Bill Text: TX HB1111 | 2019-2020 | 86th Legislature | Comm Sub


Bill Title: Relating to maternal and newborn health care.

Spectrum: Bipartisan Bill

Status: (Engrossed) 2019-05-22 - Not again placed on intent calendar [HB1111 Detail]

Download: Texas-2019-HB1111-Comm_Sub.html
 
 
  By: Davis of Harris, et al. H.B. No. 1111
        (Senate Sponsor - Kolkhorst)
         (In the Senate - Received from the House April 30, 2019;
  May 7, 2019, read first time and referred to Committee on Health &
  Human Services; May 20, 2019, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 9, Nays 0;
  May 20, 2019, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR H.B. No. 1111 By:  Campbell
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to maternal and newborn health care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02163 to read as follows:
         Sec. 531.02163.  STUDY ON PROVIDING CERTAIN MATERNAL CARE
  MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND
  TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the
  commission shall conduct a study on the benefits and costs of
  permitting reimbursement under Medicaid for prenatal and
  postpartum care delivered through telemedicine medical services
  and telehealth services.
         (b)  This section expires September 1, 2021.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0996 to read as follows:
         Sec. 531.0996.  PREGNANCY MEDICAL HOME PILOT PROGRAM. (a)
  The commission shall develop a pilot program to establish pregnancy
  medical homes that provide coordinated evidence-based maternity
  care management to women who reside in a pilot program area and are
  recipients of Medicaid through a Medicaid managed care model or
  arrangement under Chapter 533. The commission shall implement the
  pilot program in:
               (1)  at least two counties with populations of more
  than two million;
               (2)  at least one county with a population of more than
  100,000 and less than 500,000; and
               (3)  at least one rural county with high rates of
  maternal mortality and morbidity as determined by the commission in
  consultation with the Maternal Mortality and Morbidity Task Force
  established under Chapter 34, Health and Safety Code.
         (b)  In implementing the pilot program, the commission shall
  ensure each pregnancy medical home provides a maternity management
  team that:
               (1)  consists of health care providers, including
  obstetricians, gynecologists, family physicians, physician
  assistants, certified nurse midwives, nurse practitioners, and
  social workers, who provide health care services at the same
  location in:
                     (A)  a zip code with a high rate of maternal
  mortality and morbidity; or
                     (B)  an area with limited access to health care
  providers who provide obstetrical care;
               (2)  conducts a risk assessment of each pilot program
  participant on her entry into the program to determine the risk
  classification for her pregnancy based on recognized maternal
  mortality and morbidity risk assessment tools that indicate the
  participant's:
                     (A)  maternal age;
                     (B)  maternal race;
                     (C)  prior pregnancies that resulted in a live
  birth, stillbirth, or miscarriage; and
                     (D)  family history of disease;
               (3)  based on the assessment conducted under
  Subdivision (2), establishes an individual pregnancy care plan for
  each participant; and
               (4)  follows each participant throughout her pregnancy
  and for a reasonable amount of time postpartum to reduce poor birth
  outcomes and pregnancy-related maternal deaths occurring
  postpartum.
         (c)  The commission may incorporate as a component of the
  pilot program financial incentives for health care providers who
  participate in a maternity management team.  The commission may
  consider as a criteria for the financial incentives whether the
  health care provider in a maternity management team will implement
  strategies and best practices recommended by the Maternal Mortality
  and Morbidity Task Force established under Chapter 34, Health and
  Safety Code, for reducing maternal mortality rates and maternal
  health disparities for African American women in this state.
         (d)  The commission may waive a requirement of this section
  for a pregnancy medical home located in a rural county.
         (e)  Notwithstanding Section 531.02176, the commission may:
               (1)  provide home telemonitoring services and
  necessary durable medical equipment to pilot program participants
  who are at risk of experiencing pregnancy-related complications, as
  determined by a physician, to the extent the commission anticipates
  the services and equipment will reduce unnecessary emergency room
  visits or hospitalizations; and
               (2)  reimburse providers under Medicaid for the
  provision of home telemonitoring services and durable medical
  equipment under the pilot program.
         (f)  Not later than January 1, 2021, the commission shall
