86R9780 JG-D
 
  By: Davis of Harris, Springer, et al. H.B. No. 1111
 
  Substitute the following for H.B. No. 1111:
 
  By:  Thompson of Harris C.S.H.B. No. 1111
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to maternal and newborn health care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02163 to read as follows:
         Sec. 531.02163.  STUDY ON PROVIDING CERTAIN MATERNAL CARE
  MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND
  TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the
  commission shall conduct a study on the benefits and costs of
  permitting reimbursement under Medicaid for prenatal and
  postpartum care delivered through telemedicine medical services
  and telehealth services.
         (b)  This section expires September 1, 2021.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0996 to read as follows:
         Sec. 531.0996.  PREGNANCY MEDICAL HOME PILOT PROGRAM. (a)
  The commission shall develop a pilot program to establish pregnancy
  medical homes that provide coordinated evidence-based maternity
  care management to women who reside in a pilot program area and are
  recipients of Medicaid through a Medicaid managed care model or
  arrangement under Chapter 533. The commission shall implement the
  pilot program in:
               (1)  at least two counties with populations of more
  than two million;
               (2)  at least one county with a population of more than
  100,000 and less than 500,000; and
               (3)  at least one rural county with high rates of
  maternal mortality and morbidity as determined by the commission in
  consultation with the Maternal Mortality and Morbidity Task Force
  established under Chapter 34, Health and Safety Code.
         (b)  In implementing the pilot program, the commission shall
  ensure each pregnancy medical home provides a maternity management
  team that:
               (1)  consists of health care providers, including
  obstetricians, gynecologists, family physicians, physician
  assistants, certified nurse midwives, nurse practitioners, and
  social workers, who provide health care services at the same
  location;
               (2)  conducts a risk assessment of each pilot program
  participant on her entry into the program to determine the risk
  classification for her pregnancy;
               (3)  based on the assessment conducted under
  Subdivision (2), establishes an individual pregnancy care plan for
  each participant; and
               (4)  follows each participant throughout her pregnancy
  to reduce poor birth outcomes.
         (c)  The commission may incorporate as a component of the
  pilot program financial incentives for health care providers who
  participate in a maternity management team.
         (d)  The commission may waive a requirement of this section
  for a pregnancy medical home located in a rural county.
         (e)  Notwithstanding Section 531.02176, the commission may:
               (1)  provide home telemonitoring services and
  necessary durable medical equipment to pilot program participants
  who are at risk of experiencing pregnancy-related complications, as
  determined by a physician, to the extent the commission anticipates
  the services and equipment will reduce unnecessary emergency room
  visits or hospitalizations; and
               (2)  reimburse providers under Medicaid for the
  provision of home telemonitoring services and durable medical
  equipment under the pilot program.
         (f)  Not later than January 1, 2021, the commission shall
  submit to the legislature a report on the pilot program. The report
  must include:
               (1)  an evaluation of the pilot program's success in
  reducing poor birth outcomes; and
               (2)  a recommendation on whether the pilot program
  should continue, be expanded, or be terminated.
         (g)  The executive commissioner may adopt rules to implement
  this section.
         (h)  This section expires September 1, 2023.
         SECTION 3.  Section 33.004(f), Health and Safety Code, is
  amended to read as follows:
         (f)  The executive commissioner by rule shall [may]
  establish the amounts charged for newborn screening fees, including
  fees assessed for follow-up services, tracking confirmatory
  testing, and diagnosis. In adopting rules under this subsection,
  the executive commissioner shall ensure that amounts charged for
  newborn screening fees are sufficient to cover the costs of
  performing the screening.
         SECTION 4.  Chapter 33, Health and Safety Code, is amended by
  adding Subchapter D to read as follows:
  SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT
         Sec. 33.051.  DEFINITION. In this subchapter, "account"
  means the newborn screening preservation account established under
  Section 33.052.
         Sec. 33.052.  CREATION OF ACCOUNT. (a) The newborn
  screening preservation account is a dedicated account in the
  general revenue fund. The account is created solely for the
  perpetual care and preservation of newborn screening in this state.
