87R8928 MM-D
By: Kolkhorst S.B. No. 2028
A BILL TO BE ENTITLED
AN ACT
relating to the Medicaid program, including the administration and
operation of the Medicaid managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.024142, 531.02493, 531.0501,
531.0502, 531.0512, and 531.0605 to read as follows:
Sec. 531.024142. NONHOSPITAL AMBULANCE TRANSPORT AND
TREATMENT PROGRAM. (a) The commission by rule shall develop and
implement a program designed to improve quality of care and lower
costs in Medicaid by:
(1) reducing avoidable transports to hospital
emergency departments and unnecessary hospitalizations;
(2) encouraging transports to alternative care
settings for appropriate care; and
(3) providing greater flexibility to ambulance care
providers to address the emergency health care needs of Medicaid
recipients following a 9-1-1 emergency services call.
(b) The program must be substantially similar to the Centers
for Medicare and Medicaid Services' Emergency Triage, Treat, and
Transport (ET3) model.
Sec. 531.02493. CERTIFIED NURSE AIDE PROGRAMS. (a) The
commission by rule shall establish and implement a program to
provide certified nurse aides trained in the Grand-Aide curriculum
or a substantially similar training program to provide in-home
support to a Medicaid recipient's care team after the recipient's
discharge from a hospital. The program must allow a Medicaid
managed care organization to treat payments to certified nurse
aides providing care under the program as quality payments for
purposes of meeting contract percentage requirements.
(b) Subject to Subsection (c), the commission by rule may
establish and implement a program under which the parent of a child
with complex medical needs may receive Medicaid reimbursement if
the parent:
(1) receives training and is certified as a nurse
aide; and
(2) provides care for the child.
(c) The commission may establish the program described by
Subsection (b) only if the commission determines that the program
will reduce Medicaid costs and improve the quality of care for
Medicaid recipients who are children with complex medical needs.
Sec. 531.0501. MEDICAID WAIVER PROGRAMS: INTEREST LIST
MANAGEMENT. (a) The commission shall establish an online portal
for use by individuals seeking Medicaid waiver program services to
request to be placed on a Medicaid waiver program interest list. The
portal must:
(1) provide the current interest list questionnaire
information for each Medicaid waiver program;
(2) allow real-time access to an individual's interest
list status; and
(3) result in information that will inform the
priority for an individual's placement on the most appropriate
interest list.
(b) The commission may remove an individual from a Medicaid
waiver program interest list if the individual has not had any
communication with the commission for at least five years. After
removing the individual from the interest list, the commission
shall maintain a record of:
(1) the individual's name and any other information
the commission has concerning the individual; and
(2) the individual's initial interest list request
date.
Sec. 531.0502. MEDICAID WAIVER PROGRAMS: ENROLLMENT AND
STRATEGIC PLAN. (a) Beginning not later than September 1, 2023,
the commission shall prioritize enrollment in Medicaid waiver
programs based on a Medicaid recipient's level of need for services
under a program.
(b) The commission shall develop a strategic plan to
identify:
(1) the most effective methods for assessing the needs
of Medicaid recipients on Medicaid waiver program interest lists
and for matching a recipient with the program that best meets the
recipient's level of need; and
(2) based on a needs assessment, a method for
prioritizing Medicaid recipients on Medicaid waiver program
interest lists and assigning those recipients who have been on an
interest list for five years or more a position on the list.
Sec. 531.0512. NOTIFICATION REGARDING CONSUMER DIRECTION
MODEL. The commission shall:
(1) develop a procedure to:
(A) verify that a Medicaid recipient or the
recipient's parent or legal guardian is informed regarding the
consumer-direction model and provided the option to choose to
receive care under that model; and
(B) if the individual declines to receive care
under the consumer-directed model, document the declination; and
(2) ensure that each Medicaid managed care
organization implements the procedure.
Sec. 531.0605. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
PROGRAM. (a) The commission shall collaborate with Medicaid
managed care organizations to develop and implement a pilot program
that is substantially similar to the program described by Section
3, Medicaid Services Investment and Accountability Act of 2019
(Pub. L. No. 116-16), to provide coordinated care through a health
home to children with complex medical conditions.
