2005 Legislative Compendium: Rural Health

Establishment of Emergency Services Districts

HB 2619 by Rep. Glen Hegar (R-Katy) and Sen. Judith Zaffirini (D-Laredo) requires the Office of Rural Community Affairs to create a program that will provide rural communities with information, training, and technical assistance related to Emergency Service Districts (ESD). Many people elected to serve on the boards of rural Texas' ESDs have no specific knowledge of the roles, functions, and budgetary issues of their office. These ESDs are political subdivisions established by the voters of an area for the purpose of raising money through ad valorem and/or sales taxes. ESDs have multiple purposes, most importantly to protect life through the provision of emergency rescue and ambulance services and the protection of property from fire.

Telemedicine Regulation and Reimbursement

SB 1340 by Sen. Frank Madla (D-San Antonio) and Rep. Dianne Delisi (R-Temple) requires the Texas State Board of Medical Examiners to adopt rules establishing supervisory requirements for a physician delegating a service to an individual who is not a physician, registered nurse, advanced practice nurse, or physician assistant, including one authorized to be a telepresenter. The bill also mandates the development and implementation of a mental health pilot program for Medicaid recipients that 1) ensures the delivery of mental health services, 2) ensures adequate supervision of mental health care providers who are not psychiatrists and who provide services through the use of telehealth or telemedicine, and 3) enables the state to determine whether extension of the use of telehealth or telemedicine would improve the delivery of mental health services.

The Texas Medicaid program offers few opportunities for reimbursement to physicians providing services to far-off patients via telemedicine. Reimbursement is limited to scenarios involving only physicians affiliated with a Texas medical or osteopathic school at the hub site, interacting at the remote site with another physician, advanced practice nurse, certified nurse midwife, federally qualified health center, or rural health clinic. All physicians and other providers involved must have a Medicaid number. Services provided to Medicaid patients via telemedicine outside these conditions are not eligible for reimbursement. TMA supported SB 1340, which proved a modest success in that it 1) establishes a separate modifier for telemedicine medical services eligible for reimbursement, easing claim filing hassles; 2) allows for reimbursement when the remote site presenter is a trained health professional who complies with the minimum standards to be determined by the executive commissioner of the Health and Human Services Commission; and 3) shall provide reimbursement to a physician for overseeing a telemedicine consultation if the telepresenter at the hub site is a physician, advanced practice nurse, registered nurse, or physician assistant.

Rural Health Close Call

SB 1240 by Senator Madla and HB 3102 by Rep. Jim McReynolds (D-Lufkin) were two bills TMA staunchly opposed: They would have allowed the employment of physicians by critical access hospitals, sole community hospitals not located in a metropolitan service area, and hospitals located in counties with less than 50,000 people.

Senator Madla and Representative McReynolds are long-time rural health and physician advocates. The rationale for the development of these bills was that the ability of hospitals to employ physicians would increase a rural area's ability to recruit and retain physicians by offering a set salary and benefits along with administrative support. TMA opposed these bills because of the many recruitment tools already available to rural communities and the fact that this type of law would breach the prohibition on the corporate practice of medicine, possibly negatively infringing on the patient-physician relationship.

Rural Health TMA Staff Contacts:

  • Yvonne Barton, Legislative Affairs, (512) 370-1359
  • Jen Blake, Governmental Affairs, (512) 370-1376

   Overview  | Tax Reform | Scope of Practice | Physician Ownership | Inadequate Health Plan Networks (Balanced Billing) | Managed Care/Insurance Reform | Texas State Board of Medical Examiners Sunset and Physician Licensure | Agency Sunset Review  | Corporate Practice of Medicine | Health Care Funding | Medicaid and CHIP | Indigent Care and the Uninsured | Workers' Compensation | Professional Liability Reform | Medical Education/Workforce | Child Health, Safety, and Nutrition/Fitness | Public Health | Border Health | Mental Health | Trauma/EMS | Prescription Drugs | Medical Science | Long-Term Care | Abortion | Transplantation/Organ Donation | Table of Contents


Last Updated On

June 06, 2011

Originally Published On

March 23, 2010

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