  submit to the legislature a report on the pilot program. The report
  must include:
               (1)  an evaluation of the pilot program's success in
  reducing poor birth outcomes; and
               (2)  a recommendation on whether the pilot program
  should continue, be expanded, or be terminated.
         (f-1)  The report required under Subsection (f) may include
  statistical information and findings based on confidential
  information collected under Section 34.019, Health and Safety Code,
  provided the information and findings:
               (1)  are aggregated; and
               (2)  do not include any personally identifying
  information of a woman, her family, or a health care provider.
         (g)  The executive commissioner shall:
               (1)  adopt rules to implement this section; and
               (2)  adopt and implement policies and procedures to
  ensure that confidential information obtained under this section is
  not disclosed in violation of state or federal law.
         (h)  This section expires September 1, 2023.
         SECTION 3.  Section 33.004(f), Health and Safety Code, is
  amended to read as follows:
         (f)  The executive commissioner by rule shall [may]
  establish the amounts charged for newborn screening fees, including
  fees assessed for follow-up services, tracking confirmatory
  testing, and diagnosis. In adopting rules under this subsection,
  the executive commissioner shall ensure that amounts charged for
  newborn screening fees are sufficient to cover the costs of
  performing the screening.
         SECTION 4.  Chapter 33, Health and Safety Code, is amended by
  adding Subchapter D to read as follows:
  SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT
         Sec. 33.051.  DEFINITION. In this subchapter, "account"
  means the newborn screening preservation account established under
  Section 33.052.
         Sec. 33.052.  CREATION OF ACCOUNT. (a) The newborn
  screening preservation account is a dedicated account in the
  general revenue fund. The account is created solely for the
  perpetual care and preservation of newborn screening in this state.
         (b)  Money in the account may be appropriated only to the
  department and only for the purpose of carrying out the newborn
  screening program established under this chapter.
         (c)  On November 1 of each year, the department shall
  transfer to the account any unexpended and unencumbered money from
  Medicaid reimbursements collected by the department for newborn
  screening services during the preceding state fiscal year.
         (d)  The account is composed of:
               (1)  money transferred to the account under Subsection
  (c);
               (2)  gifts, grants, donations, and legislative
  appropriations; and
               (3)  interest earned on the investment of money in the
  account.
         (e)  Section 403.0956, Government Code, does not apply to the
  account.
         (f)  The department administers the account. The department
  may solicit and receive gifts, grants, and donations from any
  source for the benefit of the account.
         Sec. 33.053.  DEDICATED USE. (a) The department may use any
  money remaining in the account after paying the costs of operating
  the newborn screening program established under this chapter only
  to:
               (1)  pay for capital assets, improvements, equipment,
  and renovations for the laboratory established by the department to
  ensure the continuous operation of the newborn screening program;
  and
               (2)  pay for necessary renovations, construction,
  capital assets, equipment, supplies, staff, and training
  associated with providing additional newborn screening tests not
  offered under this chapter before September 1, 2019, including the
  operational costs incurred during the first year of implementing
  the additional tests.
         (b)  The department may not use money from the account for
  the department's general operating expenses.
         Sec. 33.054.  REPORT. If the department requires an
  additional newborn screening test under Subchapter B the costs of
  which are funded with money appropriated from the newborn screening
  preservation account, the department shall, not later than December
  31 of the first even-numbered year following the addition of the
  test, prepare and submit a written report regarding the actions
  taken by the department to fund and implement the test during the
  preceding two years to:
               (1)   the governor;
               (2)  the lieutenant governor;
               (3)  the speaker of the house of representatives; and
               (4)  each standing committee of the legislature having
  primary jurisdiction over the department.
         SECTION 5.  Chapter 34, Health and Safety Code, is amended by
  adding Sections 34.0158 and 34.0159 to read as follows:
         Sec. 34.0158.  REPORT ON ACTIONS TO ADDRESS MATERNAL
  MORTALITY RATES. Not later than December 1 of each even-numbered
  year, the commission shall submit to the governor, the lieutenant
