After Years of Fighting Telehealth, Texas Now Leads the Country in Telehealth Policy Advances


by Robby Fraceschini

For years in Texas telehealth was the focus of litigation between the Texas Medical Board and Teladoc targeted at online prescribing regulation, administrative rulemaking procedures and accusations of anticompetitive behavior. In fact, until 2017, Texas required an in-person visit to establish a patient-provider relationship. Flash forward to 2019, however, and the state has made a turn in telehealth policy with the passage of several telehealth-related bills. As the state with the largest uninsured population, this new approach to telehealth may be its legislature’s attempt to plug care access gaps

Texas telehealth priorities outlined in bills

The state’s recent legislative actions reflect which populations and types of health care will benefit from telehealth, including children’s mental health, members of Medicaid managed care plans and behavioral health.

In the state budget, legislators allocated $49.5 million to create the Texas Child Mental Health Consortium. The consortium is intended to foster collaboration among health agencies and institutions in Texas, and will oversee the Texas Child Health Access Through Telemedicine program. “This bill will help physicians identify children and adolescents who are struggling with mental health challenges and get them into treatment. More importantly, it will help prevent young people from becoming a danger to themselves and others,” Senator Jane Nelson said in a press release.

Governor Greg Abbott also signed legislation requiring telehealth coverage parity in Medicaid managed care. While the bill does not require that telehealth services be paid at the same rate as in-person services, it does promote telehealth advocates’ notion that providers should be able to provide services through the modality most appropriate for their patients, and get paid for it. Parity has emerged as a priority in other states, including New Mexico, where a payment parity bill was signed earlier this year, and in California, where legislators are still debating a similar bill.

Other bills signaled a focus on behavioral health. As of September, Texas will be part of the Inter-Jurisdictional Psychology Compact, allowing psychologists in Texas and other compact states to practice across state lines, including through telehealth. Another bill also clarifies that Texas health professionals can provide tele-mental health across state lines, so long as they do so in compliance with other states’ laws.

Potential to improve access to care in a state with a high level of uninsured

These legislative advances may lead to increased use of telehealth in a state where residents increasingly lack access to coverage or care. Roughly 19% of Texans under the age of 65 lack health insurance, the highest rate of any state. Without Medicaid expansion in the state’s near-term future, Texas’s uninsured rate is likely to stay stubbornly high.

Texans also face hurdles to accessing the mental health care they need. A 2017 report commissioned by the state Senate found that budget cuts, hospital closures and gas in workforce development are severely straining the mental health system. When those with health needs end up on the streets, law enforcement and courts often send those individuals to prisons, where they are offered treatment. Although it often serves as an access point for treatment, the criminal justice system’s health services are constrained, and patients frequently get moved between facilities due to lack of psychiatric beds.

Yet the telehealth measures passed this year may offer hope. The Child Mental Health Consortium is tasked with finding ways to expand services to children throughout the state, including through telehealth and by training more providers. On the provider front, allowing for out of state psychologists to treat Texas residents through the compact will ease the provider shortage for mental health treatment in the state. And even more importantly, the Medicaid parity law will allow providers to expand their telehealth programs locally, offering the potential for increased care coordination and easing the burden of visit travel times in one of the country’s most rural states.

No single policy initiative will be a silver bullet, but Texas so far stands out as a leading state attempting to use telehealth to plug its gaps in coverage and care in 2019. Ultimately, Texas’ telehealth policy shifts reflect telehealth’s critical role as a care delivery mode for addressing and solving today’s healthcare needs.