Texas 2019 - 86th Regular

Texas House Bill HB1111 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Davis of Harris, et al. H.B. No. 1111
2		-	(Senate Sponsor - Kolkhorst)
3		-	(In the Senate - Received from the House April 30, 2019;
4		-	May 7, 2019, read first time and referred to Committee on Health &
5		-	Human Services; May 20, 2019, reported adversely, with favorable
6		-	Committee Substitute by the following vote: Yeas 9, Nays 0;
7		-	May 20, 2019, sent to printer.)
8		-	Click here to see the committee vote
9		-	COMMITTEE SUBSTITUTE FOR H.B. No. 1111 By: Campbell
	1	+	By: Davis of Harris, Springer, Guerra, H.B. No. 1111
	2	+	Thompson of Harris, Turner of Tarrant,
10	3
11	4
12	5		A BILL TO BE ENTITLED
13	6		AN ACT
14	7		relating to maternal and newborn health care.
15	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	9		SECTION 1. Subchapter B, Chapter 531, Government Code, is
17	10		amended by adding Section 531.02163 to read as follows:
18	11		Sec. 531.02163. STUDY ON PROVIDING CERTAIN MATERNAL CARE
19	12		MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND
20	13		TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the
21	14		commission shall conduct a study on the benefits and costs of
22	15		permitting reimbursement under Medicaid for prenatal and
23	16		postpartum care delivered through telemedicine medical services
24	17		and telehealth services.
25	18		(b) This section expires September 1, 2021.
26	19		SECTION 2. Subchapter B, Chapter 531, Government Code, is
27	20		amended by adding Section 531.0996 to read as follows:
28	21		Sec. 531.0996. PREGNANCY MEDICAL HOME PILOT PROGRAM. (a)
29	22		The commission shall develop a pilot program to establish pregnancy
30	23		medical homes that provide coordinated evidence-based maternity
31	24		care management to women who reside in a pilot program area and are
32	25		recipients of Medicaid through a Medicaid managed care model or
33	26		arrangement under Chapter 533. The commission shall implement the
34	27		pilot program in:
35	28		(1) at least two counties with populations of more
36	29		than two million;
37	30		(2) at least one county with a population of more than
38	31		100,000 and less than 500,000; and
39	32		(3) at least one rural county with high rates of
40	33		maternal mortality and morbidity as determined by the commission in
41	34		consultation with the Maternal Mortality and Morbidity Task Force
42	35		established under Chapter 34, Health and Safety Code.
43	36		(b) In implementing the pilot program, the commission shall
44	37		ensure each pregnancy medical home provides a maternity management
45	38		team that:
46	39		(1) consists of health care providers, including
47	40		obstetricians, gynecologists, family physicians, physician
48	41		assistants, certified nurse midwives, nurse practitioners, and
49	42		social workers, who provide health care services at the same
50	43		location in:
51	44		(A) a zip code with a high rate of maternal
52	45		mortality and morbidity; or
53	46		(B) an area with limited access to health care
54	47		providers who provide obstetrical care;
55	48		(2) conducts a risk assessment of each pilot program
56	49		participant on her entry into the program to determine the risk
57	50		classification for her pregnancy based on recognized maternal
58	51		mortality and morbidity risk assessment tools that indicate the
59	52		participant's:
60	53		(A) maternal age;
61	54		(B) maternal race;
62	55		(C) prior pregnancies that resulted in a live
63	56		birth, stillbirth, or miscarriage; and
64	57		(D) family history of disease;
65	58		(3) based on the assessment conducted under
66	59		Subdivision (2), establishes an individual pregnancy care plan for
67	60		each participant; and
68	61		(4) follows each participant throughout her pregnancy
69	62		and for a reasonable amount of time postpartum to reduce poor birth
70	63		outcomes and pregnancy-related maternal deaths occurring
71	64		postpartum.
72	65		(c) The commission may incorporate as a component of the
73	66		pilot program financial incentives for health care providers who
74	67		participate in a maternity management team. The commission may
75	68		consider as a criteria for the financial incentives whether the
76	69		health care provider in a maternity management team will implement
77	70		strategies and best practices recommended by the Maternal Mortality
78	71		and Morbidity Task Force established under Chapter 34, Health and
79	72		Safety Code, for reducing maternal mortality rates and maternal
80	73		health disparities for African American women in this state.
