Texas Medicaid and Medical Telecommunications

Texas Medicaid covers medical telecommunication services for a range of medical, behavioral health and therapy services for children and adolescents. Medical telecommunication services must meet the same standard of care required for in-person services.

Who Can Provide It?

Telemedicine
Telemedicine providers may include:
- Physician
- Physician groups
- Clinical nurse specialist (CNS)
- Nurse practitioner (NP)
- Physician assistant (PA)
- Certified nurse midwife (CNM)
- Hospitals
A valid provider-patient relationship must exist between the provider and patient. A valid relationship exists if:
- The provider meets the same standard of care required for in-person service.
- The provider has previously administered in-person services or telemedicine service to the patient.
The current telemedicine service can establish a valid provider-patient relationship, which allows services to be provided remotely during the first visit with a new patient.

Before providing telemedicine services, the provider must:
- Obtain written or verbal informed consent for treatment from the patient or patient’s parent or guardian. The consent for telemedicine must be documented in the patient’s medical record.
- Provide written or verbal notification of relevant privacy practices and make a good faith effort to obtain the patient’s written acknowledgment of the notice, including by email.
After providing telemedicine services, the provider should:
- Provide the patient with guidance on the appropriate follow-up care and/or the next medical appointment.
Note: Texas Medicaid does not currently cover medical telecommunications for dentistry.
Telehealth
Telehealth service providers may include individuals as well as organizations.

Individuals:
- Licensed professional counselor (LPC)
- Licensed marriage and family therapist (LMFT)
- Licensed clinical social worker (LCSW)
- Psychologist
- Licensed psychological associate
- Provisionally licensed psychologist
- Licensed dietitian
Organizations:
- Early Childhood Intervention (ECI) services program
  - Statewide program for families with children ages birth through 35 months who have developmental delays or disabilities.
  - Promotes development and learning in familiar environments, provides family support and coordinates services to mitigate the impact of delays and disabilities and help children reach their potential.
  - Families with children enrolled in Medicaid do not pay for any ECI services.
  - When a delay or suspected delay is identified, health and medical professionals must make a referral to ECI as soon as possible, but no later than 7 days following identification.
- Comprehensive Care Program (CCP)
  - An expanded portion of Texas Health Steps that covers Medicaid services not usually allowed or that are more limited for the adult population.
  - Individuals must be ages birth through 20 years and eligible for and enrolled in Medicaid at the time of the service request and service delivery.
  - CCP may cover inpatient and outpatient medical, dental and therapy services as well as medical equipment and supplies.
- School Health and Related Services (SHARS) program
  - Allows local school districts, including public charter schools, to obtain Medicaid reimbursement for certain health-related services documented in a student’s Individualized Education Program (IEP).
  - Services must be medically necessary and reasonable to ensure that children with disabilities are able to participate in the educational program.
  - SHARS may cover a range of therapy, nursing, personal care and other services.

For Providers: Need to Know

Health-care providers enrolled in Texas Medicaid may provide eligible medical telecommunication services under their Texas Medicaid provider identifier number.
Texas Medicaid requirements and limitations are provided in the TMPPM in its the Telecommunication Services Handbook and Children’s Services Handbook. The TMPPM is updated monthly, and providers should always consult the current version.
Medicaid managed care organization (MCO) can provide a list of participating providers who use medical telecommunications. MCOs are obligated to consider reimbursement for all medically necessary Medicaid-covered benefits delivered via medical telecommunications.
A patient or parent/caregiver’s written or verbal consent for telemedicine or telehealth must be documented in the patient’s medical record.
Providers may issue a valid prescription as part of a remote medical service.
Medical records must be maintained for all telemedicine and telehealth services. Documentation for a service provided via medical telecommunications must be the same as for a comparable in-person service.

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