         (b)  Money in the account may be appropriated only to the
  department and only for the purpose of carrying out the newborn
  screening program established under this chapter.
         (c)  On November 1 of each year, the department shall
  transfer to the account any unexpended and unencumbered money from
  Medicaid reimbursements collected by the department for newborn
  screening services during the preceding state fiscal year.
         (d)  The account is composed of:
               (1)  money transferred to the account under Subsection
  (c);
               (2)  gifts, grants, donations, and legislative
  appropriations; and
               (3)  interest earned on the investment of money in the
  account.
         (e)  Section 403.0956, Government Code, does not apply to the
  account.
         (f)  The department administers the account. The department
  may solicit and receive gifts, grants, and donations from any
  source for the benefit of the account.
         Sec. 33.053.  DEDICATED USE. (a) The department may use any
  money remaining in the account after paying the costs of operating
  the newborn screening program established under this chapter only
  to:
               (1)  pay for capital assets, improvements, equipment,
  and renovations for the laboratory established by the department to
  ensure the continuous operation of the newborn screening program;
  and
               (2)  pay for necessary renovations, construction,
  capital assets, equipment, supplies, staff, and training
  associated with providing additional newborn screening tests not
  offered under this chapter before September 1, 2019, including the
  operational costs incurred during the first year of implementing
  the additional tests.
         (b)  The department may not use money from the account for
  the department's general operating expenses.
         Sec. 33.054.  REPORT. If the department requires an
  additional newborn screening test under Subchapter B the costs of
  which are funded with money appropriated from the newborn screening
  preservation account, the department shall, not later than December
  31 of the first even-numbered year following the addition of the
  test, prepare and submit a written report regarding the actions
  taken by the department to fund and implement the test during the
  preceding two years to:
               (1)   the governor;
               (2)  the lieutenant governor;
               (3)  the speaker of the house of representatives; and
               (4)  each standing committee of the legislature having
  primary jurisdiction over the department.
         SECTION 5.  Chapter 34, Health and Safety Code, is amended by
  adding Sections 34.0158 and 34.0159 to read as follows:
         Sec. 34.0158.  REPORT ON ACTIONS TO ADDRESS MATERNAL
  MORTALITY RATES. Not later than December 1 of each even-numbered
  year, the commission shall submit to the governor, the lieutenant
  governor, the speaker of the house of representatives, the
  Legislative Budget Board, and the appropriate standing committees
  of the legislature a written report summarizing the actions taken
  to address maternal morbidity and reduce maternal mortality rates.
  The report must include information from programs and initiatives
  created to address maternal morbidity and reduce maternal mortality
  rates in this state, including:
               (1)  Medicaid;
               (2)  the children's health insurance program, including
  the perinatal program;
               (3)  the Healthy Texas Women program;
               (4)  the Family Planning Program;
               (5)  this state's program under the Maternal and Child
  Health Services Block Grant Act (42 U.S.C. Section 701 et seq.);
               (6)  the Perinatal Advisory Council;
               (7)  state health plans; and
               (8)  the Healthy Texas Babies program.
         Sec. 34.0159.  PROGRAM EVALUATIONS. The commission, in
  collaboration with the task force and other interested parties,
  shall:
               (1)  explore options for expanding the pilot program
  for pregnancy medical homes established under Section 531.0996,
  Government Code;
               (2)  explore methods for increasing the benefits
  provided under Medicaid, including specialty care and
  prescriptions, for women at greater risk of a high-risk pregnancy
  or premature delivery;
               (3)  evaluate the impact of supplemental payments made
  to obstetrics providers for pregnancy risk assessments on
  increasing access to maternal health services;
               (4)  evaluate a waiver to fund managed care
  organization payments for case management and care coordination
  services for women at high risk of severe maternal morbidity on
  conclusion of their eligibility for Medicaid;
               (5)  evaluate the average time required for pregnant
  women to complete the Medicaid enrollment process;
               (6)  evaluate the use of Medicare codes for Medicaid
  care coordination;
               (7)  study the impact of programs funded from the Teen
  Pregnancy Prevention Program federal grant and evaluate whether the
  state should continue funding the programs; and
               (8)  evaluate the use of telemedicine medical services
  for women during pregnancy and the postpartum period.
