89R6229 KKR-D
By: Bhojani H.B. No. 4459
A BILL TO BE ENTITLED
AN ACT
relating to the provision of certain services under the Medicaid
managed care program to recipients who are victims of family
violence.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 540, Government Code, as effective April
1, 2025, is amended by adding Subchapter T to read as follows:
SUBCHAPTER T. FAMILY VIOLENCE SERVICES
Sec. 540.0951. DEFINITIONS. In this subchapter:
(1) "Family violence" has the meaning assigned by
Section 71.004, Family Code.
(2) "Family violence services provider" means a
licensed health care provider, licensed mental health or behavioral
health provider, or other provider designated by commission rule
who provides family violence services.
(3) "Family violence services" means services that
provide trauma-informed care to a recipient who is a survivor of
family violence, including health care services, mental and
behavioral health services, and other services designated by
commission rule as family violence services.
(4) "Service coordination" includes:
(A) contact between a recipient and a service
coordinator for a Medicaid managed care organization;
(B) coordination, including with providers, to
assist a recipient in accessing benefits provided by the
organization; and
(C) coordination, including with providers as
appropriate, to assist a recipient in accessing services provided
by other entities or service providers in the recipient's
community.
Sec. 540.0952. FAMILY VIOLENCE SERVICES; SERVICE
COORDINATION. (a) A contract between a Medicaid managed care
organization and the commission to provide health care services to
recipients must:
(1) require the contracting Medicaid managed care
organization to:
(A) ensure recipients who are survivors of family
violence have access to family violence services providers and
family violence services; and
(B) provide family violence services
coordination to those recipients; and
(2) include performance metrics designed to assist the
commission in evaluating the organization's coordination and
provision of those services, including metrics related to:
(A) the number of family violence screenings
conducted;
(B) the number and types of referrals for family
violence services; and
(C) the organization's engagement with family
violence services providers.
(b) In implementing family violence services coordination
for recipients, a Medicaid managed care organization must:
(1) establish partnerships with licensed family
violence services providers to develop service coordination
pathways for recipients who are survivors of family violence;
(2) develop protocols for integrating the provision of
trauma-informed family violence services with health care and
mental health services provided to recipients in a manner that
meets a recipient's specific needs;
(3) require health care and mental health providers
participating in the organization's provider network to conduct
screenings of recipients to identify signs that a recipient is a
survivor of family violence that:
(A) use evidence-based screening methods
sensitive to a recipient's needs; and
(B) are conducted by personnel with appropriate
training about trauma-informed care, family violence awareness,
and culturally competent support practices;
(4) develop a streamlined process for referring
recipients to domestic violence services providers that ensures
continuity of care and provides access to specialized services and
family violence resources, including emergency shelters and
organizations providing legal support; and
(5) ensure recipients have access to mental and
behavioral health services that specifically address trauma
experienced by survivors of domestic violence, including:
(A) counseling to address the immediate and
long-term mental health needs of a recipient; and
(B) group counseling or support groups.
Sec. 540.0953. SERVICE COORDINATOR TRAINING. A Medicaid
managed care organization must ensure that each individual who
provides family violence service coordination to recipients under
this subchapter receive training on trauma-informed care, family
violence awareness, and culturally competent support practices.
Sec. 540.0954. MEDICAID MANAGED CARE ORGANIZATION ANNUAL
REPORT. A Medicaid managed care organization shall annually submit
to the commission a written report detailing the organization's
efforts to comply with this subchapter during the preceding year.
The report must include data on:
(1) the number of family violence screenings conducted
by providers included in the organization's provider network;
(2) the number and type of recipient referrals for
family violence services made by providers; and
(3) the scope of family violence mental health and
behavioral health services provided to recipients.
Sec. 540.0955. ANNUAL AUDIT. (a) The commission shall
annually conduct a performance audit of a Medicaid managed care
organization to:
(1) ensure the organization is providing family
violence services coordination; and
(2) evaluate the organization's performance in
providing family violence services and service coordination to
recipients under this subchapter.
(b) In evaluating a Medicaid managed care organization's
performance under Subsection (a), the commission shall:
(1) use the metrics included in the organization's
contract with the commission; and
(2) assess the quality of care and service
coordination provided to recipients by the organization.
Sec. 540.0956. RULES. The executive commissioner shall
adopt rules necessary to implement this subchapter, including rules
designating:
(1) services that are considered family violence
services; and
(2) health care providers that may receive Medicaid
reimbursement for providing family violence services.
SECTION 2. Section 32.024, Human Resources Code, is amended
by adding Subsection (ss) to read as follows:
(ss) The commission shall ensure that medical assistance
reimbursement is provided to a family violence services provider
for providing family violence services to a recipient under
Subchapter T, Chapter 540, Government Code.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 540, Government Code, as effective April
1, 2025, that is entered into or renewed on or after the effective
date of this Act, require that the managed care organization comply
with Subchapter T, Chapter 540, Government Code, as added by this
Act.
(b) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations under
Chapter 533, Government Code, or under Chapter 540, Government
Code, as effective April 1, 2025, before the effective date of this
Act to require those managed care organizations to comply with
Subchapter T, Chapter 540, Government Code, as added by this Act.
To the extent of a conflict between Subchapter T, Chapter 540,
Government Code, as added by this Act, and a provision of a contract
with a managed care organization entered into before the effective
date of this Act, the contract provision prevails.
SECTION 4. 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 5. This Act takes effect September 1, 2025.