Texas 2023 - 88th Regular

Texas House Bill HB4541 Compare Versions

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1	1	88R4080 MM-D
2	2	By: Oliverson H.B. No. 4541
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the establishment of a pilot program to provide
8	8	comprehensive whole child care for children with complex medical
9	9	needs.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter B, Chapter 531, Government Code, is
12	12	amended by adding Section 531.06051 to read as follows:
13	13	Sec. 531.06051. PILOT PROGRAM FOR COMPREHENSIVE WHOLE CHILD
14	14	CARE FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. (a) In this section:
15	15	(1) "Child with complex medical needs" means a child
16	16	who has:
17	17	(A) one or more chronic health conditions that:
18	18	(i) affect three or more organ systems; and
19	19	(ii) result in severe functional
20	20	limitations, high health care needs or utilization, or the need for
21	21	or use of medical technology; or
22	22	(B) one life-limiting illness or rare pediatric
23	23	disease as defined in Section 529(a)(3) of the Federal Food, Drug,
24	24	and Cosmetic Act (21 U.S.C. 360ff(a)(3)).
25	25	(2) "Pilot program" means the comprehensive whole
26	26	child care for children with complex medical needs pilot program
27	27	established under this section.
28	28	(3) "Recipient" means a recipient of Medicaid.
29	29	(4) "Specialty provider" means a person who provides
30	30	health-related goods or services to a recipient, including a
31	31	provider of medication, therapy services, or durable medical
32	32	equipment or other equipment.
33	33	(b) The commission shall enter into an agreement with the
34	34	Dell Medical School at The University of Texas at Austin to develop
35	35	and implement in one or more areas of this state a phased pilot
36	36	program to establish an alternative model of care using existing
37	37	capitated rates outside the managed care model to provide
38	38	transformative, comprehensive multidisciplinary whole child care
39	39	and fully integrated health homes for children with complex medical
40	40	needs.
41	41	(c) The pilot program shall be designed to:
42	42	(1) develop, improve, and increase access to service
43	43	delivery innovations and comprehensive care centers of excellence
44	44	throughout this state for children with complex medical needs;
45	45	(2) incorporate and develop increased capacity
46	46	through a phased approach for children to receive:
47	47	(A) intermediate and post-acute care services;
48	48	(B) pediatric palliative and hospice care; and
49	49	(C) transition services and continuity of care;
50	50	(3) improve delivery and access in rural communities;
51	51	(4) continue to build and improve capacity to provide
52	52	health care services using telecommunications and information
53	53	technology;
54	54	(5) use existing electronic medical records systems to
55	55	integrate and streamline technology to improve access to care and
56	56	health outcomes for children participating in the program, track
57	57	the use of funding and best practices for maximizing money spent
58	58	under the pilot program, and better coordinate care, including with
59	59	respect to:
60	60	(A) diagnoses and cohesive care plans;
61	61	(B) treatment plans;
62	62	(C) telemedicine medical services and telehealth
63	63	services; and
64	64	(D) coordinated access and integration with home
65	65	health providers;
66	66	(6) develop and align targeted incentives to induce
67	67	integration and true value-based care that will result in:
68	68	(A) cohesive, coordinated multidisciplinary care
69	69	with improved health outcomes for children participating in the
70	70	program and long-term cost effectiveness;
71	71	(B) continuity of care for children
72	72	participating in the program; and
73	73	(C) reduced emergency room visits and
74	74	hospitalizations;
75	75	(7) identify shared needs to improve health outcomes,
76	76	including behavioral, social, and familial needs;
77	77	(8) use and incentivize appropriate and meaningful
78	78	quality outcome measures customized and tailored for children with
79	79	complex medical needs, including:
80	80	(A) improving coordination of care and access to
81	81	services;
82	82	(B) developing a shared plan of care;
83	83	(C) reducing unscheduled hospitalizations;
84	84	(D) reducing unmet needs; and
85	85	(E) encouraging families to be shared decision
86	86	makers;
87	87	(9) allow physicians or the medical team of a child
88	88	with complex medical needs to determine medical necessity of the
89	89	services recommended or provided for the child;
90	90	(10) allow the parent or guardian of a child with
91	91	complex medical needs to opt the child out of receiving benefits
92	92	through the STAR Kids managed care program and instead have the
93	93	child receive benefits under the pilot program; and
94	94	(11) be administered by a neutral board established by
95	95	the Dell Medical School at The University of Texas at Austin.
