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A BILL TO BE ENTITLED
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AN ACT
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relating to the use of social determinants of health in the Medicaid |
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managed care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.001, Government Code, is amended by |
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adding Subdivision (6-a) to read as follows: |
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(6-a) "Social determinants of health" means the |
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environmental conditions in which a person is born, lives, learns, |
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works, plays, worships, and ages that affect a range of health, |
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functional, and quality of life outcomes and risks. |
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SECTION 2. Section 533.003(a), Government Code, is amended |
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to read as follows: |
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(a) In awarding contracts to managed care organizations, |
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the commission shall: |
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(1) give preference to organizations that have |
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significant participation in the organization's provider network |
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from each health care provider in the region who has traditionally |
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provided care to Medicaid and charity care patients; |
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(2) give extra consideration to organizations that |
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agree to assure continuity of care for at least three months beyond |
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the period of Medicaid eligibility for recipients; |
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(3) consider the need to use different managed care |
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plans to meet the needs of different populations; |
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(4) consider the ability of organizations to process |
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Medicaid claims electronically; and |
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(5) give extra consideration to organizations that use |
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enriched data sets incorporating social determinants of health to |
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manage socially complex populations in a manner that achieves: |
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(A) cost savings through implementation of |
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appropriate interventions for those populations; and |
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(B) favorable health outcomes for those |
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populations by reducing preventable emergency room visits, |
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hospitalizations, and institutionalizations [in the initial |
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implementation of managed care in the South Texas service region, |
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give extra consideration to an organization that either: |
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[(A) is locally owned, managed, and operated, if |
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one exists; or |
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[(B) is in compliance with the requirements of |
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Section 533.004]. |
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SECTION 3. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.022 to read as follows: |
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Sec. 533.022. ANNUAL REPORT ON USE OF SOCIAL DETERMINANTS |
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OF HEALTH. Each Medicaid managed care organization that uses |
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enriched data sets described by Section 533.003(a)(5) shall submit |
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to the commission an annual report that assesses any cost savings |
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and favorable health outcomes achieved by using those data sets. |
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SECTION 4. Section 533.003(a), Government Code, as amended |
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by this Act, applies to a contract entered into or renewed on or |
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after the effective date of this Act. A contract entered into or |
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renewed before that date is governed by the law in effect on the |
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date the contract was entered into or renewed, and that law is |
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continued in effect for that purpose. |
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SECTION 5. 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 6. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2021. |