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A BILL TO BE ENTITLED
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AN ACT
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relating to improving health outcomes for certain recipients and |
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enrollees under certain state health benefits programs, through |
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improved program administration. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. It is the intent of the Legislature to improve |
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health outcomes for children and pregnant women through the Case |
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Management for Children and Pregnant Women Program. In recognizing |
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that nonmedical factors impact health outcomes, the Legislature |
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hereby authorizes the Medicaid program to provide case management |
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services for nonmedical needs that will improve health outcomes for |
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children and pregnant women. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.024183 to read as follows: |
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Sec. 531.024183. STANDARDIZED SCREENING QUESTIONS FOR |
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ASSESSING NONMEDICAL HEALTH-RELATED NEEDS OF CERTAIN PREGNANT |
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WOMEN; INFORMED CONSENT. (a) In this section: "Alternatives to |
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abortion program" means the program established by the commission |
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to enhance and increase resources that promote childbirth for women |
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facing unplanned pregnancy. |
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(b) The commission shall adopt standardized assessment |
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questions designed to screen for, identify, and aggregate data |
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regarding the nonmedical health-related needs of pregnant women |
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eligible for benefits under a public benefits program administered |
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by the commission or another health and human services agency, |
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including: |
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(1) Medicaid, and |
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(2) the alternatives to abortion program. |
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(c) Subject to Subsection (d), the standardized screening |
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questions must be used by managed care organizations participating |
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in Medicaid and providers participating in the alternatives to |
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abortion program. |
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(d) A managed care organization or provider participating |
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in the alternatives to abortion program may not conduct an |
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assessment of a pregnant woman using the standardized assessment |
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questions required by this section unless the organization or |
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provider: |
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(1) informs the woman: |
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(A) about the type of data that will be collected |
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during the assessment and the purposes for which the data will be |
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used; and |
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(B) that the collected data will become part of |
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the woman's medical record or service plan; and |
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(2) obtains the woman's informed consent to perform |
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the assessment. |
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(e) A managed care organization or alternatives to abortion |
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provider must provide to the commission, in the form and manner |
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prescribed by the commission, data the organization or provider |
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collects using the standardized screening questions required by |
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this section. |
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SECTION 3. Chapter 531, Government Code, is amended by |
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adding Subchapter Q to read as follows: |
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SUBCHAPTER Q. CASE MANAGEMENT SERVICES FOR CERTAIN PREGNANT WOMEN |
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Sec. 531.651. DEFINITIONS. In this subchapter: |
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(1) "Program services" means case management services |
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provided under the case management program for children and |
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pregnant women program as defined by Section 533.002555, including |
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assisting the enrollee's managed care organization in coordinating |
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the provision of Medicaid benefits in a manner that is consistent |
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with the plan of care. Services provided through this program to do |
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not pre-empt or replace a managed care organization's service |
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coordination function as required by the Commission. |
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(2) "Case management for children and pregnant women |
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program" has the meaning assigned by Section 533.002555. |
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(3) "Nonmedical health-related needs screening" means |
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an assessment conducted using the standardized screening tool |
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required under Section 531.024183. |
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Sec. 531.652. CASE MANAGEMENT FOR CHILDREN AND PREGNANT |
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WOMEN PROGRAM: PROVIDER QUALIFICATIONS. Program services may be |
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provided only by a provider who completes the standardized case |
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management training required by the commission under Section |
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531.653 and who is: |
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(1) an advanced practice nurse who holds a license, |
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other than a provisional or temporary license, under Chapter 301, |
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Occupations Code; |
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(2) a registered nurse who holds a license, other than |
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a provisional or temporary license, under Chapter 301, Occupations |
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Code, and: |
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(A) completed a baccalaureate degree program in |
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nursing; or |
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(B) completed an associate degree program in |
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nursing and has: |
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(i) at least two years of cumulative paid |
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full-time work experience; or |
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(ii) at least two years of cumulative, |
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supervised full-time educational internship or practicum |
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experience obtained in the last 10 years that included assessing |
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the psychosocial and health needs of and making community referrals |
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of: |
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(a) children who are 21 years of age |
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or younger; or |
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(b) pregnant women; |
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(3) a social worker who holds a license, other than a |
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provisional or temporary license, under Chapter 505, Occupations |
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Code, appropriate for the individual's practice, including the |
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practice of independent social work; |
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(4) a community health worker as defined by Section |
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48.001, Health and Safety Code, who is certified by the Department |
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of State Health Services; or |
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(5) a doula who is certified by a recognized national |
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certification program, as determined by the commission, unless the |
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doula qualifies as a certified community health worker under |
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Subdivision (4). |
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Sec. 531.653. CASE MANAGEMENT FOR CHILDREN AND PREGNANT |
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WOMEN PROGRAM: PROVIDER TRAINING. The commission shall require |
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that each provider of services in the case management for children |
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and pregnant women program complete training prescribed by the |
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commission. The training must be trauma-informed and include |
