Texas 2021 - 87th Regular

Texas Senate Bill SB2028 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Kolkhorst, et al. S.B. No. 2028
	1	+	By: Kolkhorst S.B. No. 2028
	2	+	(In the Senate - Filed March 12, 2021; April 1, 2021, read
	3	+	first time and referred to Committee on Health & Human Services;
	4	+	April 29, 2021, reported adversely, with favorable Committee
	5	+	Substitute by the following vote: Yeas 9, Nays 0; April 29, 2021,
	6	+	sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 2028 By: Buckingham
2	9
3	10
4	11		A BILL TO BE ENTITLED
5	12		AN ACT
6	13		relating to the Medicaid program, including the administration and
7	14		operation of the Medicaid managed care program.
8	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	16		SECTION 1. Subchapter B, Chapter 531, Government Code, is
10	17		amended by adding Sections 531.024142, 531.02493, 531.0501,
11	18		531.0512, and 531.0605 to read as follows:
12	19		Sec. 531.024142. NONHOSPITAL AMBULANCE TRANSPORT AND
13	20		TREATMENT PROGRAM. (a) The commission by rule shall develop and
14	21		implement a program designed to improve quality of care and lower
15	22		costs in Medicaid by:
16	23		(1) reducing avoidable transports to hospital
17	24		emergency departments and unnecessary hospitalizations;
18	25		(2) encouraging transports to alternative care
19	26		settings for appropriate care; and
20	27		(3) providing greater flexibility to ambulance care
21	28		providers to address the emergency health care needs of Medicaid
22	29		recipients following a 9-1-1 emergency services call.
23	30		(b) The program must be substantially similar to the Centers
24	31		for Medicare and Medicaid Services' Emergency Triage, Treat, and
25	32		Transport (ET3) model.
26	33		Sec. 531.02493. CERTIFIED NURSE AIDE PROGRAM. (a) The
27	34		commission shall study:
28	35		(1) the cost-effectiveness of providing, as a Medicaid
29	36		benefit through a certified nurse aide trained in the Grand-Aide
30	37		curriculum or a substantially similar training program, in-home
31	38		support to a Medicaid recipient's care team after the recipient's
32	39		discharge from a hospital; and
33	40		(2) the feasibility of allowing a Medicaid managed
34	41		care organization to treat payments to certified nurse aides
35	42		providing care as described by Subdivision (1) as quality
36	43		improvement costs.
37	44		(b) Not later than December 1, 2022, the commission shall
38	45		prepare and submit a report to the governor and the legislature that
39	46		summarizes the commission's findings and conclusions from the
40	47		study.
41	48		(c) This section expires September 1, 2023.
42	49		Sec. 531.0501. MEDICAID WAIVER PROGRAMS: INTEREST LIST
43	50		MANAGEMENT. (a) The commission, in consultation with the
44	51		Intellectual and Developmental Disability System Redesign Advisory
45	52		Committee established under Section 534.053 and the STAR Kids
46	53		Managed Care Advisory Committee, shall study the feasibility of
47	54		creating an online portal for individuals to request to be placed
48	55		and check the individual's placement on a Medicaid waiver program
49	56		interest list. As part of the study, the commission shall determine
50	57		the most cost-effective automated method for determining the level
51	58		of need of an individual seeking services through a Medicaid waiver
52	59		program.
53	60		(b) Not later than January 1, 2023, the commission shall
54	61		prepare and submit a report to the governor, the lieutenant
55	62		governor, the speaker of the house of representatives, and the
56	63		standing legislative committees with primary jurisdiction over
57	64		health and human services that summarizes the commission's findings
58	65		and conclusions from the study.
59	66		(c) Subsections (a) and (b) and this subsection expire
60	67		September 1, 2023.
61	68		(d) The commission shall develop a protocol in the office of
62	69		the ombudsman to improve the capture and updating of contact
63	70		information for an individual who contacts the office of the
64	71		ombudsman regarding Medicaid waiver programs or services.