81	74		(d) The commission may waive a requirement of this section
82	75		for a pregnancy medical home located in a rural county.
83	76		(e) Notwithstanding Section 531.02176, the commission may:
84	77		(1) provide home telemonitoring services and
85	78		necessary durable medical equipment to pilot program participants
86	79		who are at risk of experiencing pregnancy-related complications, as
87	80		determined by a physician, to the extent the commission anticipates
88	81		the services and equipment will reduce unnecessary emergency room
89	82		visits or hospitalizations; and
90	83		(2) reimburse providers under Medicaid for the
91	84		provision of home telemonitoring services and durable medical
92	85		equipment under the pilot program.
93	86		(f) Not later than January 1, 2021, the commission shall
94	87		submit to the legislature a report on the pilot program. The report
95	88		must include:
96	89		(1) an evaluation of the pilot program's success in
97	90		reducing poor birth outcomes; and
98	91		(2) a recommendation on whether the pilot program
99	92		should continue, be expanded, or be terminated.
100	93		(f-1) The report required under Subsection (f) may include
101	94		statistical information and findings based on confidential
102	95		information collected under Section 34.019, Health and Safety Code,
103	96		provided the information and findings:
104	97		(1) are aggregated; and
105	98		(2) do not include any personally identifying
106	99		information of a woman, her family, or a health care provider.
107	100		(g) The executive commissioner shall:
108	101		(1) adopt rules to implement this section; and
109	102		(2) adopt and implement policies and procedures to
110	103		ensure that confidential information obtained under this section is
111	104		not disclosed in violation of state or federal law.
112	105		(h) This section expires September 1, 2023.
113	106		SECTION 3. Section 33.004(f), Health and Safety Code, is
114	107		amended to read as follows:
115	108		(f) The executive commissioner by rule shall [may]
116	109		establish the amounts charged for newborn screening fees, including
117	110		fees assessed for follow-up services, tracking confirmatory
118	111		testing, and diagnosis. In adopting rules under this subsection,
119	112		the executive commissioner shall ensure that amounts charged for
120	113		newborn screening fees are sufficient to cover the costs of
121	114		performing the screening.
122	115		SECTION 4. Chapter 33, Health and Safety Code, is amended by
123	116		adding Subchapter D to read as follows:
124	117		SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT
125	118		Sec. 33.051. DEFINITION. In this subchapter, "account"
126	119		means the newborn screening preservation account established under
127	120		Section 33.052.
128	121		Sec. 33.052. CREATION OF ACCOUNT. (a) The newborn
129	122		screening preservation account is a dedicated account in the
130	123		general revenue fund. The account is created solely for the
131	124		perpetual care and preservation of newborn screening in this state.
132	125		(b) Money in the account may be appropriated only to the
133	126		department and only for the purpose of carrying out the newborn
134	127		screening program established under this chapter.
135	128		(c) On November 1 of each year, the department shall
136	129		transfer to the account any unexpended and unencumbered money from
137	130		Medicaid reimbursements collected by the department for newborn
138	131		screening services during the preceding state fiscal year.
139	132		(d) The account is composed of:
140	133		(1) money transferred to the account under Subsection
141	134		(c);
142	135		(2) gifts, grants, donations, and legislative
143	136		appropriations; and
144	137		(3) interest earned on the investment of money in the
145	138		account.
146	139		(e) Section 403.0956, Government Code, does not apply to the
147	140		account.
148	141		(f) The department administers the account. The department
149	142		may solicit and receive gifts, grants, and donations from any
150	143		source for the benefit of the account.
151	144		Sec. 33.053. DEDICATED USE. (a) The department may use any
152	145		money remaining in the account after paying the costs of operating
153	146		the newborn screening program established under this chapter only
154	147		to:
155	148		(1) pay for capital assets, improvements, equipment,
156	149		and renovations for the laboratory established by the department to
157	150		ensure the continuous operation of the newborn screening program;
158	151		and
159	152		(2) pay for necessary renovations, construction,
160	153		capital assets, equipment, supplies, staff, and training
161	154		associated with providing additional newborn screening tests not
162	155		offered under this chapter before September 1, 2019, including the
163	156		operational costs incurred during the first year of implementing
164	157		the additional tests.
