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  By: Hull H.B. No. 1575
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to improving health outcomes for certain recipients and
  enrollees under certain state health benefits programs, through
  improved program administration.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  It is the intent of the Legislature to improve
  health outcomes for children and pregnant women through the Case
  Management for Children and Pregnant Women Program. In recognizing
  that nonmedical factors impact health outcomes, the Legislature
  hereby authorizes the Medicaid program to provide case management
  services for nonmedical needs that will improve health outcomes for
  children and pregnant women.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.024183 to read as follows:
         Sec. 531.024183.  STANDARDIZED SCREENING QUESTIONS FOR
  ASSESSING NONMEDICAL HEALTH-RELATED NEEDS OF CERTAIN PREGNANT
  WOMEN; INFORMED CONSENT. (a) In this section: "Alternatives to
  abortion program" means the program established by the commission
  to enhance and increase resources that promote childbirth for women
  facing unplanned pregnancy.
         (b)  The commission shall adopt standardized assessment
  questions designed to screen for, identify, and aggregate data
  regarding the nonmedical health-related needs of pregnant women
  eligible for benefits under a public benefits program administered
  by the commission or another health and human services agency,
  including:
               (1)  Medicaid, and
               (2)  the alternatives to abortion program.
         (c)  Subject to Subsection (d), the standardized screening
  questions must be used by managed care organizations participating
  in Medicaid and providers participating in the alternatives to
  abortion program.
         (d)  A managed care organization or provider participating
  in the alternatives to abortion program may not conduct an
  assessment of a pregnant woman using the standardized assessment
  questions required by this section unless the organization or
  provider:
               (1)  informs the woman:
                     (A)  about the type of data that will be collected
  during the assessment and the purposes for which the data will be
  used; and 
                     (B)  that the collected data will become part of
  the woman's medical record or service plan; and 
               (2)  obtains the woman's informed consent to perform
  the assessment.
         (e)  A managed care organization or alternatives to abortion
  provider must provide to the commission, in the form and manner
  prescribed by the commission, data the organization or provider
  collects using the standardized screening questions required by
  this section.
         SECTION 3.  Chapter 531, Government Code, is amended by
  adding Subchapter Q to read as follows:
  SUBCHAPTER Q. CASE MANAGEMENT SERVICES FOR CERTAIN PREGNANT WOMEN
         Sec. 531.651.  DEFINITIONS. In this subchapter: 
               (1)  "Program services" means case management services
  provided under the case management program for children and
  pregnant women program as defined by Section 533.002555, including
  assisting the enrollee's managed care organization in coordinating
  the provision of Medicaid benefits in a manner that is consistent
  with the plan of care. Services provided through this program to do
  not pre-empt or replace a managed care organization's service
  coordination function as required by the Commission.
               (2)  "Case management for children and pregnant women
  program" has the meaning assigned by Section 533.002555.
               (3)  "Nonmedical health-related needs screening" means
  an assessment conducted using the standardized screening tool
  required under Section 531.024183.
         Sec. 531.652.  CASE MANAGEMENT FOR CHILDREN AND PREGNANT
  WOMEN PROGRAM: PROVIDER QUALIFICATIONS. Program services may be
  provided only by a provider who completes the standardized case
  management training required by the commission under Section
  531.653 and who is:
               (1)  an advanced practice nurse who holds a license,
  other than a provisional or temporary license, under Chapter 301,
  Occupations Code;
               (2)  a registered nurse who holds a license, other than
  a provisional or temporary license, under Chapter 301, Occupations
  Code, and:
                     (A)  completed a baccalaureate degree program in
  nursing; or
                     (B)  completed an associate degree program in
  nursing and has:
                           (i)  at least two years of cumulative paid
  full-time work experience; or
                           (ii)  at least two years of cumulative,
  supervised full-time educational internship or practicum
  experience obtained in the last 10 years that included assessing
  the psychosocial and health needs of and making community referrals
  of:
                                 (a)  children who are 21 years of age
  or younger; or
                                 (b)  pregnant women;
               (3)  a social worker who holds a license, other than a
  provisional or temporary license, under Chapter 505, Occupations
  Code, appropriate for the individual's practice, including the
  practice of independent social work;
               (4)  a community health worker as defined by Section
  48.001, Health and Safety Code, who is certified by the Department
  of State Health Services; or
               (5)  a doula who is certified by a recognized national
  certification program, as determined by the commission, unless the
  doula qualifies as a certified community health worker under
  Subdivision (4).
