1 Tex. Admin. Code § 354.1434 - Home Telemonitoring Benefits and Limitations

(a) Home telemonitoring services are a benefit of the Texas Medicaid Program as provided in this section and are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.

(b) Home telemonitoring services require scheduled remote monitoring of data related to a recipient's health and transmission of the data to a licensed home health agency, federally qualified health center, rural health clinic, or hospital.

(c) Home telemonitoring services providers must:

(1) comply with all applicable federal, state, and local laws and regulations;

(2) be enrolled and approved for participation in the Texas Medicaid Program as home telemonitoring service providers;

(3) bill for services covered under the Texas Medicaid Program in the manner and format prescribed by HHSC;

(4) establish a plan of care that includes outcome measures for each recipient who receives home telemonitoring services;

(5) share the plan of care with the recipient's physician;

(6) share clinical information gathered while providing home telemonitoring services with the recipient's physician; and

(7) not duplicate disease management program services provided under Human Resources Code § 32.057 and further described in Division 32 of this subchapter (relating to Texas Medicaid Wellness Program).

(d) Home telemonitoring services are available to Texas Medicaid recipients who:

(1) are diagnosed with diabetes, hypertension, or any other conditions allowed by Texas Government Code § 531.02164 and determined by HHSC to be cost effective and clinically effective; and

(2) exhibit at least one of the following risk factors:

(A) two or more hospitalizations in the prior 12-month period;

(B) frequent or recurrent emergency room admissions;

(C) a documented history of poor adherence to ordered medication regimens;

(D) a documented risk of falls; and

(E) a documented history of care access challenges.

(e) Home telemonitoring services are available to Texas Medicaid recipients who are 20 years of age and younger, with one or more of the following conditions:

(1) end-stage solid organ disease;

(2) organ transplant recipient; or

(3) requiring mechanical ventilation.

(f) Home telemonitoring services may be discontinued for a condition, if after implementation, HHSC determines the provision and reimbursement of services are not cost-effective and clinically effective for that condition.

(g) HHSC reimburses home telemonitoring services providers in accordance with Chapter 355 of this title (relating to Reimbursement Rates).

Notes

1 Tex. Admin. Code § 354.1434

The provisions of this §354.1434 adopted to be effective October 1, 2013, 38 TexReg 6579; Amended by Texas Register, Volume 48, Number 03, January 20, 2023, TexReg 0210, eff. 1/23/2023; Amended by Texas Register, Volume 50, Number 08, February 21, 2025, TexReg 0972, eff. 2/27/2025