165	158		(b) The department may not use money from the account for
166	159		the department's general operating expenses.
167	160		Sec. 33.054. REPORT. If the department requires an
168	161		additional newborn screening test under Subchapter B the costs of
169	162		which are funded with money appropriated from the newborn screening
170	163		preservation account, the department shall, not later than December
171	164		31 of the first even-numbered year following the addition of the
172	165		test, prepare and submit a written report regarding the actions
173	166		taken by the department to fund and implement the test during the
174	167		preceding two years to:
175	168		(1) the governor;
176	169		(2) the lieutenant governor;
177	170		(3) the speaker of the house of representatives; and
178	171		(4) each standing committee of the legislature having
179	172		primary jurisdiction over the department.
180	173		SECTION 5. Chapter 34, Health and Safety Code, is amended by
181	174		adding Sections 34.0158 and 34.0159 to read as follows:
182	175		Sec. 34.0158. REPORT ON ACTIONS TO ADDRESS MATERNAL
183	176		MORTALITY RATES. Not later than December 1 of each even-numbered
184	177		year, the commission shall submit to the governor, the lieutenant
185	178		governor, the speaker of the house of representatives, the
186	179		Legislative Budget Board, and the appropriate standing committees
187	180		of the legislature a written report summarizing the actions taken
188	181		to address maternal morbidity and reduce maternal mortality rates.
189	182		The report must include information from programs and initiatives
190	183		created to address maternal morbidity and reduce maternal mortality
191	184		rates in this state, including:
192	185		(1) Medicaid;
193	186		(2) the children's health insurance program, including
194	187		the perinatal program;
195	188		(3) the Healthy Texas Women program;
196	189		(4) the Family Planning Program;
197	190		(5) this state's program under the Maternal and Child
198	191		Health Services Block Grant Act (42 U.S.C. Section 701 et seq.);
199	192		(6) the Perinatal Advisory Council;
200	193		(7) state health plans; and
201	194		(8) the Healthy Texas Babies program.
202	195		Sec. 34.0159. PROGRAM EVALUATIONS. The commission, in
203	196		collaboration with the task force and other interested parties,
204	197		shall:
205	198		(1) explore options for expanding the pilot program
206	199		for pregnancy medical homes established under Section 531.0996,
207	200		Government Code;
208	201		(2) explore methods for increasing the benefits
209	202		provided under Medicaid, including specialty care and
210	203		prescriptions, for women at greater risk of a high-risk pregnancy
211	204		or premature delivery;
212	205		(3) evaluate the impact of supplemental payments made
213	206		to obstetrics providers for pregnancy risk assessments on
214	207		increasing access to maternal health services;
215	208		(4) evaluate a waiver to fund managed care
216	209		organization payments for case management and care coordination
217	210		services for women at high risk of severe maternal morbidity on
218	211		conclusion of their eligibility for Medicaid;
219	212		(5) evaluate the average time required for pregnant
220	213		women to complete the Medicaid enrollment process;
221	214		(6) evaluate the use of Medicare codes for Medicaid
222	215		care coordination;
223	216		(7) study the impact of programs funded from the Teen
224	217		Pregnancy Prevention Program federal grant and evaluate whether the
225	218		state should continue funding the programs; and
226	219		(8) evaluate the use of telemedicine medical services
227	220		for women during pregnancy and the postpartum period.
228	221		SECTION 6. Chapter 34, Health and Safety Code, is amended by
229	222		adding Sections 34.019, 34.020, and 34.021 to read as follows:
230	223		Sec. 34.019. DATA COLLECTION. The task force, under the
231	224		direction of the department, shall annually collect information
232	225		relating to maternity care and postpartum depression in this state.
