88R13754 MM-F
By: Plesa H.B. No. 4111
A BILL TO BE ENTITLED
AN ACT
relating to access to and the provision of behavioral and mental
health care services and trauma-informed care in the Medicaid
managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 533.0051(a) and (d), Government Code,
are amended to read as follows:
(a) The commission shall establish outcome-based
performance measures and incentives to include in each contract
between a health maintenance organization and the commission for
the provision of health care services, including behavioral and
mental health care services, to recipients that is procured and
managed under a value-based purchasing model. The performance
measures and incentives must:
(1) be designed to facilitate and increase recipients'
access to appropriate health care services, including behavioral
and mental health care services; [and]
(2) to the extent possible, align with other state and
regional quality care improvement initiatives; and
(3) for contracts for the provision of behavioral and
mental health care services to recipients under the STAR Health
program, be designed to facilitate and increase recipients' access
to trauma-informed care.
(d) Subject to Subsection (f), the commission shall assess
the feasibility and cost-effectiveness of including provisions in a
contract described by Subsection (a) that require the health
maintenance organization to provide to the providers in the
organization's provider network pay-for-performance opportunities
that support quality improvements in the care of recipients.
Pay-for-performance opportunities may include incentives for
providers to provide care after normal business hours and to
participate in the early and periodic screening, diagnosis, and
treatment program and other activities that improve recipients'
access to care, including trauma-informed care and behavioral and
mental health care services. If the commission determines that the
provisions are feasible and may be cost-effective, the commission
shall develop and implement a pilot program in at least one health
care service region under which the commission will include the
provisions in contracts with health maintenance organizations
offering managed care plans in the region.
SECTION 2. Section 533.0052, Government Code, is amended by
amending Subsection (a) and adding Subsections (c), (d), and (e) to
read as follows:
(a) A contract between a managed care organization and the
commission for the organization to provide health care services,
including behavioral and mental health care services, to recipients
under the STAR Health program must include a requirement that
[trauma-informed care training be offered to] each contracted
physician or provider who diagnoses or provides treatment for a
behavioral or mental health condition or prescribes psychotropic
medication receive training regarding the impact of trauma on
children and trauma-informed care.
(c) The commission shall determine the appropriate
information to include in the training required by Subsection (a).
The training must include information regarding:
(1) the effects of trauma, toxic stress, and adverse
childhood experiences on a child's:
(A) brain development; and
(B) cognitive, emotional, psychological,
physical, and behavioral functioning;
(2) trauma screening and accessing a child's trauma
history;
(3) the management of traumatic memories and
trauma-related symptoms;
(4) the overlap between symptoms of trauma and
symptoms of mental health disorders, including
attention-deficit/hyperactivity disorder, bipolar disorder, and
oppositional defiant disorder;
(5) the potential risks of using psychotropic
medication for children who have experienced trauma;
(6) the availability of research-supported or
evidence-based, trauma-informed, non-pharmacological
interventions;
(7) appropriate coding and billing procedures for
reimbursement of trauma-informed care, treatments, and services;
and
(8) the impact of trauma on children with an
intellectual or developmental disability.
(d) The commission shall make at least one opportunity to
receive the training required by Subsection (a) available at no
cost to each physician or provider described by Subsection (a) with
whom a contract is entered into or renewed.
(e) The commission may establish performance measures and
incentives described by Section 533.0051 to encourage improved
access to trauma-informed care and behavioral and mental health
care services for recipients under the STAR Health program and to
support contracted physicians or providers described by Subsection
(a) in receiving:
(1) training required by Subsection (a); and
(2) additional training in research-supported or
evidence-based, trauma-informed, non-pharmacological
interventions.
SECTION 3. Not later than January 1, 2024, the executive
commissioner of the Health and Human Services Commission shall
adopt rules necessary to implement Sections 533.0051 and 533.0052,
Government Code, as amended by this Act.
SECTION 4. (a) Sections 533.0051 and 533.0052, Government
Code, as amended by this Act, apply only to a contract between the
Health and Human Services Commission and a managed care
organization that is entered into or renewed on or after the
effective date of this Act.
(b) To the extent permitted by law or the terms of the
contract, the Health and Human Services Commission shall amend a
contract entered into before the effective date of this Act with a
managed care organization to comply with Sections 533.0051 and
533.0052, Government Code, as amended by this Act.
SECTION 5. Notwithstanding Section 533.0052, Government
Code, as amended by this Act, a physician or provider is not
required to complete the training described by that section before
September 1, 2027.
SECTION 6. 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 7. This Act takes effect September 1, 2023.