case-by-case basis, require a Medicaid managed care organization to discontinue the use of telecommunications or information technology for assessment or care coordination services if the commission determines that the discontinuation is in the recipient's best interest. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.