87R8928 MM-D
 
  By: Kolkhorst S.B. No. 2028
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the Medicaid program, including the administration and
  operation of the Medicaid managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.024142, 531.02493, 531.0501,
  531.0502, 531.0512, and 531.0605 to read as follows:
         Sec. 531.024142.  NONHOSPITAL AMBULANCE TRANSPORT AND
  TREATMENT PROGRAM. (a) The commission by rule shall develop and
  implement a program designed to improve quality of care and lower
  costs in Medicaid by:
               (1)  reducing avoidable transports to hospital
  emergency departments and unnecessary hospitalizations;
               (2)  encouraging transports to alternative care
  settings for appropriate care; and
               (3)  providing greater flexibility to ambulance care
  providers to address the emergency health care needs of Medicaid
  recipients following a 9-1-1 emergency services call.
         (b)  The program must be substantially similar to the Centers
  for Medicare and Medicaid Services' Emergency Triage, Treat, and
  Transport (ET3) model.
         Sec. 531.02493.  CERTIFIED NURSE AIDE PROGRAMS. (a) The
  commission by rule shall establish and implement a program to
  provide certified nurse aides trained in the Grand-Aide curriculum
  or a substantially similar training program to provide in-home
  support to a Medicaid recipient's care team after the recipient's
  discharge from a hospital. The program must allow a Medicaid
  managed care organization to treat payments to certified nurse
  aides providing care under the program as quality payments for
  purposes of meeting contract percentage requirements.
         (b)  Subject to Subsection (c), the commission by rule may
  establish and implement a program under which the parent of a child
  with complex medical needs may receive Medicaid reimbursement if
  the parent:
               (1)  receives training and is certified as a nurse
  aide; and
               (2)  provides care for the child.
         (c)  The commission may establish the program described by
  Subsection (b) only if the commission determines that the program
  will reduce Medicaid costs and improve the quality of care for
  Medicaid recipients who are children with complex medical needs. 
         Sec. 531.0501.  MEDICAID WAIVER PROGRAMS: INTEREST LIST
  MANAGEMENT. (a) The commission shall establish an online portal
  for use by individuals seeking Medicaid waiver program services to
  request to be placed on a Medicaid waiver program interest list. The
  portal must:
               (1)  provide the current interest list questionnaire
  information for each Medicaid waiver program;
               (2)  allow real-time access to an individual's interest
  list status; and
               (3)  result in information that will inform the
  priority for an individual's placement on the most appropriate
  interest list.
         (b)  The commission may remove an individual from a Medicaid
  waiver program interest list if the individual has not had any
  communication with the commission for at least five years. After
  removing the individual from the interest list, the commission
  shall maintain a record of:
               (1)  the individual's name and any other information
  the commission has concerning the individual; and
               (2)  the individual's initial interest list request
  date.
         Sec. 531.0502.  MEDICAID WAIVER PROGRAMS: ENROLLMENT AND
  STRATEGIC PLAN. (a) Beginning not later than September 1, 2023,
  the commission shall prioritize enrollment in Medicaid waiver
  programs based on a Medicaid recipient's level of need for services
  under a program.
         (b)  The commission shall develop a strategic plan to
  identify:
               (1)  the most effective methods for assessing the needs
  of Medicaid recipients on Medicaid waiver program interest lists
  and for matching a recipient with the program that best meets the
  recipient's level of need; and
               (2)  based on a needs assessment, a method for
  prioritizing Medicaid recipients on Medicaid waiver program
  interest lists and assigning those recipients who have been on an
  interest list for five years or more a position on the list.
         Sec. 531.0512.  NOTIFICATION REGARDING CONSUMER DIRECTION
  MODEL. The commission shall:
               (1)  develop a procedure to:
                     (A)  verify that a Medicaid recipient or the
  recipient's parent or legal guardian is informed regarding the
  consumer-direction model and provided the option to choose to
  receive care under that model; and
                     (B)  if the individual declines to receive care
  under the consumer-directed model, document the declination; and
               (2)  ensure that each Medicaid managed care
  organization implements the procedure.
         Sec. 531.0605.  ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
  PROGRAM. (a) The commission shall collaborate with Medicaid
  managed care organizations to develop and implement a pilot program
  that is substantially similar to the program described by Section
  3, Medicaid Services Investment and Accountability Act of 2019
  (Pub. L. No. 116-16), to provide coordinated care through a health
  home to children with complex medical conditions.