         SECTION 6.  Chapter 34, Health and Safety Code, is amended by
  adding Sections 34.019, 34.020, and 34.021 to read as follows:
         Sec. 34.019.  DATA COLLECTION. The task force, under the
  direction of the department, shall annually collect information
  relating to maternity care and postpartum depression in this state.
  The information must be based on statistics for the preceding year
  and include the:
               (1)  number of births by Medicaid recipients;
               (2)  number of births by women with health benefit plan
  coverage;
               (3)  number of Medicaid recipients screened for
  postpartum depression;
               (4)  number of women screened for postpartum depression
  under health benefit plan coverage;
               (5)  number of women treated for postpartum depression
  under health benefit plan coverage;
               (6)  number of women screened for postpartum depression
  under the Healthy Texas Women program;
               (7)  number of women treated for postpartum depression
  under the Healthy Texas Women program;
               (8)  number of claims for postpartum depression
  treatment paid by the Healthy Texas Women program;
               (9)  number of claims for postpartum depression
  treatment rejected by the Healthy Texas Women program;
               (10)  postpartum depression screening and treatment
  billing codes and the number of claims for each billing code under
  the Healthy Texas Women program;
               (11)  average number of days from the date of a
  postpartum depression screening to the date the patient begins
  treatment under Medicaid;
               (12)  average number of days from the date of a
  postpartum depression screening to the date the patient begins
  treatment under the Healthy Texas Women program;
               (13)  number of women who screened positive for
  postpartum depression under Medicaid and the average number of days
  following childbirth for the screening to occur;
               (14)  number of women who screened positive for
  postpartum depression under health benefit plan coverage and the
  average number of days following childbirth for the screening to
  occur; and
               (15)  number of women who screened positive for
  postpartum depression under the Healthy Texas Women program and the
  average number of days following childbirth for the screening to
  occur.
         Sec. 34.020.  PROGRAM TO DELIVER PRENATAL AND POSTPARTUM
  CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN
  COUNTIES. (a) In this section:
               (1)  "Postpartum care" and "prenatal care" have the
  meanings assigned by Section 32.002.
               (2)  "Telehealth service" and "telemedicine medical
  service" have the meanings assigned by Section 111.001, Occupations
  Code.
         (b)  The commission, in consultation with the task force,
  shall develop a program to deliver prenatal and postpartum care
  through telehealth services or telemedicine medical services to
  pregnant women with a low risk of experiencing pregnancy-related
  complications, as determined by a physician. The commission shall
  implement the program in:
               (1)  at least two counties with populations of more
  than two million;
               (2)  at least one county with a population of more than
  100,000 and less than 500,000; and
               (3)  at least one rural county with high rates of
  maternal mortality and morbidity as determined by the commission in
  consultation with the task force.
         (c)  The commission shall develop criteria for selecting
  participants for the program by analyzing information in the
  reports prepared by the task force under this chapter and the
  outcomes of the study conducted under Section 531.02163, Government
  Code.
         (d)  In developing and administering the program, the
  commission shall endeavor to use innovative, durable medical
  equipment to monitor fetal and maternal health.
         (e)  Notwithstanding Section 531.02176, Government Code, and
  if the commission determines it is feasible and cost-effective, the
  commission may:
               (1)  provide home telemonitoring services and
  necessary durable medical equipment to women participating in the
  program to the extent the commission anticipates the services and
  equipment will reduce unnecessary emergency room visits or
  hospitalizations; and
               (2)  reimburse providers under Medicaid for the
  provision of home telemonitoring services and durable medical
  equipment under the program.
         (f)  Not later than January 1, 2021, the commission shall
  submit to the legislature a report on the program that evaluates the
  program's success in delivering prenatal and postpartum care
  through telehealth services or telemedicine medical services under
  Subsection (b).