233	226		The information must be based on statistics for the preceding year
234	227		and include the:
235	228		(1) total number of live births;
236	229		(2) number of births by Medicaid recipients;
237	230		(3) number of births by women with health benefit plan
238	231		coverage;
239	232		(4) number of Medicaid recipients screened for
240	233		postpartum depression;
241	234		(5) number of women screened for postpartum depression
242	235		under health benefit plan coverage;
243	236		(6) number of women treated for postpartum depression
244	237		under health benefit plan coverage;
245	238		(7) number of women screened for postpartum depression
246	239		under the Healthy Texas Women program;
247	240		(8) number of women treated for postpartum depression
248	241		under the Healthy Texas Women program;
249	242		(9) number of claims for postpartum depression
250	243		treatment paid by the Healthy Texas Women program;
251	244		(10) number of claims for postpartum depression
252	245		treatment rejected by the Healthy Texas Women program;
253	246		(11) postpartum depression screening and treatment
254	247		billing codes and the number of claims for each billing code under
255	248		the Healthy Texas Women program;
256	249		(12) average number of days from the date of a
257	250		postpartum depression screening to the date the patient begins
258	251		treatment under Medicaid;
259	252		(13) average number of days from the date of a
260	253		postpartum depression screening to the date the patient begins
261	254		treatment under the Healthy Texas Women program;
262	255		(14) number of women who screened positive for
263	256		postpartum depression under Medicaid and the average number of days
264	257		following childbirth for the screening to occur;
265	258		(15) number of women who screened positive for
266	259		postpartum depression under health benefit plan coverage and the
267	260		average number of days following childbirth for the screening to
268	261		occur; and
269	262		(16) number of women who screened positive for
270	263		postpartum depression under the Healthy Texas Women program and the
271	264		average number of days following childbirth for the screening to
272	265		occur.
273	266		Sec. 34.020. PROGRAM TO DELIVER PRENATAL AND POSTPARTUM
274	267		CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN
275	268		COUNTIES. (a) In this section:
276	269		(1) "Postpartum care" and "prenatal care" have the
277	270		meanings assigned by Section 32.002.
278	271		(2) "Telehealth service" and "telemedicine medical
279	272		service" have the meanings assigned by Section 111.001, Occupations
280	273		Code.
281	274		(b) The commission, in consultation with the task force,
282	275		shall develop a program to deliver prenatal and postpartum care
283	276		through telehealth services or telemedicine medical services to
284	277		pregnant women with a low risk of experiencing pregnancy-related
285	278		complications, as determined by a physician. The commission shall
286	279		implement the program in:
287	280		(1) at least two counties with populations of more
288	281		than two million;
289	282		(2) at least one county with a population of more than
290	283		100,000 and less than 500,000; and
291	284		(3) at least one rural county with high rates of
292	285		maternal mortality and morbidity as determined by the commission in
293	286		consultation with the task force.
294	287		(c) The commission shall develop criteria for selecting
295	288		participants for the program by analyzing information in the
296	289		reports prepared by the task force under this chapter and the
297	290		outcomes of the study conducted under Section 531.02163, Government
298	291		Code.
299	292		(d) In developing and administering the program, the
300	293		commission shall endeavor to use innovative, durable medical
301	294		equipment to monitor fetal and maternal health.
302	295		(e) Notwithstanding Section 531.02176, Government Code, and
303	296		if the commission determines it is feasible and cost-effective, the
304	297		commission may:
305	298		(1) provide home telemonitoring services and
306	299		necessary durable medical equipment to women participating in the
307	300		program to the extent the commission anticipates the services and
308	301		equipment will reduce unnecessary emergency room visits or
309	302		hospitalizations; and
310	303		(2) reimburse providers under Medicaid for the
311	304		provision of home telemonitoring services and durable medical
312	305		equipment under the program.
313	306		(f) Not later than January 1, 2021, the commission shall
314	307		submit to the legislature a report on the program that evaluates the
315	308		program's success in delivering prenatal and postpartum care
316	309		through telehealth services or telemedicine medical services under
317		-	Subsection (b). ~~This subsection expires September 1, 2023.~~
	310	+	Subsection (b).
318	311		Sec. 34.021. APPLICATION FOR FEDERAL GRANTS. (a) The
319	312		executive commissioner shall apply to the United States Department
320	313		of Health and Human Services for grants under the federal
321	314		Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
322	315		(b) This section expires September 1, 2027.
