Texas fills a prescription for rural areas with telemedicine
“The telemedicine community had a really good legislative session,” said Nora Belcher, executive director at Texas e-Health Alliance. Belcher, along with 40 other organizations, including the Texas Medical Association (TMA) and the Texas Academy of Family Physicians (TAFP) were able to help guide the passage of legislation that will assist patients in rural areas who need a doctor. In 2015, the Texas Medical Board proposed a rule requiring physicians to meet with patients in person before they can treat them remotely, or another provider must be physically present during the first telemedicine appointment to establish a doctor-patient relationship. With the passing of Senate Bill 1107, authored by Sen. Charles Schwertner and Rep. Four Price, the guidelines and costs are about to change, but reaching this point was not an easy task, according to Belcher. Texas has tussled with definitions of proper doctor-patient relationship protocols. “Several months before the 85th Legislature convened, the Texas Academy of Family Physicians, Texas Medical Association and the Texas e-Health Alliance began plotting a course to modernize our telemedicine statutes,” said Chief Executive Officer and Executive Vice President of TAFP Tom Banning. “Our goal was to design a statutory framework that would reduce the regulatory footprint governing the provision of telemedicine service in Texas.”
Carlos J. Cardenas, MD, president of TMA also shared his sentiments on legislation that will benefit Texans and the medical community. “TMA is extremely pleased Texas patients will be protected by a law, Senate Bill 1107, that clarifies the standard of telemedicine care, including the stipulation that the standard of care for telemedicine treatment must be equal to that of traditional in-person, face-to-face care, “TMA is proud to have been part of the core group of advocates- TMA, the Texas Academy of Family Physicians and the Texas E-Health Alliance- who worked tirelessly with a variety of stakeholders to move this important legislation through the 85th Texas Legislature. Our goal was to make it consistent with our core principles of licensure- that telemedicine IS the practice of medicine, and as such it must be based on accepted standards of care; and because it is a means of providing a covered service, it must be part of insurance coverage plans.”
“My group, along with the other organizations began meeting last year,” said Belcher. “We were trying to get that last piece to fall into place and have doctors, hospitals and the industry on board. It changes the way we look at telemedicine by allowing the doctor to use their best judgment. Can they meet the standard of care to treat that patient using technology?” SB 1107 provides options for patient and doctor interaction through interactive video and audio calls. The bill no longer requires another clinician to be present with the patient during a remote visit, which means direct-to-consumer companies can expand their reach. Physicians who treat patients via video consultation will need to take previous medical records and test results into account. This interactive service will be paid for and reimbursed the same as in-person medical visits. “The new bill makes Texas the last state to remove a requirement that patients establish an in-person relationship with their provider before receiving telemedicine services,” said Belcher who also commented that Schwertner and Price did a fantastic job working out the bill. “I am pleased to have sponsored SB 1107 in the Texas House because it provides a clear regulatory framework for the potential greater statewide expansion of telemedicine services. In turn, this will benefit Texas patients with greater access and convenience to health care services and procedures,” said Price.
Once the telehealth visit is complete, will medicine be prescribed to the patient? SB 1107 stipulates that the Texas Medical Board, the Texas Board of Nursing, the Texas Physician Assistant Board and the Texas State Board of Pharmacy would be required to adopt rules defining valid prescriptions for telemedicine visits. Jointly, they would develop and publish on each respective board’s website responses to frequently asked questions in relation to the determination of a valid prescription issued during a telemedicine visit. “These individuals in rural communities, they don’t have a doctor and they want to use the telephone or video to talk to the doctor when they know they have a sinus infection, strep throat or a urinary tract infection,” said Belcher. “To be able to make an assessment so that they can prescribe remotely… that’s a big deal.”
The bill is set to take effect immediately, except for some amended wording regarding co-pay and insurance coverage. “As more physicians Integrate and use telemedicine in their practices, the health plans will have to modernize their approach to paying for telemedicine services,” said Banning. “Unless or until the health plans recognize the appropriateness and efficiencies of care delivered through telemedicine and pay for that care, we will be unable to use this valuable tool to its fullest.”
Three other bills joining the telemedicine train are House Bill 1697, Senate Bill 922 and Senate Bill 1633. All of them have made it through the legislature, but two of them are still waiting to be signed by Gov. Greg Abbott. HB 1697, authored by Rep. Four Price, Rep. Cindy Burkett, Rep. J.D. Sheffield, Rep. Senfronia Thompson and Rep. Oscar Longoria, will establish a grant program for teleNICU services for premature infants. “The idea here is that the baby stays at its home hospital and then the neonatal doctor sees the baby remotely rather than air or ambulance inbound to a children’s hospital in a city like Dallas,” said Belcher. For the rural areas, that the bill covers the start-up cost for the equipment, which is not cheap, but it can save millions of dollars in transfer fees for these fragile children.” The bill specifies that the Health and Human Services Commission is required to establish a tele-connectivity resource program that would award grants to rural health care facilities to connect these facilities with pediatric specialists who provide telemedicine medical services. Requirements to be eligible for the grant are outlined in the bill, which has been signed and takes effect Sept. 1.
Senate Bill 922, authored by Sen. Dawn Buckingham, allows school districts and open-enrollment charter schools to use telemedicine in the School Health and Related Services (SHARS) program. “SHARS is where you have a kid that under IDEA (Individuals Dedicated to Excellence and Achievement) that has an action plan that they need something like speech language pathology at the school,” said Belcher. “The school is actually the telemedicine provider that offers therapy. If the child needing the assistance is in a rural area and there is only one speech language pathologist and eight schools, this individual would be driving a lot and SB 922 closes that gap.” This bill has been sent Abbott, but has not been signed.
Senate Bill 1633, authored by Sen. Charles Perry, would allow more telepharmacy technology to be used in Texas in areas where they don’t have pharmacies. “Normally, a pharmacist is required to be on site with the pharmacy tech,” said Belcher. “This bill would allow the pharmacist to remotely supervise the pharmacy tech located in a rural area.” This bill has been sent to Abbott, but has not been signed.
The United States Department of Agriculture (USDA) recently announced that they awarded four loans to help provide broadband service in rural portions of California, Illinois, Iowa and Texas. The $43.6 million will add nearly 1,000 miles of fiber to fund broadband service. The USDA awarded a $24.8 million loan to the Central Texas Telephone Cooperative, Inc., to construct 568 miles of fiber and install equipment upgrades in seven of its 17 exchanges. The USDA is providing these loans through the Rural Development’s Telecommunications Program. This program funds infrastructure and equipment to deliver broadband and distance learning and telemedicine services throughout rural America.
The USDA has also announced an application window through July 17 for Distance Learning and Telemedicine Grants. Find out more about a June 15 webinar and who is eligible to apply here.
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