By: Hull H.B. No. 1575
A BILL TO BE ENTITLED
AN ACT
relating to improving health outcomes for certain recipients and
enrollees under certain state health benefits programs, through
improved program administration.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. It is the intent of the Legislature to improve
health outcomes for children and pregnant women through the Case
Management for Children and Pregnant Women Program. In recognizing
that nonmedical factors impact health outcomes, the Legislature
hereby authorizes the Medicaid program to provide case management
services for nonmedical needs that will improve health outcomes for
children and pregnant women.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.024183 to read as follows:
Sec. 531.024183. STANDARDIZED SCREENING QUESTIONS FOR
ASSESSING NONMEDICAL HEALTH-RELATED NEEDS OF CERTAIN PREGNANT
WOMEN; INFORMED CONSENT. (a) In this section: "Alternatives to
abortion program" means the program established by the commission
to enhance and increase resources that promote childbirth for women
facing unplanned pregnancy.
(b) The commission shall adopt standardized assessment
questions designed to screen for, identify, and aggregate data
regarding the nonmedical health-related needs of pregnant women
eligible for benefits under a public benefits program administered
by the commission or another health and human services agency,
including:
(1) Medicaid, and
(2) the alternatives to abortion program.
(c) Subject to Subsection (d), the standardized screening
questions must be used by managed care organizations participating
in Medicaid and providers participating in the alternatives to
abortion program.
(d) A managed care organization or provider participating
in the alternatives to abortion program may not conduct an
assessment of a pregnant woman using the standardized assessment
questions required by this section unless the organization or
provider:
(1) informs the woman:
(A) about the type of data that will be collected
during the assessment and the purposes for which the data will be
used; and
(B) that the collected data will become part of
the woman's medical record or service plan; and
(2) obtains the woman's informed consent to perform
the assessment.
(e) A managed care organization or alternatives to abortion
provider must provide to the commission, in the form and manner
prescribed by the commission, data the organization or provider
collects using the standardized screening questions required by
this section.
SECTION 3. Chapter 531, Government Code, is amended by
adding Subchapter Q to read as follows:
SUBCHAPTER Q. CASE MANAGEMENT SERVICES FOR CERTAIN PREGNANT WOMEN
Sec. 531.651. DEFINITIONS. In this subchapter:
(1) "Program services" means case management services
provided under the case management program for children and
pregnant women program as defined by Section 533.002555, including
assisting the enrollee's managed care organization in coordinating
the provision of Medicaid benefits in a manner that is consistent
with the plan of care. Services provided through this program to do
not pre-empt or replace a managed care organization's service
coordination function as required by the Commission.
(2) "Case management for children and pregnant women
program" has the meaning assigned by Section 533.002555.
(3) "Nonmedical health-related needs screening" means
an assessment conducted using the standardized screening tool
required under Section 531.024183.
Sec. 531.652. CASE MANAGEMENT FOR CHILDREN AND PREGNANT
WOMEN PROGRAM: PROVIDER QUALIFICATIONS. Program services may be
provided only by a provider who completes the standardized case
management training required by the commission under Section
531.653 and who is:
(1) an advanced practice nurse who holds a license,
other than a provisional or temporary license, under Chapter 301,
Occupations Code;
(2) a registered nurse who holds a license, other than
a provisional or temporary license, under Chapter 301, Occupations
Code, and:
(A) completed a baccalaureate degree program in
nursing; or
(B) completed an associate degree program in
nursing and has:
(i) at least two years of cumulative paid
full-time work experience; or
(ii) at least two years of cumulative,
supervised full-time educational internship or practicum
experience obtained in the last 10 years that included assessing
the psychosocial and health needs of and making community referrals
of:
(a) children who are 21 years of age
or younger; or
(b) pregnant women;
(3) a social worker who holds a license, other than a
provisional or temporary license, under Chapter 505, Occupations
Code, appropriate for the individual's practice, including the
practice of independent social work;
(4) a community health worker as defined by Section
48.001, Health and Safety Code, who is certified by the Department
of State Health Services; or
(5) a doula who is certified by a recognized national
certification program, as determined by the commission, unless the
doula qualifies as a certified community health worker under
Subdivision (4).