         Sec. 531.653.  CASE MANAGEMENT FOR CHILDREN AND PREGNANT
  WOMEN PROGRAM: PROVIDER TRAINING. The commission shall require
  that each provider of services in the case management for children
  and pregnant women program complete training prescribed by the
  commission. The training must be trauma-informed and include
  instruction on:
               (1)  social services provided by this state and local
  governments in this state; 
               (2)  community assistance programs, including programs
  providing:
                     (A)  nutrition and housing assistance;
                     (B)  counseling and parenting services;
                     (C)  substance use disorder treatment; and
                     (D)  domestic violence assistance and shelter;
               (3)  domestic violence and coercive control dynamics;
               (4)  methods for explaining and eliciting an eligible
  recipient's informed consent to receive:
                     (A)  case management services screening; and 
                     (B)  any services that may be offered as a result
  of the screening; and
               (5)  procedures for:
                     (A)  an eligible recipient to:
                           (i)  decline case management services
  screening; or
                           (ii)  withdraw consent for offered services;
  and
                     (B)  ensuring that the recipient is not subject to
  any retaliatory action for declining or discontinuing any
  screenings or services provided by this program.
         Sec. 531.654.  INITIAL MEDICAL AND NONMEDICAL
  HEALTH-RELATED SCREENINGS OF CERTAIN RECIPIENTS AND ENROLLEES. (a)
  A managed care organization that provides health care services to a
  pregnant woman under the STAR Medicaid managed care program shall,
  subject to Section 531.024183(d), conduct an initial health needs
  screening and nonmedical health-related needs screening of each
  pregnant recipient or enrollee to determine, regardless of whether
  the recipient or enrollee is considered to have a high-risk
  pregnancy, if the recipient or enrollee:
               (1)  is eligible for service coordination benefits to
  be provided by the managed care organization; or 
               (2)  if the recipient or enrollee should be referred
  for services under the case management for children and pregnant
  women program. 
         (b)  Service coordination benefits described by Subsection
  (a) must include identifying and coordinating the provision of
  non-covered services, community supports, and other resources the
  managed care organization or provider has determined will improve
  the recipient's or enrollee's health outcomes. 
         (c)  A managed care organization must use the results of the
  screenings conducted under Subsection (a) to determine if a
  recipient or enrollee requires a more comprehensive assessment or
  service coordination or referral for services in the case
  management for children and pregnant women program.
         (d)  A managed care organization must inform each pregnant
  woman for which an assessment is being conducted that:
               (1)  the woman has a right to decline the assessment or
  choose to discontinue receiving the services identified by the
  assessment at any time; and
               (2)  declining or discontinuing the services will not
  result in retaliatory action against the woman in the provision of
  other services.
         Sec. 531.655.  CASE MANAGEMENT FOR CHILDREN AND PREGNANT
  WOMEN PROGRAM SERVICES OPTIONAL. A managed care organization
  providing screenings under Section 531.654 must inform each
  pregnant woman who is referred for services in the case management
  for children and pregnant women program that:
               (1)  the woman has a right to decline the services or
  choose to discontinue receiving the services at any time; and
               (2)  declining or discontinuing the services will not
  result in retaliatory action against the woman in the provision of
  other services.
         SECTION 4.  Section 32.024, Human Resources Code, is amended
  by adding Subsection (pp) to read as follows:
         (pp)  For purposes of enrollment as a provider and
  reimbursement under the medical assistance program, the commission
  shall establish a separate provider type for a community health
  worker as defined by Section 48.001, Health and Safety Code, who
  provides case management services under the children and pregnant
  women program, as defined by Section 533.002555, Government Code.
         (qq)  For purposes of enrollment as a provider and
  reimbursement under the medical assistance program, the commission
  shall establish a provider type for a doula who is certified by a
  recognized national doula certification program approved by the
  commission.
         SECTION 5.  (a) In this section:
               (1)  "Case management for children and pregnant women
  program" has the meaning assigned by Section 533.002555, Government
  Code.
               (2)  "Commission" means the Health and Human Services
  Commission.
         (b)  Not later than December 1, 2024, the commission shall
  prepare and submit to the legislature a status report on the
  implementation of case management services provided to pregnant
  women under the case management for children and pregnant women
  program during the preceding fiscal year. To the extent available,
  the report shall include de-identified information about:
               (1)  the nonmedical health-related needs of the women
  receiving case management services;
               (2)  the number and types of referrals made of women to
  nonmedical community assistance programs and providers; and
               (3)  the birth outcomes for the women.
         SECTION 6.  As soon as practicable after the effective date
  of this Act, the Health and Human Services Commission shall:
               (1)  develop the standardized assessment tool as
  required by Section 531.024183, Government Code, as added by this
  Act; and
               (2)  revise the commission's standardized provider
  training for the case management for children and pregnant women
  program to comply with Section 531.653, Government Code, as added
  by this Act.
         SECTION 7.  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 8.  This Act takes effect September 1, 2023.