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A BILL TO BE ENTITLED
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AN ACT
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relating to maternal and newborn health care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02163 to read as follows: |
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Sec. 531.02163. STUDY ON PROVIDING CERTAIN MATERNAL CARE |
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MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND |
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TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the |
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commission shall conduct a study on the benefits and costs of |
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permitting reimbursement under Medicaid for prenatal and |
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postpartum care delivered through telemedicine medical services |
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and telehealth services. |
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(b) This section expires September 1, 2021. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0996 to read as follows: |
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Sec. 531.0996. PREGNANCY MEDICAL HOME PILOT PROGRAM. (a) |
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The commission shall develop a pilot program to establish pregnancy |
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medical homes that provide coordinated evidence-based maternity |
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care management to women who reside in a pilot program area and are |
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recipients of Medicaid through a Medicaid managed care model or |
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arrangement under Chapter 533. The commission shall implement the |
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pilot program in: |
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(1) at least two counties with populations of more |
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than two million; |
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(2) at least one county with a population of more than |
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100,000 and less than 500,000; and |
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(3) at least one rural county with high rates of |
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maternal mortality and morbidity as determined by the commission in |
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consultation with the Maternal Mortality and Morbidity Task Force |
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established under Chapter 34, Health and Safety Code. |
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(b) In implementing the pilot program, the commission shall |
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ensure each pregnancy medical home provides a maternity management |
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team that: |
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(1) consists of health care providers, including |
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obstetricians, gynecologists, family physicians, physician |
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assistants, certified nurse midwives, nurse practitioners, and |
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social workers, who provide health care services at the same |
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location in: |
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(A) a zip code with a high rate of maternal |
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mortality and morbidity; or |
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(B) an area with limited access to health care |
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providers who provide obstetrical care; |
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(2) conducts a risk assessment of each pilot program |
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participant on her entry into the program to determine the risk |
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classification for her pregnancy based on recognized maternal |
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mortality and morbidity risk assessment tools that indicate the |
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participant's: |
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(A) maternal age; |
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(B) maternal race; |
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(C) prior pregnancies that resulted in a live |
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birth, stillbirth, or miscarriage; and |
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(D) family history of disease; |
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(3) based on the assessment conducted under |
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Subdivision (2), establishes an individual pregnancy care plan for |
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each participant; and |
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(4) follows each participant throughout her pregnancy |
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and for a reasonable amount of time postpartum to reduce poor birth |
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outcomes and pregnancy-related maternal deaths occurring |
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postpartum. |
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(c) The commission may incorporate as a component of the |
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pilot program financial incentives for health care providers who |
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participate in a maternity management team. The commission may |
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consider as a criteria for the financial incentives whether the |
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health care provider in a maternity management team will implement |
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strategies and best practices recommended by the Maternal Mortality |
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and Morbidity Task Force established under Chapter 34, Health and |
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Safety Code, for reducing maternal mortality rates and maternal |
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health disparities for African American women in this state. |
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(d) The commission may waive a requirement of this section |
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for a pregnancy medical home located in a rural county. |
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(e) Notwithstanding Section 531.02176, the commission may: |
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(1) provide home telemonitoring services and |
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necessary durable medical equipment to pilot program participants |
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who are at risk of experiencing pregnancy-related complications, as |
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determined by a physician, to the extent the commission anticipates |
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the services and equipment will reduce unnecessary emergency room |
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visits or hospitalizations; and |
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(2) reimburse providers under Medicaid for the |
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provision of home telemonitoring services and durable medical |
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equipment under the pilot program. |
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(f) Not later than January 1, 2021, the commission shall |
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submit to the legislature a report on the pilot program. The report |
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must include: |
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(1) an evaluation of the pilot program's success in |
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reducing poor birth outcomes; and |
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(2) a recommendation on whether the pilot program |
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should continue, be expanded, or be terminated. |
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(f-1) The report required under Subsection (f) may include |
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statistical information and findings based on confidential |
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information collected under Section 34.019, Health and Safety Code, |
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provided the information and findings: |
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(1) are aggregated; and |
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(2) do not include any personally identifying |
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information of a woman, her family, or a health care provider. |
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(g) The executive commissioner shall: |
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(1) adopt rules to implement this section; and |
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(2) adopt and implement policies and procedures to |
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ensure that confidential information obtained under this section is |
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not disclosed in violation of state or federal law. |
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(h) This section expires September 1, 2023. |
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SECTION 3. Section 33.004(f), Health and Safety Code, is |
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amended to read as follows: |
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(f) The executive commissioner by rule shall [may] |