323	316		SECTION 7. Section 81.090(c), Health and Safety Code, is
324	317		amended to read as follows:
325	318		(c) A physician or other person in attendance at a delivery
326	319		shall:
327	320		(1) take or cause to be taken a sample of blood or
328	321		other appropriate specimen from the mother on admission for
329	322		delivery; and
330	323		(2) submit the sample to an appropriately certified
331	324		laboratory for diagnostic testing approved by the United States
332	325		Food and Drug Administration for hepatitis B infection and
333	326		syphilis.
334		-	SECTION 8. Section 241.183(a), Health and Safety Code, is
335		-	amended to read as follows:
336		-	(a) The executive commissioner, in consultation with the
337		-	department, shall adopt rules:
338		-	(1) establishing the levels of care for neonatal and
339		-	maternal care to be assigned to hospitals;
340		-	(2) prescribing criteria for designating levels of
341		-	neonatal and maternal care, respectively, including specifying the
342		-	minimum requirements to qualify for each level designation;
343		-	(3) establishing a process for the assignment of
344		-	levels of care to a hospital for neonatal and maternal care,
345		-	respectively;
346		-	(4) establishing a process for amending the level of
347		-	care designation requirements, including a process for assisting
348		-	facilities in implementing any changes made necessary by the
349		-	amendments;
350		-	(5) dividing the state into neonatal and maternal care
351		-	regions;
352		-	(6) facilitating transfer agreements through regional
353		-	coordination;
354		-	(7) requiring payment, other than quality or
355		-	outcome-based funding, to be based on services provided by the
356		-	facility, regardless of the hospital's [facility's] level of care
357		-	designation; [and]
358		-	(8) prohibiting the denial of a neonatal or maternal
359		-	level of care designation to a hospital that meets the minimum
360		-	requirements for that level of care designation;
361		-	(9) establishing a process through which a hospital
362		-	may obtain a limited follow-up survey by an independent third party
363		-	to appeal the level of care designation assigned to the hospital;
364		-	(10) permitting a hospital to satisfy any requirement
365		-	for a Level I or II level of care designation that relates to an
366		-	obstetrics or gynecological physician by:
367		-	(A) granting maternal care privileges to a family
368		-	physician with obstetrics training or experience; and
369		-	(B) developing and implementing a plan for
370		-	responding to obstetrical emergencies that require services or
371		-	procedures outside the scope of privileges granted to the family
372		-	physician described by Paragraph (A);
373		-	(11) clarifying that, regardless of a hospital's level
374		-	of care designation, a health care provider at a designated
375		-	facility or hospital may provide the full range of health care
376		-	services:
377		-	(A) that the provider is authorized to provide
378		-	under state law; and
379		-	(B) for which the hospital has granted privileges
380		-	to the provider; and
381		-	(12) requiring the department to provide to each
382		-	hospital that receives a level of care designation a written
383		-	explanation of the basis for the designation, including, as
384		-	applicable, specific reasons that prevented the hospital from
385		-	receiving a higher level of care designation.
386		-	SECTION 9. Subchapter H, Chapter 241, Health and Safety
387		-	Code, is amended by adding Sections 241.1835, 241.1836, and
388		-	241.1865 to read as follows:
389		-	Sec. 241.1835. USE OF TELEMEDICINE MEDICAL SERVICES.
390		-	(a) In this section, "telemedicine medical service" has the
391		-	meaning assigned by Section 111.001, Occupations Code.
392		-	(b) The rules adopted under Section 241.183 must allow the
393		-	use of telemedicine medical services by a physician providing
394		-	on-call services to satisfy certain requirements identified by the
395		-	executive commissioner in the rules for a Level I, II, or III level
396		-	of care designation.
397		-	(c) In identifying a requirement for a level of care
398		-	designation that may be satisfied through the use of telemedicine
399		-	medical services under Subsection (b), the executive commissioner,
400		-	in consultation with the department, physicians of appropriate
401		-	specialties, statewide hospital associations, and other
402		-	appropriate interested persons, must ensure that the provision of a
403		-	service or procedure through the use of telemedicine medical
404		-	services is in accordance with the standard of care applicable to
405		-	the provision of the same service or procedure in an in-person
406		-	setting.
