Texas 2023 - 88th Regular

Texas House Bill HB4111 Compare Versions

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1	1	88R13754 MM-F
2	2	By: Plesa H.B. No. 4111
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to access to and the provision of behavioral and mental
8	8	health care services and trauma-informed care in the Medicaid
9	9	managed care program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Sections 533.0051(a) and (d), Government Code,
12	12	are amended to read as follows:
13	13	(a) The commission shall establish outcome-based
14	14	performance measures and incentives to include in each contract
15	15	between a health maintenance organization and the commission for
16	16	the provision of health care services, including behavioral and
17	17	mental health care services, to recipients that is procured and
18	18	managed under a value-based purchasing model. The performance
19	19	measures and incentives must:
20	20	(1) be designed to facilitate and increase recipients'
21	21	access to appropriate health care services, including behavioral
22	22	and mental health care services; [and]
23	23	(2) to the extent possible, align with other state and
24	24	regional quality care improvement initiatives; and
25	25	(3) for contracts for the provision of behavioral and
26	26	mental health care services to recipients under the STAR Health
27	27	program, be designed to facilitate and increase recipients' access
28	28	to trauma-informed care.
29	29	(d) Subject to Subsection (f), the commission shall assess
30	30	the feasibility and cost-effectiveness of including provisions in a
31	31	contract described by Subsection (a) that require the health
32	32	maintenance organization to provide to the providers in the
33	33	organization's provider network pay-for-performance opportunities
34	34	that support quality improvements in the care of recipients.
35	35	Pay-for-performance opportunities may include incentives for
36	36	providers to provide care after normal business hours and to
37	37	participate in the early and periodic screening, diagnosis, and
38	38	treatment program and other activities that improve recipients'
39	39	access to care, including trauma-informed care and behavioral and
40	40	mental health care services. If the commission determines that the
41	41	provisions are feasible and may be cost-effective, the commission
42	42	shall develop and implement a pilot program in at least one health
43	43	care service region under which the commission will include the
44	44	provisions in contracts with health maintenance organizations
45	45	offering managed care plans in the region.
46	46	SECTION 2. Section 533.0052, Government Code, is amended by
47	47	amending Subsection (a) and adding Subsections (c), (d), and (e) to
48	48	read as follows:
49	49	(a) A contract between a managed care organization and the
50	50	commission for the organization to provide health care services,
51	51	including behavioral and mental health care services, to recipients
52	52	under the STAR Health program must include a requirement that
53	53	[trauma-informed care training be offered to] each contracted
54	54	physician or provider who diagnoses or provides treatment for a
55	55	behavioral or mental health condition or prescribes psychotropic
56	56	medication receive training regarding the impact of trauma on
57	57	children and trauma-informed care.
58	58	(c) The commission shall determine the appropriate
59	59	information to include in the training required by Subsection (a).
60	60	The training must include information regarding:
61	61	(1) the effects of trauma, toxic stress, and adverse
62	62	childhood experiences on a child's:
63	63	(A) brain development; and
64	64	(B) cognitive, emotional, psychological,
65	65	physical, and behavioral functioning;
66	66	(2) trauma screening and accessing a child's trauma
67	67	history;
68	68	(3) the management of traumatic memories and
69	69	trauma-related symptoms;
70	70	(4) the overlap between symptoms of trauma and
71	71	symptoms of mental health disorders, including
72	72	attention-deficit/hyperactivity disorder, bipolar disorder, and
73	73	oppositional defiant disorder;
74	74	(5) the potential risks of using psychotropic
75	75	medication for children who have experienced trauma;
76	76	(6) the availability of research-supported or
77	77	evidence-based, trauma-informed, non-pharmacological
78	78	interventions;
79	79	(7) appropriate coding and billing procedures for
80	80	reimbursement of trauma-informed care, treatments, and services;
81	81	and
82	82	(8) the impact of trauma on children with an
83	83	intellectual or developmental disability.
84	84	(d) The commission shall make at least one opportunity to
85	85	receive the training required by Subsection (a) available at no
86	86	cost to each physician or provider described by Subsection (a) with
87	87	whom a contract is entered into or renewed.
88	88	(e) The commission may establish performance measures and
89	89	incentives described by Section 533.0051 to encourage improved
90	90	access to trauma-informed care and behavioral and mental health
91	91	care services for recipients under the STAR Health program and to
92	92	support contracted physicians or providers described by Subsection
93	93	(a) in receiving:
94	94	(1) training required by Subsection (a); and
95	95	(2) additional training in research-supported or
96	96	evidence-based, trauma-informed, non-pharmacological
97	97	interventions.
98	98	SECTION 3. Not later than January 1, 2024, the executive
99	99	commissioner of the Health and Human Services Commission shall
100	100	adopt rules necessary to implement Sections 533.0051 and 533.0052,
101	101	Government Code, as amended by this Act.
102	102	SECTION 4. (a) Sections 533.0051 and 533.0052, Government
103	103	Code, as amended by this Act, apply only to a contract between the
104	104	Health and Human Services Commission and a managed care
105	105	organization that is entered into or renewed on or after the
106	106	effective date of this Act.
107	107	(b) To the extent permitted by law or the terms of the
108	108	contract, the Health and Human Services Commission shall amend a
109	109	contract entered into before the effective date of this Act with a
110	110	managed care organization to comply with Sections 533.0051 and
111	111	533.0052, Government Code, as amended by this Act.
112	112	SECTION 5. Notwithstanding Section 533.0052, Government
113	113	Code, as amended by this Act, a physician or provider is not
114	114	required to complete the training described by that section before
115	115	September 1, 2027.
116	116	SECTION 6. If before implementing any provision of this Act
117	117	a state agency determines that a waiver or authorization from a
118	118	federal agency is necessary for implementation of that provision,
119	119	the agency affected by the provision shall request the waiver or
120	120	authorization and may delay implementing that provision until the
121	121	waiver or authorization is granted.
122	122	SECTION 7. This Act takes effect September 1, 2023.