65	72		Sec. 531.0512. NOTIFICATION REGARDING CONSUMER DIRECTION
66	73		MODEL. The commission shall:
67	74		(1) develop a procedure to:
68	75		(A) verify that a Medicaid recipient or the
69	76		recipient's parent or legal guardian is informed regarding the
70	77		consumer direction model and provided the option to choose to
71	78		receive care under that model; and
72	79		(B) if the individual declines to receive care
73	80		under the consumer direction model, document the declination; and
74	81		(2) ensure that each Medicaid managed care
75	82		organization implements the procedure.
76	83		Sec. 531.0605. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
77	84		PROGRAM. (a) The commission shall collaborate with Medicaid
78	85		managed care organizations and the STAR Kids Managed Care Advisory
79	86		Committee to develop and implement a pilot program that is
80	87		substantially similar to the program described by Section 3,
81	88		Medicaid Services Investment and Accountability Act of 2019 (Pub.
82	89		L. No. 116-16), to provide coordinated care through a health home
83	90		to children with complex medical conditions.
84	91		(b) The commission shall seek guidance from the Centers for
85	92		Medicare and Medicaid Services and the United States Department of
86	93		Health and Human Services regarding the design of the program and,
87	94		based on the guidance, may actively seek and apply for federal
88	95		funding to implement the program.
89	96		(c) Not later than December 31, 2024, the commission shall
90	97		prepare and submit a report to the legislature that includes:
91	98		(1) a summary of the commission's implementation of
92	99		the pilot program; and
93	100		(2) if the pilot program has been operating for a
94	101		period sufficient to obtain necessary data, a summary of the
95	102		commission's evaluation of the effect of the pilot program on the
96	103		coordination of care for children with complex medical conditions
97	104		and a recommendation as to whether the pilot program should be
98	105		continued, expanded, or terminated.
99	106		(d) The pilot program terminates and this section expires
100	107		September 1, 2025.
101	108		SECTION 2. Section 533.00251, Government Code, is amended
102	109		by adding Subsection (h) to read as follows:
103	110		(h) In addition to the minimum performance standards the
104	111		commission establishes for nursing facility providers seeking to
105	112		participate in the STAR+PLUS Medicaid managed care program, the
106	113		executive commissioner shall adopt rules establishing minimum
107	114		performance standards applicable to nursing facility providers
108	115		that participate in the program. The commission is responsible for
109	116		monitoring provider performance in accordance with the standards
110	117		and requiring corrective actions, as the commission determines
111	118		necessary, from providers that do not meet the standards. The
112	119		commission shall share data regarding the requirements of this
113	120		subsection with STAR+PLUS Medicaid managed care organizations as
114	121		appropriate.
115	122		SECTION 3. Subchapter A, Chapter 533, Government Code, is
116	123		amended by adding Section 533.00515 to read as follows:
117	124		Sec. 533.00515. MEDICATION THERAPY MANAGEMENT. The
118	125		executive commissioner shall collaborate with Medicaid managed
119	126		care organizations to implement medication therapy management
120	127		services to lower costs and improve quality outcomes for recipients
121	128		by reducing adverse drug events.
122	129		SECTION 4. Section 533.009(c), Government Code, is amended
123	130		to read as follows:
124	131		(c) The executive commissioner, by rule, shall prescribe
125	132		the minimum requirements that a managed care organization, in
126	133		providing a disease management program, must meet to be eligible to
127	134		receive a contract under this section. The managed care
128	135		organization must, at a minimum, be required to:
129	136		(1) provide disease management services that have
130	137		performance measures for particular diseases that are comparable to
131	138		the relevant performance measures applicable to a provider of
132	139		disease management services under Section 32.057, Human Resources
133	140		Code; [and]
134	141		(2) show evidence of ability to manage complex
135	142		diseases in the Medicaid population; and
136	143		(3) if a disease management program provided by the
137	144		organization has low active participation rates, identify the
138	145		reason for the low rates and develop an approach to increase active
139	146		participation in disease management programs for high-risk
140	147		recipients.
141	148		SECTION 5. Section 32.028, Human Resources Code, is amended
142	149		by adding Subsection (p) to read as follows:
143	150		(p) The executive commissioner shall establish a
144	151		reimbursement rate for medication therapy management services.
