A new law in Texas could bring telemedicine visits to underserved children in the state's schools.
Starting next week, providers in the Lone Star State will be able to receive reimbursement for conducting telemedicine visits with Medicaid-enrolled children while they're in school. Lawmakers and providers have heralded the move as a way to improve access for children whose parents aren't always able to take off work.
The law requires the kids' parent or guardian to give consent for the visit, and a health professional, the school nurse, must be present with the patient during the session. If the child has a primary care physician, the law requires them to be provided with relevant records, and if they don't, the telemedicine provider must provide that information to their parent, along with a list of primary care providers.
“We always talk about accessibility and affordability, and telemedicine is the path to doing that," said Republican State Rep. Jodie Laubenberg, the bill's author. "I've always been very excited about this whole telemedicine concept."
Officials at Dallas-based Children's Health are particularly excited about the new law, because it means they will be able to sustain their quickly-growing school-based telemedicine program. The program has more than doubled in its second year, serving 57 schools in north Texas.
“It will allow us now to continue this innovative work we've been doing and actually get paid for these visits,” said Julie Hall-Barrow, the system's senior director of healthcare innovation and telemedicine.The system has gotten some funding for the pilot project through Texas's Medicaid Delivery System Reform Incentive Payment program.
Previously, patients could only do school-based telemedicine consultations with their own primary care physician, Hall-Barrow said. The problem is, many of the children who need the program don't have primary care physicians, Hall-Barrow said.
The system has two nurse practitioners and one doctor who evaluate patients, and they can make the important determination of whether a parent needs to leave work for a contagious child or whether the child can go back to class, Hall-Barrow said.
Although the law identifies a “physician” as the telemedicine provider, Hall-Barrow said the system expects to be able to use nurse practitioners once it's cleared by attorneys or an adjustment is made by lawmakers in the next legislative session.Though nurse practitioners have faced issues with practice authority in several states, she said Texas doctors are largely content with their use in telemedicine.
Laubenberg said the bill allows for the telemedicine session to be conducted by a nurse practitioner as long as they're overseen by a physician, as their authority is prescribed elsewhere in Texas state law.
Despite the Texas law's requirement a health professional to be present at the school, an office secretary or a teacher could just as easily facilitate a telemedicine visit as state policies evolve, said Jonathan Linkous, CEO of the American Telemedicine Association. Georgia and New Mexico have similar laws on reimbursement, and in the end, that's the only thing stopping the expansion of telemedicine, he said.
“It's not about the technology,” which has become significantly cheaper, Linkous said. “The issue is can you get this hooked up, and can you use it (legally) and can you get a provider to participate in the program and can you get paid?”