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establish the amounts charged for newborn screening fees, including |
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fees assessed for follow-up services, tracking confirmatory |
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testing, and diagnosis. In adopting rules under this subsection, |
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the executive commissioner shall ensure that amounts charged for |
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newborn screening fees are sufficient to cover the costs of |
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performing the screening. |
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SECTION 4. Chapter 33, Health and Safety Code, is amended by |
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adding Subchapter D to read as follows: |
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SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT |
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Sec. 33.051. DEFINITION. In this subchapter, "account" |
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means the newborn screening preservation account established under |
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Section 33.052. |
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Sec. 33.052. CREATION OF ACCOUNT. (a) The newborn |
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screening preservation account is a dedicated account in the |
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general revenue fund. The account is created solely for the |
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perpetual care and preservation of newborn screening in this state. |
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(b) Money in the account may be appropriated only to the |
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department and only for the purpose of carrying out the newborn |
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screening program established under this chapter. |
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(c) On November 1 of each year, the department shall |
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transfer to the account any unexpended and unencumbered money from |
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Medicaid reimbursements collected by the department for newborn |
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screening services during the preceding state fiscal year. |
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(d) The account is composed of: |
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(1) money transferred to the account under Subsection |
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(c); |
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(2) gifts, grants, donations, and legislative |
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appropriations; and |
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(3) interest earned on the investment of money in the |
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account. |
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(e) Section 403.0956, Government Code, does not apply to the |
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account. |
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(f) The department administers the account. The department |
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may solicit and receive gifts, grants, and donations from any |
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source for the benefit of the account. |
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Sec. 33.053. DEDICATED USE. (a) The department may use any |
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money remaining in the account after paying the costs of operating |
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the newborn screening program established under this chapter only |
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to: |
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(1) pay for capital assets, improvements, equipment, |
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and renovations for the laboratory established by the department to |
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ensure the continuous operation of the newborn screening program; |
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and |
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(2) pay for necessary renovations, construction, |
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capital assets, equipment, supplies, staff, and training |
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associated with providing additional newborn screening tests not |
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offered under this chapter before September 1, 2019, including the |
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operational costs incurred during the first year of implementing |
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the additional tests. |
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(b) The department may not use money from the account for |
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the department's general operating expenses. |
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Sec. 33.054. REPORT. If the department requires an |
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additional newborn screening test under Subchapter B the costs of |
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which are funded with money appropriated from the newborn screening |
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preservation account, the department shall, not later than December |
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31 of the first even-numbered year following the addition of the |
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test, prepare and submit a written report regarding the actions |
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taken by the department to fund and implement the test during the |
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preceding two years to: |
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(1) the governor; |
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(2) the lieutenant governor; |
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(3) the speaker of the house of representatives; and |
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(4) each standing committee of the legislature having |
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primary jurisdiction over the department. |
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SECTION 5. Chapter 34, Health and Safety Code, is amended by |
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adding Sections 34.0158 and 34.0159 to read as follows: |
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Sec. 34.0158. REPORT ON ACTIONS TO ADDRESS MATERNAL |
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MORTALITY RATES. Not later than December 1 of each even-numbered |
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year, the commission shall submit to the governor, the lieutenant |
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governor, the speaker of the house of representatives, the |
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Legislative Budget Board, and the appropriate standing committees |
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of the legislature a written report summarizing the actions taken |
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to address maternal morbidity and reduce maternal mortality rates. |
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The report must include information from programs and initiatives |
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created to address maternal morbidity and reduce maternal mortality |
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rates in this state, including: |
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(1) Medicaid; |
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(2) the children's health insurance program, including |
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the perinatal program; |
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(3) the Healthy Texas Women program; |
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(4) the Family Planning Program; |
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(5) this state's program under the Maternal and Child |
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Health Services Block Grant Act (42 U.S.C. Section 701 et seq.); |
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(6) the Perinatal Advisory Council; |
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(7) state health plans; and |
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(8) the Healthy Texas Babies program. |
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Sec. 34.0159. PROGRAM EVALUATIONS. The commission, in |
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collaboration with the task force and other interested parties, |
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shall: |
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(1) explore options for expanding the pilot program |
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for pregnancy medical homes established under Section 531.0996, |
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Government Code; |
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(2) explore methods for increasing the benefits |
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provided under Medicaid, including specialty care and |
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prescriptions, for women at greater risk of a high-risk pregnancy |
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or premature delivery; |
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(3) evaluate the impact of supplemental payments made |
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to obstetrics providers for pregnancy risk assessments on |
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increasing access to maternal health services; |
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(4) evaluate a waiver to fund managed care |
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organization payments for case management and care coordination |