96	96	(d) Under the pilot program, the commission may take any
97	97	measures permitted under federal law that are necessary to:
98	98	(1) supersede and rework existing systemic and
99	99	regulatory barriers to care and integration for children with
100	100	complex medical needs under Medicaid;
101	101	(2) reduce administrative burdens inherent in the
102	102	current Medicaid system while maintaining high accountability
103	103	standards;
104	104	(3) adopt a specific procedure or other billing code
105	105	under Medicaid for a health care provider to diagnose or treat
106	106	conditions specific to children with complex medical needs,
107	107	including for:
108	108	(A) a value-based whole child visit to include a
109	109	bundled payment for multidisciplinary whole child complex care;
110	110	(B) care coordination;
111	111	(C) family support;
112	112	(D) intermediate and post-acute care;
113	113	(E) transition services;
114	114	(F) mid-tier caregiver workforce providers,
115	115	including certified nursing assistant care; and
116	116	(G) parents as paid caregivers; and
117	117	(4) allow a third-party payor to act in the capacity of
118	118	a preferred provider organization operating under Chapter 1301,
119	119	Insurance Code.
120	120	(e) The commission, in coordination with the Dell Medical
121	121	School at The University of Texas at Austin, shall develop a
122	122	statewide, neutral third-party de-identified data collection
123	123	registry to:
124	124	(1) improve access to care and recipient outcomes
125	125	under the pilot program;
126	126	(2) track funding and cost effectiveness,
127	127	utilization, clinical practices, safety and effectiveness, and the
128	128	allocation of resources under the pilot program; and
129	129	(3) identify best practices for the provision of care
130	130	to children with complex medical needs.
131	131	(e-1) The registry developed under Subsection (e) must be
132	132	integrated and coordinated with the all payor claims database
133	133	established under Subchapter I, Chapter 38, Insurance Code.
134	134	(f) For purposes of funding the pilot program, the
135	135	commission may:
136	136	(1) establish a Medicaid directed provider payment
137	137	program for children with complex medical needs who are enrolled in
138	138	the STAR Kids managed care program and make a portion of the
139	139	directed provider payment program funds available for the pilot
140	140	program based on the recipient's anticipated or actual
141	141	participation in the pilot program;
142	142	(2) obtain additional federal money under the
143	143	Advancing Care for Exceptional (ACE) Kids Act of 2019 enacted as
144	144	part of the Medicaid Services Investment and Accountability Act of
145	145	2019 (Pub. L. No. 116-16);
146	146	(3) leverage enhanced federal medical assistance
147	147	percentage funding related to establishing health homes available
148	148	under the Patient Protection and Affordable Care Act (Pub. L.
149	149	No. 111-148) as amended by the Health Care and Education
150	150	Reconciliation Act of 2010 (Pub. L. No. 111-152); and
151	151	(4) make funds available from a portion of STAR Kids
152	152	managed care program experience rebates.
153	153	(g) Not later than March 1, 2025, the commission, in
154	154	coordination with the Dell Medical School at The University of
155	155	Texas at Austin, shall prepare and submit to the governor,
156	156	lieutenant governor, and speaker of the house of representatives a
157	157	written report that includes:
158	158	(1) a summary of the pilot program's progress;
159	159	(2) an assessment of the impact of providing
160	160	transformative, comprehensive multidisciplinary whole child care
161	161	and fully integrated health homes for children with complex medical
162	162	needs;
163	163	(3) an update on any waiver or amendment request
164	164	necessary to modify the state Medicaid plan to provide the level of
165	165	care and health homes for children with complex medical needs
166	166	necessary under the pilot program;
167	167	(4) a description of the level of care and status of
168	168	health homes being provided to children with complex medical needs
169	169	at the time the report is prepared;
170	170	(5) an analysis of the effectiveness of providing the
171	171	level of care and health homes for children with complex medical
172	172	needs at the level at which those services are provided at the time
173	173	the report is prepared;
174	174	(6) estimates of the costs and potential savings of
175	175	expanding health programs administered by the commission to meet
176	176	the needs of children with complex medical needs;
177	177	(7) proposed modification to eligibility criteria for
178	178	providing the level of care and health homes for children with
179	179	complex medical needs under the pilot program; and
180	180	(8) any legislative recommendations.
181	181	(h) Not later than September 1, 2028, the commission shall
182	182	prepare and submit to the governor, lieutenant governor, and
183	183	speaker of the house of representatives a final written report on
184	184	the pilot program that includes:
185	185	(1) a summary of the results of the pilot program;
186	186	(2) a statement on the pilot program's success in
187	187	providing transformative, comprehensive multidisciplinary whole
188	188	child care and fully integrated health homes for children with
189	189	complex medical needs;
190	190	(3) a recommendation as to whether the pilot program
191	191	should be continued as a pilot program or permanent program; and
192	192	(4) any legislative recommendations.
193	193	(i) The pilot program established under this section
194	194	concludes September 1, 2028.
195	195	(j) This section expires September 1, 2029.
196	196	SECTION 2. Section 531.0605, Government Code, is repealed.
197	197	SECTION 3. If before implementing any provision of this Act
198	198	a state agency determines that a waiver or authorization, including
199	199	a state plan amendment, from a federal agency is necessary for
200	200	implementation of that provision, the agency affected by the
201	201	provision shall request the waiver or authorization and may delay
202	202	implementing that provision until the waiver or authorization is
203	203	granted.
204	204	SECTION 4. This Act takes effect September 1, 2023.