88R4080 MM-D
 
  By: Parker S.B. No. 2360
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the establishment of a pilot program to provide
  comprehensive whole child care for children with complex medical
  needs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.06051 to read as follows:
         Sec. 531.06051.  PILOT PROGRAM FOR COMPREHENSIVE WHOLE CHILD
  CARE FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. (a) In this section:
               (1)  "Child with complex medical needs" means a child
  who has:
                     (A)  one or more chronic health conditions that:
                           (i)  affect three or more organ systems; and
                           (ii)  result in severe functional
  limitations, high health care needs or utilization, or the need for
  or use of medical technology; or
                     (B)  one life-limiting illness or rare pediatric
  disease as defined in Section 529(a)(3) of the Federal Food, Drug,
  and Cosmetic Act (21 U.S.C. 360ff(a)(3)).
               (2)  "Pilot program" means the comprehensive whole
  child care for children with complex medical needs pilot program
  established under this section.
               (3)  "Recipient" means a recipient of Medicaid.
               (4)  "Specialty provider" means a person who provides
  health-related goods or services to a recipient, including a
  provider of medication, therapy services, or durable medical
  equipment or other equipment.
         (b)  The commission shall enter into an agreement with the
  Dell Medical School at The University of Texas at Austin to develop
  and implement in one or more areas of this state a phased pilot
  program to establish an alternative model of care using existing
  capitated rates outside the managed care model to provide
  transformative, comprehensive multidisciplinary whole child care
  and fully integrated health homes for children with complex medical
  needs.
         (c)  The pilot program shall be designed to:
               (1)  develop, improve, and increase access to service
  delivery innovations and comprehensive care centers of excellence
  throughout this state for children with complex medical needs;
               (2)  incorporate and develop increased capacity
  through a phased approach for children to receive:
                     (A)  intermediate and post-acute care services;
                     (B)  pediatric palliative and hospice care; and
                     (C)  transition services and continuity of care;
               (3)  improve delivery and access in rural communities;
               (4)  continue to build and improve capacity to provide
  health care services using telecommunications and information
  technology;
               (5)  use existing electronic medical records systems to
  integrate and streamline technology to improve access to care and
  health outcomes for children participating in the program, track
  the use of funding and best practices for maximizing money spent
  under the pilot program, and better coordinate care, including with
  respect to:
                     (A)  diagnoses and cohesive care plans;
                     (B)  treatment plans;
                     (C)  telemedicine medical services and telehealth
  services; and
                     (D)  coordinated access and integration with home
  health providers;
               (6)  develop and align targeted incentives to induce
  integration and true value-based care that will result in:
                     (A)  cohesive, coordinated multidisciplinary care
  with improved health outcomes for children participating in the
  program and long-term cost effectiveness;
                     (B)  continuity of care for children
  participating in the program; and
                     (C)  reduced emergency room visits and
  hospitalizations;
               (7)  identify shared needs to improve health outcomes,
  including behavioral, social, and familial needs;
               (8)  use and incentivize appropriate and meaningful
  quality outcome measures customized and tailored for children with
  complex medical needs, including:
                     (A)  improving coordination of care and access to
  services;
                     (B)  developing a shared plan of care;
                     (C)  reducing unscheduled hospitalizations;
                     (D)  reducing unmet needs; and
                     (E)  encouraging families to be shared decision
  makers;
               (9)  allow physicians or the medical team of a child
  with complex medical needs to determine medical necessity of the
  services recommended or provided for the child;
               (10)  allow the parent or guardian of a child with
  complex medical needs to opt the child out of receiving benefits
  through the STAR Kids managed care program and instead have the
  child receive benefits under the pilot program; and
               (11)  be administered by a neutral board established by
  the Dell Medical School at The University of Texas at Austin.