Sec. 531.653. CASE MANAGEMENT FOR CHILDREN AND PREGNANT
WOMEN PROGRAM: PROVIDER TRAINING. The commission shall require
that each provider of services in the case management for children
and pregnant women program complete training prescribed by the
commission. The training must be trauma-informed and include
instruction on:
(1) social services provided by this state and local
governments in this state;
(2) community assistance programs, including programs
providing:
(A) nutrition and housing assistance;
(B) counseling and parenting services;
(C) substance use disorder treatment; and
(D) domestic violence assistance and shelter;
(3) domestic violence and coercive control dynamics;
(4) methods for explaining and eliciting an eligible
recipient's informed consent to receive:
(A) case management services screening; and
(B) any services that may be offered as a result
of the screening; and
(5) procedures for:
(A) an eligible recipient to:
(i) decline case management services
screening; or
(ii) withdraw consent for offered services;
and
(B) ensuring that the recipient is not subject to
any retaliatory action for declining or discontinuing any
screenings or services provided by this program.
Sec. 531.654. INITIAL MEDICAL AND NONMEDICAL
HEALTH-RELATED SCREENINGS OF CERTAIN RECIPIENTS AND ENROLLEES. (a)
A managed care organization that provides health care services to a
pregnant woman under the STAR Medicaid managed care program shall,
subject to Section 531.024183(d), conduct an initial health needs
screening and nonmedical health-related needs screening of each
pregnant recipient or enrollee to determine, regardless of whether
the recipient or enrollee is considered to have a high-risk
pregnancy, if the recipient or enrollee:
(1) is eligible for service coordination benefits to
be provided by the managed care organization; or
(2) if the recipient or enrollee should be referred
for services under the case management for children and pregnant
women program.
(b) Service coordination benefits described by Subsection
(a) must include identifying and coordinating the provision of
non-covered services, community supports, and other resources the
managed care organization or provider has determined will improve
the recipient's or enrollee's health outcomes.
(c) A managed care organization must use the results of the
screenings conducted under Subsection (a) to determine if a
recipient or enrollee requires a more comprehensive assessment or
service coordination or referral for services in the case
management for children and pregnant women program.
(d) A managed care organization must inform each pregnant
woman for which an assessment is being conducted that:
(1) the woman has a right to decline the assessment or
choose to discontinue receiving the services identified by the
assessment at any time; and
(2) declining or discontinuing the services will not
result in retaliatory action against the woman in the provision of
other services.
Sec. 531.655. CASE MANAGEMENT FOR CHILDREN AND PREGNANT
WOMEN PROGRAM SERVICES OPTIONAL. A managed care organization
providing screenings under Section 531.654 must inform each
pregnant woman who is referred for services in the case management
for children and pregnant women program that:
(1) the woman has a right to decline the services or
choose to discontinue receiving the services at any time; and
(2) declining or discontinuing the services will not
result in retaliatory action against the woman in the provision of
other services.
SECTION 4. Section 32.024, Human Resources Code, is amended
by adding Subsection (pp) to read as follows:
(pp) For purposes of enrollment as a provider and
reimbursement under the medical assistance program, the commission
shall establish a separate provider type for a community health
worker as defined by Section 48.001, Health and Safety Code, who
provides case management services under the children and pregnant
women program, as defined by Section 533.002555, Government Code.
(qq) For purposes of enrollment as a provider and
reimbursement under the medical assistance program, the commission
shall establish a provider type for a doula who is certified by a
recognized national doula certification program approved by the
commission.
SECTION 5. (a) In this section:
(1) "Case management for children and pregnant women
program" has the meaning assigned by Section 533.002555, Government
Code.
(2) "Commission" means the Health and Human Services
Commission.
(b) Not later than December 1, 2024, the commission shall
prepare and submit to the legislature a status report on the
implementation of case management services provided to pregnant
women under the case management for children and pregnant women
program during the preceding fiscal year. To the extent available,
the report shall include de-identified information about:
(1) the nonmedical health-related needs of the women
receiving case management services;
(2) the number and types of referrals made of women to
nonmedical community assistance programs and providers; and
(3) the birth outcomes for the women.
SECTION 6. As soon as practicable after the effective date
of this Act, the Health and Human Services Commission shall:
(1) develop the standardized assessment tool as
required by Section 531.024183, Government Code, as added by this
Act; and
(2) revise the commission's standardized provider
training for the case management for children and pregnant women
program to comply with Section 531.653, Government Code, as added
by this Act.
SECTION 7. 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 8. This Act takes effect September 1, 2023.