         (b)  The commission shall seek guidance from the Centers for
  Medicare and Medicaid Services and the United States Department of
  Health and Human Services regarding the design of the program and
  actively seek and apply for federal funding to implement the
  program.
         (c)  Not later than December 31, 2024, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's evaluation of the
  effect of the pilot program on the coordination of care for children
  with complex medical conditions; and
               (2)  a recommendation as to whether the pilot program
  should be continued, expanded, or terminated.
         (d)  The pilot program terminates and this section expires
  September 1, 2025.
         SECTION 2.  Section 533.0025, Government Code, is amended by
  adding Subsections (j) and (k) to read as follows:
         (j)  The commission shall implement the most cost-effective
  option for the delivery of basic attendant and habilitation
  services and services under the community attendant services
  program for recipients under the STAR Medicaid managed care
  program.
         (k)  The commission shall determine and implement the most
  cost-effective option for the delivery of hospice services for
  recipients under the STAR+PLUS Medicaid managed care program.
         SECTION 3.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Sections 533.00515 and 533.0069 to read as
  follows:
         Sec. 533.00515.  MEDICATION THERAPY MANAGEMENT. The
  executive commissioner shall collaborate with Medicaid managed
  care organizations to implement medication therapy management
  services to lower costs and improve quality outcomes for recipients
  by reducing adverse drug events.
         Sec. 533.0069.  COORDINATION OF SCHOOL HEALTH AND RELATED
  SERVICES. (a) The commission, in coordination with Medicaid
  managed care organizations and the Texas Education Agency, shall
  develop and adopt a policy for the Medicaid managed care program to
  ensure the coordination and delivery of benefits and services
  provided under the school health and related services program,
  including coordination of school health and related services with
  early childhood intervention services. 
         (b)  Not later than December 31, 2024, the commission shall
  prepare and submit a report to the legislature that includes a
  summary of the commission's efforts regarding coordinating school
  health and related services and early childhood intervention
  services.
         SECTION 4.  Section 533.0076, Government Code, is amended by
  amending Subsection (c) and adding Subsection (d) to read as
  follows:
         (c)  The commission shall allow a recipient who is enrolled
  in a managed care plan under this chapter to disenroll from that
  plan and enroll in another managed care plan[:
               [(1)] at any time for cause in accordance with federal
  law[; and
               [(2) once for any reason after the periods described by
  Subsections (a) and (b)].
         (d)  The commission shall ensure that each recipient
  receives information regarding the recipient's option under
  Subsection (c). 
         SECTION 5.  Section 533.009(c), Government Code, is amended
  to read as follows:
         (c)  The executive commissioner, by rule, shall prescribe
  the minimum requirements that a managed care organization, in
  providing a disease management program, must meet to be eligible to
  receive a contract under this section. The managed care
  organization must, at a minimum, be required to:
               (1)  provide disease management services that have
  performance measures for particular diseases that are comparable to
  the relevant performance measures applicable to a provider of
  disease management services under Section 32.057, Human Resources
  Code; [and]
               (2)  show evidence of ability to manage complex
  diseases in the Medicaid population; and
               (3)  if a disease management program provided by the
  organization has low active participation rates, identify the
  reason for the low rates and develop an approach to increase active
  participation in disease management programs for high-risk
  recipients.
         SECTION 6.  Section 32.028, Human Resources Code, is amended
  by adding Subsection (p) to read as follows:
         (p)  The executive commissioner shall establish a
  reimbursement rate for medication therapy management services.
         SECTION 7.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Sections 32.0611 and 32.0612 to read as
  follows:
         Sec. 32.0611.  COMMUNITY ATTENDANT SERVICES PROGRAM: HIRING
  PROCESS. The commission shall require an entity with which the
  commission contracts to provide personal attendant services to
  recipients under the community attendant services program to
  streamline the application and hiring process for prospective
  attendants, including requiring the entity to consolidate any
  required application documents and forms.
         Sec. 32.0612.  COMMUNITY ATTENDANT SERVICES PROGRAM:
  QUALITY INITIATIVES AND EDUCATION INCENTIVES. (a) The commission
  shall develop specific quality initiatives for attendants
  providing services under the community attendant services program
  to improve quality outcomes for program recipients. 