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services for women at high risk of severe maternal morbidity on |
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conclusion of their eligibility for Medicaid; |
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(5) evaluate the average time required for pregnant |
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women to complete the Medicaid enrollment process; |
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(6) evaluate the use of Medicare codes for Medicaid |
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care coordination; |
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(7) study the impact of programs funded from the Teen |
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Pregnancy Prevention Program federal grant and evaluate whether the |
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state should continue funding the programs; and |
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(8) evaluate the use of telemedicine medical services |
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for women during pregnancy and the postpartum period. |
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SECTION 6. Chapter 34, Health and Safety Code, is amended by |
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adding Sections 34.019, 34.020, and 34.021 to read as follows: |
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Sec. 34.019. DATA COLLECTION. The task force, under the |
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direction of the department, shall annually collect information |
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relating to maternity care and postpartum depression in this state. |
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The information must be based on statistics for the preceding year |
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and include the: |
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(1) total number of live births; |
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(2) number of births by Medicaid recipients; |
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(3) number of births by women with health benefit plan |
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coverage; |
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(4) number of Medicaid recipients screened for |
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postpartum depression; |
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(5) number of women screened for postpartum depression |
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under health benefit plan coverage; |
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(6) number of women treated for postpartum depression |
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under health benefit plan coverage; |
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(7) number of women screened for postpartum depression |
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under the Healthy Texas Women program; |
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(8) number of women treated for postpartum depression |
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under the Healthy Texas Women program; |
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(9) number of claims for postpartum depression |
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treatment paid by the Healthy Texas Women program; |
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(10) number of claims for postpartum depression |
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treatment rejected by the Healthy Texas Women program; |
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(11) postpartum depression screening and treatment |
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billing codes and the number of claims for each billing code under |
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the Healthy Texas Women program; |
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(12) average number of days from the date of a |
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postpartum depression screening to the date the patient begins |
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treatment under Medicaid; |
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(13) average number of days from the date of a |
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postpartum depression screening to the date the patient begins |
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treatment under the Healthy Texas Women program; |
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(14) number of women who screened positive for |
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postpartum depression under Medicaid and the average number of days |
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following childbirth for the screening to occur; |
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(15) number of women who screened positive for |
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postpartum depression under health benefit plan coverage and the |
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average number of days following childbirth for the screening to |
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occur; and |
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(16) number of women who screened positive for |
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postpartum depression under the Healthy Texas Women program and the |
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average number of days following childbirth for the screening to |
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occur. |
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Sec. 34.020. PROGRAM TO DELIVER PRENATAL AND POSTPARTUM |
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CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN |
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COUNTIES. (a) In this section: |
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(1) "Postpartum care" and "prenatal care" have the |
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meanings assigned by Section 32.002. |
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(2) "Telehealth service" and "telemedicine medical |
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service" have the meanings assigned by Section 111.001, Occupations |
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Code. |
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(b) The commission, in consultation with the task force, |
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shall develop a program to deliver prenatal and postpartum care |
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through telehealth services or telemedicine medical services to |
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pregnant women with a low risk of experiencing pregnancy-related |
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complications, as determined by a physician. The commission shall |
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implement the program in: |
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(1) at least two counties with populations of more |
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than two million; |
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(2) at least one county with a population of more than |
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100,000 and less than 500,000; and |
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(3) at least one rural county with high rates of |
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maternal mortality and morbidity as determined by the commission in |
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consultation with the task force. |
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(c) The commission shall develop criteria for selecting |
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participants for the program by analyzing information in the |
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reports prepared by the task force under this chapter and the |
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outcomes of the study conducted under Section 531.02163, Government |
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Code. |
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(d) In developing and administering the program, the |
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commission shall endeavor to use innovative, durable medical |
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equipment to monitor fetal and maternal health. |
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(e) Notwithstanding Section 531.02176, Government Code, and |
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if the commission determines it is feasible and cost-effective, the |
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commission may: |
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(1) provide home telemonitoring services and |
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necessary durable medical equipment to women participating in the |
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program to the extent the commission anticipates the services and |
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equipment will reduce unnecessary emergency room visits or |
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hospitalizations; and |
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(2) reimburse providers under Medicaid for the |
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provision of home telemonitoring services and durable medical |
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equipment under the program. |
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(f) Not later than January 1, 2021, the commission shall |
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submit to the legislature a report on the program that evaluates the |
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program's success in delivering prenatal and postpartum care |
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through telehealth services or telemedicine medical services under |
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Subsection (b). |
