(a) Home telemonitoring services are a benefit of the Texas Medicaid Program as provided in this section and are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.
(b) Home telemonitoring services require scheduled remote monitoring of data related to a patient's health and transmission of the data to a licensed home health agency or a hospital, as those terms are defined by Texas Government Code §531.02164(a).
(c) Home telemonitoring service providers must:
  (1) comply with all applicable federal, state, and local laws and regulations;
  (2) be enrolled and approved for participation in the Texas Medicaid Program as home telemonitoring service providers;
  (3) bill for services covered under the Texas Medicaid Program in the manner and format prescribed by HHSC;
  (4) share clinical information gathered while providing home telemonitoring services with the patient's physician; and
  (5) not duplicate disease management program services provided under Human Resources Code §32.057 and further described in Division 32 of this subchapter (relating to Texas Medicaid Wellness Program).
(d) Home telemonitoring services are available only to Texas Medicaid clients who:
  (1) are diagnosed with diabetes, hypertension, or any other conditions allowed by Texas Government Code §531.02164 and determined by HHSC to be cost effective and feasible; and
  (2) exhibit two or more of the following risk factors:
    (A) two or more hospitalizations in the prior 12-month period;
    (B) frequent or recurrent emergency room admissions;
    (C) a documented history of poor adherence to ordered medication regimens;
    (D) a documented history of falls in the prior six-month period;
    (E) limited or absent informal support systems;
    (F) living alone or being home alone for extended periods of time; and
    (G) a documented history of care access challenges.
(e) Home telemonitoring services are reimbursed in accordance with Chapter 355 of this title (relating to Reimbursement Rates).
(f) Home telemonitoring services are available to Texas Medicaid clients who are 20 years of age and younger, with one or more of the following conditions:
  (1) end-stage solid organ disease;
  (2) organ transplant recipient; or
  (3) requiring mechanical ventilation.

Source Note: The provisions of this §354.1434 adopted to be effective October 1, 2013, 38 TexReg 6579; amended to be effective January 23, 2023, 48 TexReg 209