145	152		SECTION 6. Section 32.054, Human Resources Code, is amended
146	153		by adding Subsection (f) to read as follows:
147	154		(f) To prevent serious medical conditions and reduce
148	155		emergency room visits necessitated by complications resulting from
149	156		a lack of access to dental care, the commission shall provide
150	157		medical assistance reimbursement for preventive dental services,
151	158		including reimbursement for at least one preventive dental care
152	159		visit per year, for an adult recipient with a disability who is
153	160		enrolled in the STAR+PLUS Medicaid managed care program. This
154	161		subsection does not apply to an adult recipient who is enrolled in
155	162		the STAR+PLUS home and community-based services (HCBS) waiver
156	163		program. This subsection may not be construed to reduce dental
157	164		services available to persons with disabilities that are otherwise
158	165		reimbursable under the medical assistance program.
159	166		SECTION 7. Subchapter B, Chapter 32, Human Resources Code,
160	167		is amended by adding Sections 32.0317 and 32.0611 to read as
161	168		follows:
162	169		Sec. 32.0317. REIMBURSEMENT FOR SERVICES PROVIDED UNDER
163	170		SCHOOL HEALTH AND RELATED SERVICES PROGRAM. The executive
164	171		commissioner shall adopt rules requiring parental consent for
165	172		services provided under the school health and related services
166	173		program in order for a school district to receive reimbursement for
167	174		the services. The rules must allow a school district to seek a
168	175		waiver to receive reimbursement for services provided to a student
169	176		who does not have a parent or legal guardian who can provide
170	177		consent.
171	178		Sec. 32.0611. COMMUNITY ATTENDANT SERVICES: QUALITY
172	179		INITIATIVES AND EDUCATION INCENTIVES. (a) The commission shall
173	180		develop specific quality initiatives for attendants providing
174	181		community attendant services to improve quality outcomes for
175	182		recipients.
176	183		(b) The commission shall coordinate with the Texas Higher
177	184		Education Coordinating Board and the Texas Workforce Commission to
178	185		develop a program to facilitate the award of academic or workforce
179	186		education credit for programs of study or courses of instruction
180	187		leading to a degree, certificate, or credential in a health-related
181	188		field based on an attendant's work experience providing community
182	189		attendant services.
183	190		SECTION 8. (a) In this section, "commission," "executive
184	191		commissioner," and "Medicaid" have the meanings assigned by Section
185	192		531.001, Government Code.
186	193		(b) Using existing resources, the commission shall:
187	194		(1) review the commission's staff rate enhancement
188	195		programs to:
189	196		(A) identify and evaluate methods for improving
190	197		administration of those programs to reduce administrative barriers
191	198		that prevent an increase in direct care staffing and direct care
192	199		wages and benefits in nursing homes; and
193	200		(B) develop recommendations for increasing
194	201		participation in the programs;
195	202		(2) revise the commission's policies regarding the
196	203		quality incentive payment program (QIPP) to require improvements to
197	204		staff-to-patient ratios in nursing facilities participating in the
198	205		program by January 1, 2023;
199	206		(3) examine, in collaboration with the Department of
200	207		Family and Protective Services, implementation in other states of
201	208		the Centers for Medicare and Medicaid Services' Integrated Care for
202	209		Kids (InCK) Model to determine whether implementing the model could
203	210		benefit children in this state, including children enrolled in the
204	211		STAR Health Medicaid managed care program; and
205	212		(4) identify factors influencing active participation
206	213		by Medicaid recipients in disease management programs by examining
207	214		variations in:
208	215		(A) eligibility criteria for the programs; and
209	216		(B) participation rates by health plan, disease
210	217		management program, and year.
211	218		(c) The executive commissioner may approve a capitation
212	219		payment system that provides for reimbursement for physicians under
213	220		a primary care capitation model or total care capitation model.
214	221		SECTION 9. (a) In this section, "commission" and
215	222		"Medicaid" have the meanings assigned by Section 531.001,
216	223		Government Code.
217	224		(b) As soon as practicable after the effective date of this
218	225		Act, the commission shall conduct a study to determine the
219	226		cost-effectiveness and feasibility of providing to Medicaid
220	227		recipients who have been diagnosed with diabetes, including Type 1
221	228		diabetes, Type 2 diabetes, and gestational diabetes:
222	229		(1) diabetes self-management education and support
223	230		services that follow the National Standards for Diabetes
224	231		Self-Management Education and Support and that may be delivered by
225	232		a certified diabetes educator; and
226	233		(2) medical nutrition therapy services.