407		-	(d) Telemedicine medical services must be administered
408		-	under this section by a physician licensed to practice medicine
409		-	under Subtitle B, Title 3, Occupations Code.
410		-	(e) This section does not waive other requirements for a
411		-	level of care designation.
412		-	Sec. 241.1836. APPEAL PROCESS. (a) The rules adopted
413		-	under Section 241.183 establishing the appeal process for a level
414		-	of care designation assigned to a hospital must allow a hospital to
415		-	appeal to a three-person panel that includes:
416		-	(1) a representative of the department;
417		-	(2) a representative of the commission; and
418		-	(3) an independent person who:
419		-	(A) has expertise in the specialty area for which
420		-	the hospital is seeking a level of care designation;
421		-	(B) is not an employee of or affiliated with
422		-	either the department or the commission; and
423		-	(C) does not have a conflict of interest with the
424		-	hospital, department, or commission.
425		-	(b) The independent person on the panel described by
426		-	Subsection (a) must rotate after each appeal from a list of five to
427		-	seven similarly qualified persons. The department shall solicit
428		-	persons to be included on the list. A person must apply to the
429		-	department on a form prescribed by the department and be approved by
430		-	the commissioner to be included on the list.
431		-	Sec. 241.1865. WAIVER FROM LEVEL OF CARE DESIGNATION
432		-	REQUIREMENTS; CONDITIONAL DESIGNATION. (a) The department shall
433		-	develop and implement a process through which a hospital may
434		-	request and enter into an agreement with the department to:
435		-	(1) receive or maintain a level of care designation
436		-	for which the hospital does not meet all requirements conditioned
437		-	on the hospital, in accordance with a plan approved by the
438		-	department and outlined under the agreement, satisfying all
439		-	requirements for the level of care designation within a time
440		-	specified under the agreement, which may not exceed the first
441		-	anniversary of the effective date of the agreement; or
442		-	(2) waive one specific requirement for a level of care
443		-	designation in accordance with Subsection (c).
444		-	(b) A hospital may submit a written request under Subsection
445		-	(a) at any time. The department may make a determination on a
446		-	request submitted under that subsection at any time.
447		-	(c) The department may enter into an agreement with a
448		-	hospital to waive a requirement under Subsection (a)(2) only if the
449		-	department determines the waiver is justified considering:
450		-	(1) the expected impact on the accessibility of care
451		-	in the geographical area served by the hospital if the waiver is not
452		-	granted;
453		-	(2) the expected impact on quality of care;
454		-	(3) the expected impact on patient safety; and
455		-	(4) whether health care services related to the
456		-	requirement can be provided through telemedicine medical services
457		-	under Section 241.1835.
458		-	(d) A waiver agreement entered into under Subsection (a):
459		-	(1) must expire not later than at the end of each
460		-	designation cycle but may be renewed on expiration by the
461		-	department under the same or different terms; and
462		-	(2) may specify any conditions for ongoing reporting
463		-	and monitoring during the agreement.
464		-	(e) A hospital that enters into a waiver agreement under
465		-	Subsection (a) is required to satisfy all other requirements for a
466		-	level of care designation that are not waived in the agreement.
467		-	(f) The department shall post on the department's Internet
468		-	website and periodically update:
469		-	(1) a list of hospitals that enter into an agreement
470		-	with the department under this section; and
471		-	(2) an aggregated list of the requirements
472		-	conditionally met or waived in agreements entered into under this
473		-	section.
474		-	(g) A hospital that enters into an agreement with the
475		-	department under this section shall post on the hospital's Internet
476		-	website the nature and general terms of the agreement.
477		-	SECTION 10. Section 241.187, Health and Safety Code, is
478		-	amended by amending Subsection (l) and adding Subsections (m) and
479		-	(n) to read as follows:
480		-	(l) The advisory council is subject to Chapter 325,
481		-	Government Code (Texas Sunset Act). The advisory council shall be
482		-	reviewed during the period in which the Department of State Health
483		-	Services is reviewed [Unless continued in existence as provided by
484		-	that chapter, the advisory council is abolished and this section
485		-	expires September 1, 2025].
