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A BILL TO BE ENTITLED
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AN ACT
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relating to access to and the provision of behavioral and mental |
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health care services and trauma-informed care 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. Sections 533.0051(a) and (d), Government Code, |
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are amended to read as follows: |
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(a) The commission shall establish outcome-based |
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performance measures and incentives to include in each contract |
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between a health maintenance organization and the commission for |
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the provision of health care services, including behavioral and |
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mental health care services, to recipients that is procured and |
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managed under a value-based purchasing model. The performance |
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measures and incentives must: |
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(1) be designed to facilitate and increase recipients' |
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access to appropriate health care services, including behavioral |
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and mental health care services; [and] |
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(2) to the extent possible, align with other state and |
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regional quality care improvement initiatives; and |
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(3) for contracts for the provision of behavioral and |
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mental health care services to recipients under the STAR Health |
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program, be designed to facilitate and increase recipients' access |
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to trauma-informed care. |
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(d) Subject to Subsection (f), the commission shall assess |
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the feasibility and cost-effectiveness of including provisions in a |
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contract described by Subsection (a) that require the health |
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maintenance organization to provide to the providers in the |
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organization's provider network pay-for-performance opportunities |
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that support quality improvements in the care of recipients. |
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Pay-for-performance opportunities may include incentives for |
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providers to provide care after normal business hours and to |
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participate in the early and periodic screening, diagnosis, and |
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treatment program and other activities that improve recipients' |
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access to care, including trauma-informed care and behavioral and |
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mental health care services. If the commission determines that the |
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provisions are feasible and may be cost-effective, the commission |
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shall develop and implement a pilot program in at least one health |
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care service region under which the commission will include the |
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provisions in contracts with health maintenance organizations |
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offering managed care plans in the region. |
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SECTION 2. Section 533.0052, Government Code, is amended by |
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amending Subsection (a) and adding Subsections (c), (d), and (e) to |
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read as follows: |
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(a) A contract between a managed care organization and the |
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commission for the organization to provide health care services, |
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including behavioral and mental health care services, to recipients |
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under the STAR Health program must include a requirement that |
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[trauma-informed care training be offered to] each contracted |
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physician or provider who diagnoses or provides treatment for a |
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behavioral or mental health condition or prescribes psychotropic |
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medication receive training regarding the impact of trauma on |
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children and trauma-informed care. |
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(c) The commission shall determine the appropriate |
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information to include in the training required by Subsection (a). |
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The training must include information regarding: |
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(1) the effects of trauma, toxic stress, and adverse |
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childhood experiences on a child's: |
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(A) brain development; and |
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(B) cognitive, emotional, psychological, |
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physical, and behavioral functioning; |
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(2) trauma screening and accessing a child's trauma |
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history; |
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(3) the management of traumatic memories and |
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trauma-related symptoms; |
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(4) the overlap between symptoms of trauma and |
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symptoms of mental health disorders, including |
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attention-deficit/hyperactivity disorder, bipolar disorder, and |
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oppositional defiant disorder; |
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(5) the potential risks of using psychotropic |
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medication for children who have experienced trauma; |
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(6) the availability of research-supported or |
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evidence-based, trauma-informed, non-pharmacological |
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interventions; |
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(7) appropriate coding and billing procedures for |
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reimbursement of trauma-informed care, treatments, and services; |
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and |
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(8) the impact of trauma on children with an |
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intellectual or developmental disability. |
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(d) The commission shall make at least one opportunity to |
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receive the training required by Subsection (a) available at no |
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cost to each physician or provider described by Subsection (a) with |
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whom a contract is entered into or renewed. |
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(e) The commission may establish performance measures and |
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incentives described by Section 533.0051 to encourage improved |
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access to trauma-informed care and behavioral and mental health |
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care services for recipients under the STAR Health program and to |
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support contracted physicians or providers described by Subsection |
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(a) in receiving: |
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(1) training required by Subsection (a); and |
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(2) additional training in research-supported or |
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evidence-based, trauma-informed, non-pharmacological |
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interventions. |
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SECTION 3. Not later than January 1, 2024, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt rules necessary to implement Sections 533.0051 and 533.0052, |
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Government Code, as amended by this Act. |
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SECTION 4. (a) Sections 533.0051 and 533.0052, Government |
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Code, as amended by this Act, apply only to a contract between the |
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Health and Human Services Commission and a managed care |
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organization that is entered into or renewed on or after the |
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effective date of this Act. |
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(b) To the extent permitted by law or the terms of the |
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contract, the Health and Human Services Commission shall amend a |
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contract entered into before the effective date of this Act with a |
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managed care organization to comply with Sections 533.0051 and |
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533.0052, Government Code, as amended by this Act. |
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SECTION 5. Notwithstanding Section 533.0052, Government |
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Code, as amended by this Act, a physician or provider is not |
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required to complete the training described by that section before |
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September 1, 2027. |
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SECTION 6. 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 7. This Act takes effect September 1, 2023. |