(b) The commission shall seek guidance from the Centers for
Medicare and Medicaid Services and the United States Department of
Health and Human Services regarding the design of the program and
actively seek and apply for federal funding to implement the
program.
(c) Not later than December 31, 2024, the commission shall
prepare and submit a report to the legislature that includes:
(1) a summary of the commission's evaluation of the
effect of the pilot program on the coordination of care for children
with complex medical conditions; and
(2) a recommendation as to whether the pilot program
should be continued, expanded, or terminated.
(d) The pilot program terminates and this section expires
September 1, 2025.
SECTION 2. Section 533.0025, Government Code, is amended by
adding Subsections (j) and (k) to read as follows:
(j) The commission shall implement the most cost-effective
option for the delivery of basic attendant and habilitation
services and services under the community attendant services
program for recipients under the STAR Medicaid managed care
program.
(k) The commission shall determine and implement the most
cost-effective option for the delivery of hospice services for
recipients under the STAR+PLUS Medicaid managed care program.
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Sections 533.00515 and 533.0069 to read as
follows:
Sec. 533.00515. MEDICATION THERAPY MANAGEMENT. The
executive commissioner shall collaborate with Medicaid managed
care organizations to implement medication therapy management
services to lower costs and improve quality outcomes for recipients
by reducing adverse drug events.
Sec. 533.0069. COORDINATION OF SCHOOL HEALTH AND RELATED
SERVICES. (a) The commission, in coordination with Medicaid
managed care organizations and the Texas Education Agency, shall
develop and adopt a policy for the Medicaid managed care program to
ensure the coordination and delivery of benefits and services
provided under the school health and related services program,
including coordination of school health and related services with
early childhood intervention services.
(b) Not later than December 31, 2024, the commission shall
prepare and submit a report to the legislature that includes a
summary of the commission's efforts regarding coordinating school
health and related services and early childhood intervention
services.
SECTION 4. Section 533.0076, Government Code, is amended by
amending Subsection (c) and adding Subsection (d) to read as
follows:
(c) The commission shall allow a recipient who is enrolled
in a managed care plan under this chapter to disenroll from that
plan and enroll in another managed care plan[:
[(1)] at any time for cause in accordance with federal
law[; and
[(2) once for any reason after the periods described by
Subsections (a) and (b)].
(d) The commission shall ensure that each recipient
receives information regarding the recipient's option under
Subsection (c).
SECTION 5. Section 533.009(c), Government Code, is amended
to read as follows:
(c) The executive commissioner, by rule, shall prescribe
the minimum requirements that a managed care organization, in
providing a disease management program, must meet to be eligible to
receive a contract under this section. The managed care
organization must, at a minimum, be required to:
(1) provide disease management services that have
performance measures for particular diseases that are comparable to
the relevant performance measures applicable to a provider of
disease management services under Section 32.057, Human Resources
Code; [and]
(2) show evidence of ability to manage complex
diseases in the Medicaid population; and
(3) if a disease management program provided by the
organization has low active participation rates, identify the
reason for the low rates and develop an approach to increase active
participation in disease management programs for high-risk
recipients.
SECTION 6. Section 32.028, Human Resources Code, is amended
by adding Subsection (p) to read as follows:
(p) The executive commissioner shall establish a
reimbursement rate for medication therapy management services.
SECTION 7. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Sections 32.0611 and 32.0612 to read as
follows:
Sec. 32.0611. COMMUNITY ATTENDANT SERVICES PROGRAM: HIRING
PROCESS. The commission shall require an entity with which the
commission contracts to provide personal attendant services to
recipients under the community attendant services program to
streamline the application and hiring process for prospective
attendants, including requiring the entity to consolidate any
required application documents and forms.
Sec. 32.0612. COMMUNITY ATTENDANT SERVICES PROGRAM:
QUALITY INITIATIVES AND EDUCATION INCENTIVES. (a) The commission
shall develop specific quality initiatives for attendants
providing services under the community attendant services program
to improve quality outcomes for program recipients.