486		-	(m) The department, in consultation with the advisory
487		-	council, shall:
488		-	(1) conduct a strategic review of the practical
489		-	implementation of rules adopted in consultation with the department
490		-	under this subchapter that at a minimum identifies:
491		-	(A) barriers to a hospital obtaining its
492		-	requested level of care designation;
493		-	(B) whether the barriers identified under
494		-	Paragraph (A) are appropriate to ensure and improve neonatal and
495		-	maternal care;
496		-	(C) requirements for a level of care designation
497		-	that relate to gestational age; and
498		-	(D) whether, in making a level of care
499		-	designation for a hospital, the department or the perinatal
500		-	advisory council should consider:
501		-	(i) the geographic area in which the
502		-	hospital is located; and
503		-	(ii) regardless of the number of patients
504		-	of a particular gestational age treated by the hospital, the
505		-	hospital's capabilities in providing care to patients of a
506		-	particular gestational age;
507		-	(2) based on the review conducted under Subdivision
508		-	(1), recommend a modification of rules adopted under this
509		-	subchapter, as appropriate, to improve the process and methodology
510		-	of assigning level of care designations; and
511		-	(3) prepare and submit to the legislature:
512		-	(A) not later than December 31, 2019, a written
513		-	report that summarizes the department's review of neonatal care
514		-	conducted under Subdivision (1) and on actions taken by the
515		-	department and executive commissioner based on that review; and
516		-	(B) not later than December 31, 2020, a written
517		-	report that summarizes the department's review of maternal care
518		-	conducted under Subdivision (1) and on actions taken by the
519		-	department and executive commissioner based on that review.
520		-	(n) Subsection (m) and this subsection expire September 1,
521		-	2021.
522		-	SECTION 11. Chapter 1001, Health and Safety Code, is
523		-	amended by adding Subchapter K to read as follows:
	327	+	SECTION 8. Chapter 1001, Health and Safety Code, is amended
	328	+	by adding Subchapter K to read as follows:
524	329		SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT
525	330		PROGRAM
526	331		Sec. 1001.261. DEFINITIONS. In this subchapter:
527	332		(1) "Pilot program" means the high-risk maternal care
528	333		coordination services pilot program established under this
529	334		subchapter.
530	335		(2) "Promotora" or "community health worker" has the
531	336		meaning assigned by Section 48.001.
532	337		Sec. 1001.262. ESTABLISHMENT OF PILOT PROGRAM; RULES. (a)
533	338		The department shall develop and implement a high-risk maternal
534	339		care coordination services pilot program in one or more geographic
535	340		areas in this state.
536	341		(b) In implementing the pilot program, the department
537	342		shall:
538	343		(1) conduct a statewide assessment of training courses
539	344		provided by promotoras or community health workers that target
540	345		women of childbearing age;
541	346		(2) study existing models of high-risk maternal care
542	347		coordination services;
543	348		(3) identify, adapt, or create a risk assessment tool
544	349		to identify pregnant women who are at a higher risk for poor
545	350		pregnancy, birth, or postpartum outcomes; and
546	351		(4) create educational materials for promotoras and
547	352		community health workers that include information on the:
548	353		(A) assessment tool described by Subdivision
549	354		(3); and
550	355		(B) best practices for high-risk maternal care.
551	356		(c) The executive commissioner shall adopt rules as
552	357		necessary to implement this subchapter and prescribe the types of
553	358		information to be collected during the course of the pilot program
554	359		and included in the report described by Section 1001.264.
555	360		Sec. 1001.263. DUTIES OF DEPARTMENT. (a) The department
556	361		shall provide to each geographic area selected for the pilot
557	362		program the support, resources, technical assistance, training,
558	363		and guidance necessary to:
559	364		(1) screen all or a sample of pregnant patients with
560	365		the assessment tool described by Section 1001.262(b)(3); and
561	366		(2) integrate community health worker services for
562	367		women with high-risk pregnancies in:
563	368		(A) providing patient education on
564	369		health-enhancing behaviors and chronic disease management and
565	370		prevention;
566	371		(B) facilitating care coordination and
567	372		navigation activities; and
568	373		(C) identifying and reducing barriers to the
569	374		women's access to health care.
