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A BILL TO BE ENTITLED
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AN ACT
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relating to implementation of certain health care provider |
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initiatives and measures designed to reduce costs and improve |
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recipient health outcomes under Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.085, Government Code, is amended to |
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read as follows: |
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Sec. 531.085. HOSPITAL EMERGENCY ROOM USE REDUCTION |
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INITIATIVES. (a) The commission shall develop and implement a |
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comprehensive plan to reduce the use of hospital emergency room |
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services by recipients under Medicaid. The plan may include: |
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(1) a pilot program designed to facilitate program |
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participants in accessing an appropriate level of health care, |
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which may include as components: |
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(A) providing program participants access to |
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bilingual health services providers; and |
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(B) giving program participants information on |
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how to access primary care physicians, advanced practice registered |
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nurses, and local health clinics; |
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(2) a pilot program under which health care providers, |
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other than hospitals, are given financial incentives for treating |
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recipients outside of normal business hours to divert those |
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recipients from hospital emergency rooms; |
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(3) payment of a nominal referral fee to hospital |
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emergency rooms that perform an initial medical evaluation of a |
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recipient and subsequently refer the recipient, if medically |
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stable, to an appropriate level of health care, such as care |
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provided by a primary care physician, advanced practice registered |
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nurse, or local clinic; |
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(4) a program under which the commission or a managed |
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care organization that enters into a contract with the commission |
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under Chapter 533 contacts, by telephone or mail, a recipient who |
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accesses a hospital emergency room three times during a six-month |
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period and provides the recipient with information on ways the |
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recipient may secure a medical home to avoid unnecessary treatment |
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at hospital emergency rooms; |
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(5) a health care literacy program under which the |
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commission develops partnerships with other state agencies and |
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private entities to: |
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(A) assist the commission in developing |
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materials that: |
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(i) contain basic health care information |
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for parents of young children who are recipients under Medicaid and |
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who are participating in public or private child-care or |
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prekindergarten programs, including federal Head Start programs; |
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and |
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(ii) are written in a language |
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understandable to those parents and specifically tailored to be |
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applicable to the needs of those parents; |
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(B) distribute the materials developed under |
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Paragraph (A) to those parents; and |
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(C) otherwise teach those parents about the |
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health care needs of their children and ways to address those needs; |
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and |
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(6) other initiatives developed and implemented in |
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other states that have shown success in reducing the incidence of |
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unnecessary treatment in hospital emergency rooms. |
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(b) The commission shall coordinate with hospitals and |
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other providers that receive supplemental payments under the |
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uncompensated care payment program operated under the Texas Health |
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Care Transformation and Quality Improvement Program waiver issued |
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under Section 1115 of the federal Social Security Act (42 U.S.C. |
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Section 1315) to identify and implement initiatives based on best |
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practices and models that are designed to reduce Medicaid |
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recipients' use of hospital emergency room services as a primary |
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means of receiving health care benefits, including initiatives |
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designed to improve recipients' access to and use of primary care |
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providers. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0862 to read as follows: |
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Sec. 531.0862. CONTINUED IMPLEMENTATION OF CERTAIN |
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INTERVENTIONS AND BEST PRACTICES BY PROVIDERS; BIANNUAL REPORT. |
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(a) The commission shall encourage Medicaid providers to continue |
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implementing effective interventions and best practices associated |
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with improvements in the health outcomes of Medicaid recipients |
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that were developed and achieved under the Delivery System Reform |
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Incentive Payment (DSRIP) program previously operated under the |
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Texas Health Care Transformation and Quality Improvement Program |
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waiver issued under Section 1115 of the federal Social Security Act |
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(42 U.S.C. Section 1315), through: |
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(1) existing provider incentive programs and the |
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creation of new provider incentive programs; |
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(2) the terms included in contracts with Medicaid |
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managed care organizations; |
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(3) implementation of alternative payment models; or |
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(4) adoption of other cost-effective measures. |
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(b) The commission shall biannually prepare and submit a |
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report to the legislature that contains a summary of the |
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commission's efforts under this section and Section 531.085(b). |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect September 1, 2021. |