227	234		(c) If the commission determines that providing one or both
228	235		of the types of services described by Subsection (b) of this section
229	236		would improve health outcomes for Medicaid recipients and lower
230	237		Medicaid costs, the commission shall, notwithstanding Section
231	238		32.057, Human Resources Code, or Section 533.009, Government Code,
232	239		and to the extent allowed by federal law develop a program to
233	240		provide the benefits and seek prior approval from the Legislative
234	241		Budget Board before implementing the program.
235	242		SECTION 10. (a) In this section, "commission," "Medicaid,"
236	243		and "Medicaid managed care organization" have the meanings assigned
237	244		by Section 531.001, Government Code.
238	245		(b) As soon as practicable after the effective date of this
239	246		Act, the commission shall conduct a study to:
240	247		(1) identify benefits and services, other than
241	248		long-term services and supports, provided under Medicaid that are
242	249		not provided in this state under the Medicaid managed care model;
243	250		and
244	251		(2) evaluate the feasibility, cost-effectiveness, and
245	252		impact on Medicaid recipients of providing the benefits and
246	253		services identified under Subdivision (1) of this subsection
247	254		through the Medicaid managed care model.
248	255		(c) Not later than December 1, 2022, the commission shall
249	256		prepare and submit a report to the legislature that includes:
250	257		(1) a summary of the commission's evaluation under
251	258		Subsection (b)(2) of this section; and
252	259		(2) a recommendation as to whether the commission
253	260		should implement providing benefits and services identified under
254	261		Subsection (b)(1) of this section through the Medicaid managed care
255	262		model.
256	263		SECTION 11. (a) In this section:
257	264		(1) "Commission," "Medicaid," and "Medicaid managed
258	265		care organization" have the meanings assigned by Section 531.001,
259	266		Government Code.
260	267		(2) "Dually eligible individual" has the meaning
261	268		assigned by Section 531.0392, Government Code.
262	269		(b) The commission shall conduct a study regarding dually
263	270		eligible individuals who are enrolled in the Medicaid managed care
264	271		program. The study must include an evaluation of:
265	272		(1) Medicare cost-sharing requirements for those
266	273		individuals;
267	274		(2) the cost-effectiveness for a Medicaid managed care
268	275		organization to provide all Medicaid-eligible services not covered
269	276		under Medicare and require cost-sharing for those services; and
270	277		(3) the impact on dually eligible individuals and
271	278		Medicaid providers that would result from the implementation of
272	279		Subdivision (2) of this subsection.
273	280		(c) Not later than September 1, 2022, the commission shall
274	281		prepare and submit a report to the legislature that includes:
275	282		(1) a summary of the commission's findings from the
276	283		study conducted under Subsection (b) of this section; and
277	284		(2) a recommendation as to whether the commission
278	285		should implement Subsection (b)(2) of this section.
279	286		SECTION 12. Notwithstanding Section 2, Chapter 1117 (H.B.
280	287		3523), Acts of the 84th Legislature, Regular Session, 2015, Section
281	288		533.00251(c), Government Code, as amended by Section 2 of that Act,
282	289		takes effect September 1, 2023.
283	290		SECTION 13. As soon as practicable after the effective date
284	291		of this Act, the Health and Human Services Commission shall conduct
285	292		the study and make the determination required by Section
286	293		531.0501(a), Government Code, as added by this Act.
287	294		SECTION 14. If before implementing any provision of this
288	295		Act a state agency determines that a waiver or authorization from a
289	296		federal agency is necessary for implementation of that provision,
290	297		the agency affected by the provision shall request the waiver or
291	298		authorization and may delay implementing that provision until the
292	299		waiver or authorization is granted.
293	300		SECTION 15. The Health and Human Services Commission is
294	301		required to implement this Act only if the legislature appropriates
295	302		money specifically for that purpose. If the legislature does not
296	303		appropriate money specifically for that purpose, the commission
297	304		may, but is not required to, implement this Act using other
298	305		appropriations available for the purpose.
299	306		SECTION 16. This Act takes effect September 1, 2021.
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