570	375		(b) The department shall develop training courses to
571	376		prepare promotoras and community health workers in educating and
572	377		supporting women at high risk for serious complications during the
573	378		pregnancy and postpartum periods.
574	379		Sec. 1001.264. PILOT PROGRAM REPORT. (a) Not later than
575	380		December 1 of each even-numbered year, the department shall prepare
576	381		and submit a report on the pilot program to the executive
577	382		commissioner and the chairs of the standing committees of the
578	383		senate and the house of representatives with primary jurisdiction
579	384		over public health and human services. The report may be submitted
580	385		with the report required under Section 34.0156.
581	386		(b) The report submitted under this section must include an
582	387		evaluation from the commissioner of the pilot program's
583	388		effectiveness.
584	389		(c) The report submitted under this section must include a
585	390		recommendation from the department on whether the pilot program
586	391		should continue, be expanded, or be terminated.
587	392		Sec. 1001.265. EXPIRATION. This subchapter expires
588	393		September 1, 2023.
589		-	SECTION 12. (a) The executive commissioner of the Health
590		-	and Human Services Commission shall adopt the rules required by:
591		-	(1) Section 33.004(f), Health and Safety Code, as
592		-	amended by this Act, and Section 1001.262(c), Health and Safety
593		-	Code, as added by this Act, not later than December 1, 2019, subject
594		-	to Subsection (b) of this section; and
595		-	(2) Section 241.183, Health and Safety Code, as
596		-	amended by this Act, as soon as practicable after the effective date
597		-	of this Act.
	394	+	SECTION 9. (a) Except as provided by Subsection (b) of this
	395	+	section, not later than December 1, 2019, the executive
	396	+	commissioner of the Health and Human Services Commission shall
	397	+	adopt the rules required under Section 33.004(f), Health and Safety
	398	+	Code, as amended by this Act, and Section 1001.262(c), Health and
	399	+	Safety Code, as added by this Act.
598	400		(b) Notwithstanding Subchapter K, Chapter 1001, Health and
599	401		Safety Code, as added by this Act, the Department of State Health
600	402		Services and the executive commissioner of the Health and Human
601	403		Services Commission are not required to comply with that subchapter
602	404		unless a specific appropriation for the implementation of the
603	405		subchapter is provided in a general appropriations act of the 86th
604	406		Legislature.
605		-	SECTION 13. (a) The executive commissioner of the Health
606		-	and Human Services Commission shall complete for each hospital in
607		-	this state the maternal level of care designation required under
608		-	Subchapter H, Chapter 241, Health and Safety Code, as amended by
609		-	this Act, not later than August 31, 2021.
610		-	(b) Notwithstanding Section 241.186, Health and Safety
611		-	Code, a hospital is not required to have a maternal level of care
612		-	designation as a condition of reimbursement for maternal services
613		-	through the Medicaid program before September 1, 2021.
614		-	(c) A hospital that submits an application to the Department
615		-	of State Health Services for a maternal level of care designation
616		-	under Subchapter H, Chapter 241, Health and Safety Code, before the
617		-	effective date of this Act may amend the application to reflect the
618		-	applicable changes in law made by this Act.
619		-	SECTION 14. As soon as practicable after the effective date
	407	+	SECTION 10. As soon as practicable after the effective date
620	408		of this Act, the executive commissioner of the Health and Human
621	409		Services Commission shall apply to the United States Department of
622	410		Health and Human Services for grants as required by Section 34.021,
623	411		Health and Safety Code, as added by this Act.
624		-	SECTION 15. If before implementing any provision of this
	412	+	SECTION 11. If before implementing any provision of this
625	413		Act a state agency determines that a waiver or authorization from a
626	414		federal agency is necessary for implementation of that provision,
627	415		the agency affected by the provision shall request the waiver or
628	416		authorization and may delay implementing that provision until the
629	417		waiver or authorization is granted.
630		-	SECTION 16. This Act takes effect immediately if it
	418	+	SECTION 12. This Act takes effect immediately if it
631	419		receives a vote of two-thirds of all the members elected to each
632	420		house, as provided by Section 39, Article III, Texas Constitution.
633	421		If this Act does not receive the vote necessary for immediate
634	422		effect, this Act takes effect September 1, 2019.
635		-	* * * * *