87R2189 MM-D
By: Oliverson H.B. No. 4365
A BILL TO BE ENTITLED
AN ACT
relating to a pilot project to improve health care outcomes and
reduce costs under Medicaid by providing participating recipients
with enhanced case management and other services to address certain
social determinants of health.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 533, Government Code, is amended by
adding Subchapter F to read as follows:
SUBCHAPTER F. PILOT PROJECT TO ADDRESS CERTAIN SOCIAL DETERMINANTS
OF HEALTH
Sec. 533.101. DEFINITIONS. In this subchapter:
(1) "Pilot project" means the pilot project
established under Section 533.102.
(2) "Project participant" means an individual who
participates in the pilot project.
(2) "Social determinants of health" means the
environmental conditions in which an individual lives that affect
the individual's health and quality of life.
Sec. 533.102. PILOT PROJECT FOR PROVIDING ENHANCED CASE
MANAGEMENT AND OTHER SERVICES TO ADDRESS SOCIAL DETERMINANTS OF
HEALTH. (a) The executive commissioner shall seek a waiver under
Section 1115 of the federal Social Security Act (42 U.S.C. Section
1315) to the state Medicaid plan to develop and implement a
five-year pilot project to improve the health care outcomes of
Medicaid recipients and reduce associated health care costs by
providing enhanced case management and other coordinated,
evidence-based, nonmedical intervention services designed to
directly address recipient needs related to the following social
determinants of health:
(1) housing instability;
(2) food insecurity;
(3) transportation insecurity;
(4) interpersonal violence; and
(5) toxic stress.
(b) The commission shall develop and implement the pilot
project with the assistance and involvement of Medicaid managed
care organizations, public or private stakeholders, and other
persons the commission determines appropriate.
(c) A pilot project established under this section shall be
conducted in one or more regions of this state as selected by the
commission.
Sec. 533.103. BENEFITS: CASE MANAGEMENT AND INTERVENTION
SERVICES. (a) The pilot project must assign a case manager to each
project participant. The case manager will determine, authorize,
and coordinate individualized nonmedical intervention services for
participants that directly address and improve the participants'
quality of life respecting one or more of the social determinants of
health described by Section 533.102.
(b) The commission shall prescribe the nonmedical
intervention services that may be provided to project participants,
which may include:
(1) the following services to address housing
instability:
(A) tenancy support and sustaining services;
(B) housing quality and safety improvement
services;
(C) legal assistance with connecting
participants to community resources to address legal issues, other
than providing legal representation or paying for legal
representation;
(D) one-time financial assistance to secure
housing; and
(E) short-term post-hospitalization housing;
(2) the following services to address food insecurity:
(A) assistance applying for benefits under the
supplemental nutrition assistance program or the federal special
supplemental nutrition program for women, infants, and children
administered by 42 U.S.C. Section 1786;
(B) assistance accessing school-based meal
programs;
(C) assistance locating and accessing food banks
or community-based summer and after-school food programs;
(D) nutrition counseling; and
(E) financial assistance for targeted nutritious
food or meal delivery services for individuals with medically
related special dietary needs if funding cannot be obtained through
other sources;
(3) the following services to address transportation
insecurity:
(A) educational assistance to gain access to
public and private forms of transportation, including
ride-sharing; and
(B) financial assistance for public
transportation or, if public transportation is not available,
private transportation to support participants' ability to access
pilot project services; and
(4) the following services to address interpersonal
violence and toxic stress:
(A) assistance with locating and accessing
community-based social services and mental health agencies with
expertise in addressing interpersonal violence;
(B) assistance with locating and accessing
high-quality child-care and after-school programs;
(C) assistance with locating and accessing
community engagement activities;
(D) navigational services focused on identifying
and improving existing factors posing a risk to the safety and
health of victims transitioning from traumatic situations,
including:
(i) obtaining a new phone number or mailing
address;
(ii) securing immediate shelter and
long-term housing;
(iii) making school arrangements to
minimize disruption of school schedules; and
(iv) connecting participants to
medical-legal partnerships to address overlap between health care
and legal needs;
(E) legal assistance for interpersonal
violence-related issues, including assistance securing a
protection order, other than providing legal representation or
paying for legal representation;
(F) assistance accessing evidence-based
parenting support; and
(G) assistance accessing evidence-based
maternal, infant, and early home visiting services.
Sec. 533.104. PARTICIPANT ELIGIBILITY. An individual is
eligible to participate in the pilot project if the individual:
(1) is a Medicaid recipient and receives benefits
through a Medicaid managed care model or arrangement under this
chapter;
(2) resides in a region in which the pilot project is
implemented; and
(3) meets other eligibility criteria established by
the commission for project participation, including:
(A) having or being at a higher risk than the
general population of developing a chronic or serious health
condition; and
(B) experiencing at least one of the social
determinants of health described by Section 533.102.
Sec. 533.105. RULES. The executive commissioner may adopt
rules to implement this subchapter.
Sec. 533.106. REPORT. Not later than September 1 of each
even-numbered year, the commission shall submit to the legislature
a report on the pilot project. The report must include:
(1) an evaluation of the pilot project's success in
reducing or eliminating poor health outcomes and reducing
associated health care costs; and
(2) a recommendation on whether the pilot project
should be continued, expanded, or terminated.
Sec. 533.107. EXPIRATION. This subchapter expires
September 1, 2027.
SECTION 2. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall apply for and actively pursue a waiver
under Section 1115 of the federal Social Security Act (42 U.S.C.
Section 1315) to the state Medicaid plan from the federal Centers
for Medicare and Medicaid Services or any other federal agency to
implement Subchapter F, Chapter 533, Government Code, as added by
this Act. The commission may delay implementing Subchapter F,
Chapter 533, Government Code, as added by this Act, until the waiver
applied for under this section is granted.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2021.