By: Kolkhorst S.B. No. 1136
(Frank)
A BILL TO BE ENTITLED
AN ACT
relating to implementation of certain health care provider
initiatives and measures designed to reduce costs and improve
recipient health outcomes under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.085, Government Code, is amended to
read as follows:
Sec. 531.085. HOSPITAL EMERGENCY ROOM USE REDUCTION
INITIATIVES. (a) The commission shall develop and implement a
comprehensive plan to reduce the use of hospital emergency room
services by recipients under Medicaid. The plan may include:
(1) a pilot program designed to facilitate program
participants in accessing an appropriate level of health care,
which may include as components:
(A) providing program participants access to
bilingual health services providers; and
(B) giving program participants information on
how to access primary care physicians, advanced practice registered
nurses, and local health clinics;
(2) a pilot program under which health care providers,
other than hospitals, are given financial incentives for treating
recipients outside of normal business hours to divert those
recipients from hospital emergency rooms;
(3) payment of a nominal referral fee to hospital
emergency rooms that perform an initial medical evaluation of a
recipient and subsequently refer the recipient, if medically
stable, to an appropriate level of health care, such as care
provided by a primary care physician, advanced practice registered
nurse, or local clinic;
(4) a program under which the commission or a managed
care organization that enters into a contract with the commission
under Chapter 533 contacts, by telephone or mail, a recipient who
accesses a hospital emergency room three times during a six-month
period and provides the recipient with information on ways the
recipient may secure a medical home to avoid unnecessary treatment
at hospital emergency rooms;
(5) a health care literacy program under which the
commission develops partnerships with other state agencies and
private entities to:
(A) assist the commission in developing
materials that:
(i) contain basic health care information
for parents of young children who are recipients under Medicaid and
who are participating in public or private child-care or
prekindergarten programs, including federal Head Start programs;
and
(ii) are written in a language
understandable to those parents and specifically tailored to be
applicable to the needs of those parents;
(B) distribute the materials developed under
Paragraph (A) to those parents; and
(C) otherwise teach those parents about the
health care needs of their children and ways to address those needs;
and
(6) other initiatives developed and implemented in
other states that have shown success in reducing the incidence of
unnecessary treatment in hospital emergency rooms.
(b) The commission shall coordinate with hospitals and
other providers that receive supplemental payments under the
uncompensated care payment program operated under the Texas Health
Care Transformation and Quality Improvement Program waiver issued
under Section 1115 of the federal Social Security Act (42 U.S.C.
Section 1315) to identify and implement initiatives based on best
practices and models that are designed to reduce Medicaid
recipients' use of hospital emergency room services as a primary
means of receiving health care benefits, including initiatives
designed to improve recipients' access to and use of primary care
providers.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0862 to read as follows:
Sec. 531.0862. CONTINUED IMPLEMENTATION OF CERTAIN
INTERVENTIONS AND BEST PRACTICES BY PROVIDERS; BIANNUAL REPORT.
(a) The commission shall encourage Medicaid providers to continue
implementing effective interventions and best practices associated
with improvements in the health outcomes of Medicaid recipients
that were developed and achieved under the Delivery System Reform
Incentive Payment (DSRIP) program previously operated under the
Texas Health Care Transformation and Quality Improvement Program
waiver issued under Section 1115 of the federal Social Security Act
(42 U.S.C. Section 1315), through:
(1) existing provider incentive programs and the
creation of new provider incentive programs;
(2) the terms included in contracts with Medicaid
managed care organizations;
(3) implementation of alternative payment models; or
(4) adoption of other cost-effective measures.
(b) The commission shall biannually prepare and submit a
report to the legislature that contains a summary of the
commission's efforts under this section and Section 531.085(b).
SECTION 3. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. This Act takes effect September 1, 2021.