Provider Alert! Home Telemonitoring Services Added to Federally Qualified Health Centers and Rural Health Clinics

Date: July 3, 2024
 
Attention: FQHCs and RHCs

Effective date: September 1, 2024

Call to action: The purpose of this communication is to inform our providers that effective for dates of service on or after September 1, 2024, FQHC and RHC providers performing home telemonitoring services may bill and be reimbursed for HCPCS code G0511 as an add-on procedure code.

Background information: House Bill (H.B.) 2727, 88th Legislature, Regular Session, 2023 directs Health and Human Services Commission (HHSC) to add Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as providers of home telemonitoring services. In addition, the bill clarifies that the term “home telemonitoring services” is synonymous with “remote patient monitoring”, requires home telemonitoring providers to establish a plan of care with outcome measures for each patient, and requires providers to share the plan and outcome measures with the patient’s physician.

How this impacts providers:

• For FQHCs: The home telemonitoring fee should not be included in any cost reporting that is used to calculate a prospective payment system (PPS) or alternative prospective payment system (APPS) per visit encounter rate.
• For RHCs: The home telemonitoring fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) PPS per visit encounter rate.
• If an FQHC or RHC is eligible for the payment of both an encounter fee and a home telemonitoring fee for the same client on the same date of service, the FQHC or RHC must submit a claim for the home telemonitoring fee separately from the claim that was submitted for the encounter.
• Clarifications for telemedicine and telehealth include that FQHC practitioners may be employees of the FQHC or contracted with the FQHC. In addition, RHC practitioners may be employees of the RHC or contracted with the RHC.

Next step for Providers: Providers are advised to follow the guidance available in the policy once it publishes on September 1, 2024.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.