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Sec. 34.021. APPLICATION FOR FEDERAL GRANTS. (a) The |
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executive commissioner shall apply to the United States Department |
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of Health and Human Services for grants under the federal |
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Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344). |
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(b) This section expires September 1, 2027. |
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SECTION 7. Section 81.090(c), Health and Safety Code, is |
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amended to read as follows: |
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(c) A physician or other person in attendance at a delivery |
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shall: |
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(1) take or cause to be taken a sample of blood or |
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other appropriate specimen from the mother on admission for |
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delivery; and |
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(2) submit the sample to an appropriately certified |
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laboratory for diagnostic testing approved by the United States |
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Food and Drug Administration for hepatitis B infection and |
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syphilis. |
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SECTION 8. Chapter 1001, Health and Safety Code, is amended |
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by adding Subchapter K to read as follows: |
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SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT |
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PROGRAM |
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Sec. 1001.261. DEFINITIONS. In this subchapter: |
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(1) "Pilot program" means the high-risk maternal care |
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coordination services pilot program established under this |
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subchapter. |
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(2) "Promotora" or "community health worker" has the |
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meaning assigned by Section 48.001. |
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Sec. 1001.262. ESTABLISHMENT OF PILOT PROGRAM; RULES. (a) |
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The department shall develop and implement a high-risk maternal |
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care coordination services pilot program in one or more geographic |
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areas in this state. |
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(b) In implementing the pilot program, the department |
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shall: |
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(1) conduct a statewide assessment of training courses |
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provided by promotoras or community health workers that target |
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women of childbearing age; |
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(2) study existing models of high-risk maternal care |
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coordination services; |
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(3) identify, adapt, or create a risk assessment tool |
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to identify pregnant women who are at a higher risk for poor |
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pregnancy, birth, or postpartum outcomes; and |
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(4) create educational materials for promotoras and |
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community health workers that include information on the: |
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(A) assessment tool described by Subdivision |
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(3); and |
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(B) best practices for high-risk maternal care. |
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(c) The executive commissioner shall adopt rules as |
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necessary to implement this subchapter and prescribe the types of |
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information to be collected during the course of the pilot program |
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and included in the report described by Section 1001.264. |
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Sec. 1001.263. DUTIES OF DEPARTMENT. (a) The department |
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shall provide to each geographic area selected for the pilot |
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program the support, resources, technical assistance, training, |
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and guidance necessary to: |
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(1) screen all or a sample of pregnant patients with |
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the assessment tool described by Section 1001.262(b)(3); and |
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(2) integrate community health worker services for |
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women with high-risk pregnancies in: |
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(A) providing patient education on |
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health-enhancing behaviors and chronic disease management and |
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prevention; |
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(B) facilitating care coordination and |
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navigation activities; and |
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(C) identifying and reducing barriers to the |
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women's access to health care. |
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(b) The department shall develop training courses to |
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prepare promotoras and community health workers in educating and |
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supporting women at high risk for serious complications during the |
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pregnancy and postpartum periods. |
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Sec. 1001.264. PILOT PROGRAM REPORT. (a) Not later than |
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December 1 of each even-numbered year, the department shall prepare |
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and submit a report on the pilot program to the executive |
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commissioner and the chairs of the standing committees of the |
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senate and the house of representatives with primary jurisdiction |
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over public health and human services. The report may be submitted |
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with the report required under Section 34.0156. |
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(b) The report submitted under this section must include an |
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evaluation from the commissioner of the pilot program's |
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effectiveness. |
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(c) The report submitted under this section must include a |
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recommendation from the department on whether the pilot program |
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should continue, be expanded, or be terminated. |
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Sec. 1001.265. EXPIRATION. This subchapter expires |
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September 1, 2023. |
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SECTION 9. (a) Except as provided by Subsection (b) of this |
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section, not later than December 1, 2019, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt the rules required under Section 33.004(f), Health and Safety |
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Code, as amended by this Act, and Section 1001.262(c), Health and |
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Safety Code, as added by this Act. |
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(b) Notwithstanding Subchapter K, Chapter 1001, Health and |
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Safety Code, as added by this Act, the Department of State Health |
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Services and the executive commissioner of the Health and Human |
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Services Commission are not required to comply with that subchapter |
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unless a specific appropriation for the implementation of the |
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subchapter is provided in a general appropriations act of the 86th |
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Legislature. |
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SECTION 10. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission shall apply to the United States Department of |
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Health and Human Services for grants as required by Section 34.021, |
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Health and Safety Code, as added by this Act. |
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SECTION 11. If before implementing any provision of this |
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Act 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 12. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, this Act takes effect September 1, 2019. |