1. (a) Definitions. The following words and terms, when used in this chapter, will have the following meanings, unless the context clearly indicates otherwise.

   1. (1) Telemedicine--a method of health care service delivery used to facilitate medical consultations by physicians to health care providers in rural or underserved areas for purposes of patient diagnosis or treatment that requires advanced telecommunications technologies, including interactive video consultation, teleradiology, and telepathology.
   2. (2) Rural--area defined as a county with a population of 50,000 or less or a county that was not designated as a metropolitan area by the United States Bureau of the Census according to the 1990 federal census and does not have within the boundaries of the county a hospital, licensed under chapter 241, Health and Safety Code, with more than 100 beds.
   3. (3) Underserved--area that meets the definition of Medically Underserved Area (MUA) or Medically Underserved Population (MUP) by the U.S. Department of Health and Human Services.

   4. (4) Rural Health Facility--a health facility that is located in a rural county and is at least 30 miles from any accredited medical school or any teaching hospital affiliated through a written contract or agreement with an accredited medical school and that is:

      1. (A) a licensed, non-profit hospital;
      2. (B) a health clinic that is affiliated through a written contract or agreement with an accredited medical school;
      3. (C) a health clinic that is affiliated through a written contract or agreement with a teaching hospital that is affiliated through a written contract or agreement with an accredited medical school;
      4. (D) a health clinic that is affiliated through a written contract or agreement with a federally qualified health center;
      5. (E) a hospital that is licensed under chapter 241, Health and Safety Code, and is owned or operated by a municipality, county, hospital district, or hospital authority, and provides inpatient or outpatient services; or
      6. (F) a health clinic that is affiliated through a written contract or agreement with a hospital that is licensed under chapter 241, Health and Safety Code, and is owned or operated by a municipality, county, hospital district, or hospital authority, and provides inpatient or outpatient services.
   5. (5) Hub Site Provider--a physician at a rural health facility or an accredited medical or osteopathic school located in Texas, or a physician at one of the following entities affiliated through a written contract or agreement with an accredited medical or osteopathic school located in Texas: hospitals, teaching hospitals, tertiary centers, or health clinics. The hub site physician will provide consultation and diagnosis, and may develop the patient's plan of care and treatment.
   6. (6) Remote Site Provider--a health professional, such as a physician or advanced practice nurse, that is able to independently bill the Medicaid Program for a visit, or a Federally Qualified Health Center or Rural Health Clinic. Remote site providers must be located in rural or underserved areas. The remote site provider is responsible for carrying out or coordinating the plan of care and treatment after consulting with the hub site provider.

2. (b) Reimbursement for Services Performed Using Telemedicine.

   1. (1) Using telemedicine, hub site providers can bill only for the following services:

      1. (A) consultation using interactive video;
      2. (B) consultation or interpretation using telemedicine as defined by Medicaid telemedicine medical policy and as currently reimbursed under the Medicaid program; and
      3. (C) teleradiology and telepathology as they are currently reimbursed under the Medicaid program pursuant to medical policy.
   2. (2) Using telemedicine, remote site providers can bill only for a visit or encounter using interactive video as described in Medicaid telemedicine medical policy.
   3. (3) Telemedicine services are reimbursed in accordance with the existing Medicaid reimbursement methodology.
   4. (4) Providers seeking reimbursement for telemedicine services must provide and bill for the service in the manner prescribed by the Texas Department of Health.

Source Note:The provisions of this §355.7001 adopted to be effective August 23, 1998, 23 TexReg 8422; amended to be effective October 9, 2000, 25 TexReg 10133.