         (d)  Under the pilot program, the commission may take any
  measures permitted under federal law that are necessary to:
               (1)  supersede and rework existing systemic and
  regulatory barriers to care and integration for children with
  complex medical needs under Medicaid;
               (2)  reduce administrative burdens inherent in the
  current Medicaid system while maintaining high accountability
  standards;
               (3)  adopt a specific procedure or other billing code
  under Medicaid for a health care provider to diagnose or treat
  conditions specific to children with complex medical needs,
  including for:
                     (A)  a value-based whole child visit to include a
  bundled payment for multidisciplinary whole child complex care;
                     (B)  care coordination;
                     (C)  family support;
                     (D)  intermediate and post-acute care;
                     (E)  transition services;
                     (F)  mid-tier caregiver workforce providers,
  including certified nursing assistant care; and
                     (G)  parents as paid caregivers; and
               (4)  allow a third-party payor to act in the capacity of
  a preferred provider organization operating under Chapter 1301,
  Insurance Code.
         (e)  The commission, in coordination with the Dell Medical
  School at The University of Texas at Austin, shall develop a
  statewide, neutral third-party de-identified data collection
  registry to:
               (1)  improve access to care and recipient outcomes
  under the pilot program;
               (2)  track funding and cost effectiveness,
  utilization, clinical practices, safety and effectiveness, and the
  allocation of resources under the pilot program; and
               (3)  identify best practices for the provision of care
  to children with complex medical needs.
         (e-1)  The registry developed under Subsection (e) must be
  integrated and coordinated with the all payor claims database
  established under Subchapter I, Chapter 38, Insurance Code.
         (f)  For purposes of funding the pilot program, the
  commission may:
               (1)  establish a Medicaid directed provider payment
  program for children with complex medical needs who are enrolled in
  the STAR Kids managed care program and make a portion of the
  directed provider payment program funds available for the pilot
  program based on the recipient's anticipated or actual
  participation in the pilot program;
               (2)  obtain additional federal money under the
  Advancing Care for Exceptional (ACE) Kids Act of 2019 enacted as
  part of the Medicaid Services Investment and Accountability Act of
  2019 (Pub. L. No. 116-16);
               (3)  leverage enhanced federal medical assistance
  percentage funding related to establishing health homes available
  under the Patient Protection and Affordable Care Act (Pub. L.
  No. 111-148) as amended by the Health Care and Education
  Reconciliation Act of 2010 (Pub. L. No. 111-152); and
               (4)  make funds available from a portion of STAR Kids
  managed care program experience rebates.
         (g)  Not later than March 1, 2025, the commission, in
  coordination with the Dell Medical School at The University of
  Texas at Austin, shall prepare and submit to the governor,
  lieutenant governor, and speaker of the house of representatives a
  written report that includes:
               (1)  a summary of the pilot program's progress;
               (2)  an assessment of the impact of providing
  transformative, comprehensive multidisciplinary whole child care
  and fully integrated health homes for children with complex medical
  needs;
               (3)  an update on any waiver or amendment request
  necessary to modify the state Medicaid plan to provide the level of
  care and health homes for children with complex medical needs
  necessary under the pilot program;
               (4)  a description of the level of care and status of
  health homes being provided to children with complex medical needs
  at the time the report is prepared;
               (5)  an analysis of the effectiveness of providing the
  level of care and health homes for children with complex medical
  needs at the level at which those services are provided at the time
  the report is prepared;
               (6)  estimates of the costs and potential savings of
  expanding health programs administered by the commission to meet
  the needs of children with complex medical needs;
               (7)  proposed modification to eligibility criteria for
  providing the level of care and health homes for children with
  complex medical needs under the pilot program; and
               (8)  any legislative recommendations.
         (h)  Not later than September 1, 2028, the commission shall
  prepare and submit to the governor, lieutenant governor, and
  speaker of the house of representatives a final written report on
  the pilot program that includes:
               (1)  a summary of the results of the pilot program;
               (2)  a statement on the pilot program's success in
  providing transformative, comprehensive multidisciplinary whole
  child care and fully integrated health homes for children with
  complex medical needs;
               (3)  a recommendation as to whether the pilot program
  should be continued as a pilot program or permanent program; and
               (4)  any legislative recommendations.
         (i)  The pilot program established under this section
  concludes September 1, 2028.
         (j)  This section expires September 1, 2029.
         SECTION 2.  Section 531.0605, Government Code, is repealed.
         SECTION 3.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization, including
  a state plan amendment, 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 4.  This Act takes effect September 1, 2023.