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instruction on: |
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(1) social services provided by this state and local |
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governments in this state; |
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(2) community assistance programs, including programs |
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providing: |
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(A) nutrition and housing assistance; |
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(B) counseling and parenting services; |
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(C) substance use disorder treatment; and |
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(D) domestic violence assistance and shelter; |
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(3) domestic violence and coercive control dynamics; |
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(4) methods for explaining and eliciting an eligible |
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recipient's informed consent to receive: |
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(A) case management services screening; and |
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(B) any services that may be offered as a result |
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of the screening; and |
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(5) procedures for: |
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(A) an eligible recipient to: |
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(i) decline case management services |
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screening; or |
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(ii) withdraw consent for offered services; |
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and |
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(B) ensuring that the recipient is not subject to |
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any retaliatory action for declining or discontinuing any |
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screenings or services provided by this program. |
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Sec. 531.654. INITIAL MEDICAL AND NONMEDICAL |
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HEALTH-RELATED SCREENINGS OF CERTAIN RECIPIENTS AND ENROLLEES. (a) |
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A managed care organization that provides health care services to a |
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pregnant woman under the STAR Medicaid managed care program shall, |
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subject to Section 531.024183(d), conduct an initial health needs |
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screening and nonmedical health-related needs screening of each |
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pregnant recipient or enrollee to determine, regardless of whether |
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the recipient or enrollee is considered to have a high-risk |
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pregnancy, if the recipient or enrollee: |
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(1) is eligible for service coordination benefits to |
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be provided by the managed care organization; or |
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(2) if the recipient or enrollee should be referred |
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for services under the case management for children and pregnant |
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women program. |
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(b) Service coordination benefits described by Subsection |
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(a) must include identifying and coordinating the provision of |
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non-covered services, community supports, and other resources the |
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managed care organization or provider has determined will improve |
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the recipient's or enrollee's health outcomes. |
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(c) A managed care organization must use the results of the |
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screenings conducted under Subsection (a) to determine if a |
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recipient or enrollee requires a more comprehensive assessment or |
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service coordination or referral for services in the case |
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management for children and pregnant women program. |
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(d) A managed care organization must inform each pregnant |
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woman for which an assessment is being conducted that: |
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(1) the woman has a right to decline the assessment or |
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choose to discontinue receiving the services identified by the |
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assessment at any time; and |
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(2) declining or discontinuing the services will not |
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result in retaliatory action against the woman in the provision of |
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other services. |
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Sec. 531.655. CASE MANAGEMENT FOR CHILDREN AND PREGNANT |
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WOMEN PROGRAM SERVICES OPTIONAL. A managed care organization |
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providing screenings under Section 531.654 must inform each |
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pregnant woman who is referred for services in the case management |
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for children and pregnant women program that: |
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(1) the woman has a right to decline the services or |
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choose to discontinue receiving the services at any time; and |
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(2) declining or discontinuing the services will not |
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result in retaliatory action against the woman in the provision of |
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other services. |
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SECTION 4. Section 32.024, Human Resources Code, is amended |
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by adding Subsection (pp) to read as follows: |
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(pp) For purposes of enrollment as a provider and |
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reimbursement under the medical assistance program, the commission |
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shall establish a separate provider type for a community health |
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worker as defined by Section 48.001, Health and Safety Code, who |
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provides case management services under the children and pregnant |
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women program, as defined by Section 533.002555, Government Code. |
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(qq) For purposes of enrollment as a provider and |
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reimbursement under the medical assistance program, the commission |
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shall establish a provider type for a doula who is certified by a |
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recognized national doula certification program approved by the |
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commission. |
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SECTION 5. (a) In this section: |
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(1) "Case management for children and pregnant women |
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program" has the meaning assigned by Section 533.002555, Government |
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Code. |
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(2) "Commission" means the Health and Human Services |
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Commission. |
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(b) Not later than December 1, 2024, the commission shall |
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prepare and submit to the legislature a status report on the |
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implementation of case management services provided to pregnant |
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women under the case management for children and pregnant women |
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program during the preceding fiscal year. To the extent available, |
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the report shall include de-identified information about: |
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(1) the nonmedical health-related needs of the women |
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receiving case management services; |
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(2) the number and types of referrals made of women to |
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nonmedical community assistance programs and providers; and |
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(3) the birth outcomes for the women. |
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SECTION 6. As soon as practicable after the effective date |
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of this Act, the Health and Human Services Commission shall: |
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(1) develop the standardized assessment tool as |
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required by Section 531.024183, Government Code, as added by this |
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Act; and |
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(2) revise the commission's standardized provider |
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training for the case management for children and pregnant women |
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program to comply with Section 531.653, Government Code, as added |
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by this Act. |
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SECTION 7. 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 8. This Act takes effect September 1, 2023. |