         (b)  The commission shall coordinate with the Texas Higher
  Education Coordinating Board and the Texas Workforce Commission to
  develop a program to facilitate the award of academic or workforce
  education credit for programs of study or courses of instruction
  leading to a degree, certificate, or credential in a health-related
  field based on an attendant's work experience under the community
  attendant services program. 
         SECTION 8.  (a) In this section, "commission," "executive
  commissioner," and "Medicaid" have the meanings assigned by Section
  531.001, Government Code.
         (b)  Using existing resources, the commission shall:
               (1)  review the commission's staff rate enhancement
  programs to:
                     (A)  identify and evaluate methods for improving
  administration of those programs to reduce administrative barriers
  that prevent an increase in direct care staffing and direct care
  wages and benefits in nursing homes; and
                     (B)  develop recommendations for increasing
  participation in the programs;
               (2)  revise the commission's policies regarding the
  quality incentive payment program (QIPP) to require improvements to
  staff-to-patient ratios in nursing facilities participating in the
  program and to set a goal for those nursing facilities to meet all
  Centers for Medicare and Medicaid Services five-star quality rating
  metrics by September 1, 2027;
               (3)  examine, in collaboration with the Department of
  Family and Protective Services, the Centers for Medicare and
  Medicaid Services' Integrated Care for Kids (InCK) Model to
  determine whether implementing the model could benefit children in
  this state, including children enrolled in the STAR Health Medicaid
  managed care program;
               (4)  develop options for value-based arrangements with
  nursing facilities that consider facility hospitalization rates,
  infection control measures, and the number of citations for abuse
  or neglect the facility has received; and
               (5)  identify factors influencing active participation
  by Medicaid recipients in disease management programs by examining
  variations in:
                     (A)  eligibility criteria for the programs; and
                     (B)  participation rates by health plan, disease
  management program, and year.
         (c)  The executive commissioner may approve a capitation
  payment system that provides for reimbursement for physicians under
  a primary care capitation model or total care capitation model.
         SECTION 9.  (a) In this section, "commission" and "Medicaid"
  have the meanings assigned by Section 531.001, Government Code.
         (b)  As soon as practicable after the effective date of this
  Act, the commission shall conduct a study to determine the
  cost-effectiveness and feasibility of providing to Medicaid
  recipients who have been diagnosed with diabetes, including Type 1
  diabetes, Type 2 diabetes, and gestational diabetes:
               (1)  diabetes self-management education and support
  services that follow the National Standards for Diabetes
  Self-Management Education and Support and that may be delivered by
  a certified diabetes educator; and
               (2)  medical nutrition therapy services.
         (c)  If the commission determines that providing one or both
  of the types of services described by Subsection (b) of this section
  would improve health outcomes for Medicaid recipients and lower
  Medicaid costs, the commission shall, notwithstanding Section
  32.057, Human Resources Code, or Section 533.009, Government Code,
  and to the extent allowed by federal law develop a program to
  provide the benefits and seek prior approval from the Legislative
  Budget Board before implementing the program.
         SECTION 10.  (a) In this section, "commission," "Medicaid,"
  and "Medicaid managed care organization" have the meanings assigned
  by Section 531.001, Government Code.
         (b)  As soon as practicable after the effective date of this
  Act, the commission shall conduct a study to determine the
  cost-effectiveness and feasibility of requiring that a Medicaid
  managed care organization provide early childhood intervention
  case management services to Medicaid recipients who receive
  services under the school health and related services program.
         (c)  Not later than December 31, 2024, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's evaluation of the
  feasibility and cost-effectiveness of providing early childhood
  intervention case management as a Medicaid managed care benefit;
  and
               (2)  a recommendation as to whether the commission
  should implement that benefit.
         SECTION 11.  (a) In this section, "commission" and
  "Medicaid" have the meanings assigned by Section 531.001,
  Government Code.
         (b)  As soon as practicable after the effective date of this
  Act, the commission shall conduct a study to determine the
  cost-effectiveness and feasibility of providing services under the
  Community First Choice program to Medicaid recipients
  transitioning from care in an institutional setting to care in a
  community-based setting.
         (c)  If the commission determines that providing the types of
  services described by Subsection (b) of this section would improve
  health outcomes for Medicaid recipients and lower Medicaid costs,
  the commission shall to the extent allowed by federal law develop a
  program to provide the services and seek prior approval from the
  Legislative Budget Board before implementing the program.
         SECTION 12.  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 13.  This Act takes effect September 1, 2021.