(b) The commission shall coordinate with the Texas Higher
Education Coordinating Board and the Texas Workforce Commission to
develop a program to facilitate the award of academic or workforce
education credit for programs of study or courses of instruction
leading to a degree, certificate, or credential in a health-related
field based on an attendant's work experience under the community
attendant services program.
SECTION 8. (a) In this section, "commission," "executive
commissioner," and "Medicaid" have the meanings assigned by Section
531.001, Government Code.
(b) Using existing resources, the commission shall:
(1) review the commission's staff rate enhancement
programs to:
(A) identify and evaluate methods for improving
administration of those programs to reduce administrative barriers
that prevent an increase in direct care staffing and direct care
wages and benefits in nursing homes; and
(B) develop recommendations for increasing
participation in the programs;
(2) revise the commission's policies regarding the
quality incentive payment program (QIPP) to require improvements to
staff-to-patient ratios in nursing facilities participating in the
program and to set a goal for those nursing facilities to meet all
Centers for Medicare and Medicaid Services five-star quality rating
metrics by September 1, 2027;
(3) examine, in collaboration with the Department of
Family and Protective Services, the Centers for Medicare and
Medicaid Services' Integrated Care for Kids (InCK) Model to
determine whether implementing the model could benefit children in
this state, including children enrolled in the STAR Health Medicaid
managed care program;
(4) develop options for value-based arrangements with
nursing facilities that consider facility hospitalization rates,
infection control measures, and the number of citations for abuse
or neglect the facility has received; and
(5) identify factors influencing active participation
by Medicaid recipients in disease management programs by examining
variations in:
(A) eligibility criteria for the programs; and
(B) participation rates by health plan, disease
management program, and year.
(c) The executive commissioner may approve a capitation
payment system that provides for reimbursement for physicians under
a primary care capitation model or total care capitation model.
SECTION 9. (a) In this section, "commission" and "Medicaid"
have the meanings assigned by Section 531.001, Government Code.
(b) As soon as practicable after the effective date of this
Act, the commission shall conduct a study to determine the
cost-effectiveness and feasibility of providing to Medicaid
recipients who have been diagnosed with diabetes, including Type 1
diabetes, Type 2 diabetes, and gestational diabetes:
(1) diabetes self-management education and support
services that follow the National Standards for Diabetes
Self-Management Education and Support and that may be delivered by
a certified diabetes educator; and
(2) medical nutrition therapy services.
(c) If the commission determines that providing one or both
of the types of services described by Subsection (b) of this section
would improve health outcomes for Medicaid recipients and lower
Medicaid costs, the commission shall, notwithstanding Section
32.057, Human Resources Code, or Section 533.009, Government Code,
and to the extent allowed by federal law develop a program to
provide the benefits and seek prior approval from the Legislative
Budget Board before implementing the program.
SECTION 10. (a) In this section, "commission," "Medicaid,"
and "Medicaid managed care organization" have the meanings assigned
by Section 531.001, Government Code.
(b) As soon as practicable after the effective date of this
Act, the commission shall conduct a study to determine the
cost-effectiveness and feasibility of requiring that a Medicaid
managed care organization provide early childhood intervention
case management services to Medicaid recipients who receive
services under the school health and related services program.
(c) Not later than December 31, 2024, the commission shall
prepare and submit a report to the legislature that includes:
(1) a summary of the commission's evaluation of the
feasibility and cost-effectiveness of providing early childhood
intervention case management as a Medicaid managed care benefit;
and
(2) a recommendation as to whether the commission
should implement that benefit.
SECTION 11. (a) In this section, "commission" and
"Medicaid" have the meanings assigned by Section 531.001,
Government Code.
(b) As soon as practicable after the effective date of this
Act, the commission shall conduct a study to determine the
cost-effectiveness and feasibility of providing services under the
Community First Choice program to Medicaid recipients
transitioning from care in an institutional setting to care in a
community-based setting.
(c) If the commission determines that providing the types of
services described by Subsection (b) of this section would improve
health outcomes for Medicaid recipients and lower Medicaid costs,
the commission shall to the extent allowed by federal law develop a
program to provide the services and seek prior approval from the
Legislative Budget Board before implementing the program.
SECTION 12. 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 13. This Act takes effect September 1, 2021.