         Sec. 34.021.  APPLICATION FOR FEDERAL GRANTS. (a) The
  executive commissioner shall apply to the United States Department
  of Health and Human Services for grants under the federal
  Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
         (b)  This section expires September 1, 2027.
         SECTION 7.  Chapter 1001, Health and Safety Code, is amended
  by adding Subchapter K to read as follows:
  SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT
  PROGRAM
         Sec. 1001.261.  DEFINITIONS. In this subchapter:
               (1)  "Pilot program" means the high-risk maternal care
  coordination services pilot program established under this
  subchapter.
               (2)  "Promotora" or "community health worker" has the
  meaning assigned by Section 48.001.
         Sec. 1001.262.  ESTABLISHMENT OF PILOT PROGRAM; RULES. (a)
  The department shall develop and implement a high-risk maternal
  care coordination services pilot program in one or more geographic
  areas in this state.
         (b)  In implementing the pilot program, the department
  shall:
               (1)  conduct a statewide assessment of training courses
  provided by promotoras or community health workers that target
  women of childbearing age;
               (2)  study existing models of high-risk maternal care
  coordination services;
               (3)  identify, adapt, or create a risk assessment tool
  to identify pregnant women who are at a higher risk for poor
  pregnancy, birth, or postpartum outcomes; and
               (4)  create educational materials for promotoras and
  community health workers that include information on the:
                     (A)  assessment tool described by Subdivision
  (3); and
                     (B)  best practices for high-risk maternal care.
         (c)  The executive commissioner shall adopt rules as
  necessary to implement this subchapter and prescribe the types of
  information to be collected during the course of the pilot program
  and included in the report described by Section 1001.264.
         Sec. 1001.263.  DUTIES OF DEPARTMENT. (a) The department
  shall provide to each geographic area selected for the pilot
  program the support, resources, technical assistance, training,
  and guidance necessary to:
               (1)  screen all or a sample of pregnant patients with
  the assessment tool described by Section 1001.262(b)(3); and
               (2)  integrate community health worker services for
  women with high-risk pregnancies in:
                     (A)  providing patient education on
  health-enhancing behaviors and chronic disease management and
  prevention;
                     (B)  facilitating care coordination and
  navigation activities; and
                     (C)  identifying and reducing barriers to the
  women's access to health care.
         (b)  The department shall develop training courses to
  prepare promotoras and community health workers in educating and
  supporting women at high risk for serious complications during the
  pregnancy and postpartum periods.
         Sec. 1001.264.  PILOT PROGRAM REPORT. (a) Not later than
  December 1 of each even-numbered year, the department shall prepare
  and submit a report on the pilot program to the executive
  commissioner and the chairs of the standing committees of the
  senate and the house of representatives with primary jurisdiction
  over public health and human services. The report may be submitted
  with the report required under Section 34.0156.
         (b)  The report submitted under this section must include an
  evaluation from the commissioner of the pilot program's
  effectiveness.
         (c)  The report submitted under this section must include a
  recommendation from the department on whether the pilot program
  should continue, be expanded, or be terminated.
         Sec. 1001.265.  EXPIRATION. This subchapter expires
  September 1, 2023.
         SECTION 8.  (a)  Except as provided by Subsection (b) of this
  section, not later than December 1, 2019, the executive
  commissioner of the Health and Human Services Commission shall
  adopt the rules required under Section 33.004(f), Health and Safety
  Code, as amended by this Act, and Section 1001.262(c), Health and
  Safety Code, as added by this Act.
         (b)  Notwithstanding Subchapter K, Chapter 1001, Health and
  Safety Code, as added by this Act, the Department of State Health
  Services and the executive commissioner of the Health and Human
  Services Commission are not required to comply with that subchapter
  unless a specific appropriation for the implementation of the
  subchapter is provided in a general appropriations act of the 86th
  Legislature.
         SECTION 9.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall apply to the United States Department of
  Health and Human Services for grants as required by Section 34.021,
  Health and Safety Code, as added by this Act.
         SECTION 10.  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 11.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2019.