Certain Medicaid and CHIP services may now be delivered using telemedicine, telehealth, and audio-only methods. This includes many services that were made available through telemedicine, telehealth, and audio-only methods during the COVID-19 public health emergency (PHE) as well as other services.
With input from advisory committees and other stakeholders, HHSC staff evaluated services to determine whether this method of delivery is cost-effective and clinically appropriate.
This work has been completed in phases and will be completed in 2023. You can find additional information about HHSC’s evaluation framework (PDF).
If you have general questions or comments about Medicaid and CHIP teleservices, please e-mail HHSC_MCS_House_Bill_4@hhs.texas.gov.
Timeline
Phase I: Analysis - Winter 2022 - Complete
- HHSC released guidance about certain services that are approved for telemedicine, telehealth, and audio-only delivery methods on an ongoing basis.
- HHSC began releasing draft rules and other policy updates.
Phase II: Analysis - Spring 2022 - Complete
- HHSC requested stakeholders for input about additional services that were available for remote delivery during the PHE to help determine whether permanent telemedicine, telehealth, and audio-only delivery methods would be cost-effective and clinically appropriate.
- HHSC released guidance about additional services that are approved for telemedicine, telehealth, and audio-only delivery methods.
- HHSC posted draft rules required by legislation for informal comment.
Phase III: Rulemaking - Summer 2022 - Complete
- Changes to medical benefit policies were posted for public comment.
Phase IV: Finalizing Policy - Fall 2022 through 2023
- Changes to medical benefit policies were completed.
- Rules required by legislation were formally posted for public comment.
- HHSC finalized one rule and expects to finalize remaining formal rule changes in June 2023 after considering public comments.
Background Legislation
House Bill (HB) 4 (87th Legislative Session, 2021):
HHSC allowed the use of telemedicine, telehealth, and audio-only for many new Medicaid services during the COVID-19 PHE. In response, this bill requires HHSC to allow more services to be delivered using telemedicine, telehealth, and audio-only methods on a permanent basis after the PHE ends if clinically appropriate and cost-effective.
Senate Bill (SB) 670 (86th Legislative Session, 2019):
MCOs have the responsibility to determine which services could be delivered through telemedicine, telehealth, and audio-only methods.
MCOs cannot deny reimbursement to health care providers for a Medicaid service or procedure just because it was delivered via telemedicine or telehealth. MCOs also cannot deny or reduce reimbursement for a Medicaid service or procedure based on the health care provider’s choice of platform.
Additional Resources
Policy Updates
- TMHP bulletin title “HB4: Interim Guidance for Non-Behavioral Health Audio-Only Medical Office Visits” published on April 13, 2023
- TMHP bulletin title “HB4: Interim Guidance for HTW Non-Behavioral Health Audio-Only Medical Office Visits” published on April 13, 2023
- Texas Register publication of adopted rules “Medicaid Telehealth and Audio-only Delivery” published on January 20, 2023
- TMHP bulletin title Update to Article “SHARS Benefit to Change for Texas Medicaid October 1, 2022” posted on October 12, 2022
- TMHP bulletin title SHARS Benefits to Change for Texas Medicaid October 1, 2022 posted on August 12, 2022.
- TMHP bulletin title Changes to Case Management for Children and Pregnant Women, Including Teleservices, Effective September 1, 2022 posted on July 18, 2022
- TMHP bulletin title Telemedicine and Telehealth Benefit Information to Be Updated September 1, 2022 posted on July 15, 2022
- TMHP bulletin title HB4: Behavioral Health Services Delivered by Telemedicine or Telehealth Effective September 1, 2022 posted on July 15, 2022
- TMHP bulletin title Telemedicine and Telehealth Services for the HTW and HTW Plus Programs posted on July 15, 2022
- TMHP bulletin title Telehealth Services for the Early Childhood Intervention Program posted on July 15, 2022
- TMHP bulletin title HB4 PT, OT, ST, and Related Durable Medical Equipment Services: Telehealth and Exclusions posted on July 15, 2022
- TMHP bulletin title Synchronous Audiovisual Telemedicine Delivery for Certain Physician Evaluation and Management Procedure Codes Effective September 1, 2022 posted on July 15, 2022
- TMHP bulletin title Medical Nutrition Counseling Policy Updated to Allow Procedure Code S9470 Through Synchronous Telephone (Audio-Only) Technologies Delivery posted on July 15, 2022
- TMHP bulletin title Texas Health Steps Preventive Care Medical Checkups Through Synchronous Audiovisual or Synchronous Telephone (Audio-only) to Be Allowed During a State of Disaster posted on July 15, 2022
- HHSC Alert, Revised Guidance for COVID-19 Flexibility for Nursing Services by Telehealth for CLASS, DBMD, HCS and TxHmL, posted on April 29, 2022
- HHSC Information Letter No. IL22-27, Interim Guidance for Renewal of ID/RC Assessments and for Renewal, Revised, and Transfer IPCs for CLASS, HCS and TxHmL posted on April 26, 2022
- TMHP bulletin titled Telemedicine and Telehealth Services Provided by Rural Health Clinics posted on February 28, 2022