  governor, the speaker of the house of representatives, the
  Legislative Budget Board, and the appropriate standing committees
  of the legislature a written report summarizing the actions taken
  to address maternal morbidity and reduce maternal mortality rates.
  The report must include information from programs and initiatives
  created to address maternal morbidity and reduce maternal mortality
  rates in this state, including:
               (1)  Medicaid;
               (2)  the children's health insurance program, including
  the perinatal program;
               (3)  the Healthy Texas Women program;
               (4)  the Family Planning Program;
               (5)  this state's program under the Maternal and Child
  Health Services Block Grant Act (42 U.S.C. Section 701 et seq.);
               (6)  the Perinatal Advisory Council;
               (7)  state health plans; and
               (8)  the Healthy Texas Babies program.
         Sec. 34.0159.  PROGRAM EVALUATIONS. The commission, in
  collaboration with the task force and other interested parties,
  shall:
               (1)  explore options for expanding the pilot program
  for pregnancy medical homes established under Section 531.0996,
  Government Code;
               (2)  explore methods for increasing the benefits
  provided under Medicaid, including specialty care and
  prescriptions, for women at greater risk of a high-risk pregnancy
  or premature delivery;
               (3)  evaluate the impact of supplemental payments made
  to obstetrics providers for pregnancy risk assessments on
  increasing access to maternal health services;
               (4)  evaluate a waiver to fund managed care
  organization payments for case management and care coordination
  services for women at high risk of severe maternal morbidity on
  conclusion of their eligibility for Medicaid;
               (5)  evaluate the average time required for pregnant
  women to complete the Medicaid enrollment process;
               (6)  evaluate the use of Medicare codes for Medicaid
  care coordination;
               (7)  study the impact of programs funded from the Teen
  Pregnancy Prevention Program federal grant and evaluate whether the
  state should continue funding the programs; and
               (8)  evaluate the use of telemedicine medical services
  for women during pregnancy and the postpartum period.
         SECTION 6.  Chapter 34, Health and Safety Code, is amended by
  adding Sections 34.019, 34.020, and 34.021 to read as follows:
         Sec. 34.019.  DATA COLLECTION. The task force, under the
  direction of the department, shall annually collect information
  relating to maternity care and postpartum depression in this state.
  The information must be based on statistics for the preceding year
  and include the:
               (1)  total number of live births;
               (2)  number of births by Medicaid recipients;
               (3)  number of births by women with health benefit plan
  coverage;
               (4)  number of Medicaid recipients screened for
  postpartum depression;
               (5)  number of women screened for postpartum depression
  under health benefit plan coverage;
               (6)  number of women treated for postpartum depression
  under health benefit plan coverage;
               (7)  number of women screened for postpartum depression
  under the Healthy Texas Women program;
               (8)  number of women treated for postpartum depression
  under the Healthy Texas Women program;
               (9)  number of claims for postpartum depression
  treatment paid by the Healthy Texas Women program;
               (10)  number of claims for postpartum depression
  treatment rejected by the Healthy Texas Women program;
               (11)  postpartum depression screening and treatment
  billing codes and the number of claims for each billing code under
  the Healthy Texas Women program;
               (12)  average number of days from the date of a
  postpartum depression screening to the date the patient begins
  treatment under Medicaid;
               (13)  average number of days from the date of a
  postpartum depression screening to the date the patient begins
  treatment under the Healthy Texas Women program;
               (14)  number of women who screened positive for
  postpartum depression under Medicaid and the average number of days
  following childbirth for the screening to occur;
               (15)  number of women who screened positive for
  postpartum depression under health benefit plan coverage and the
  average number of days following childbirth for the screening to
  occur; and
               (16)  number of women who screened positive for
  postpartum depression under the Healthy Texas Women program and the
  average number of days following childbirth for the screening to
  occur.
         Sec. 34.020.  PROGRAM TO DELIVER PRENATAL AND POSTPARTUM
  CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN
  COUNTIES. (a) In this section:
               (1)  "Postpartum care" and "prenatal care" have the
  meanings assigned by Section 32.002.
               (2)  "Telehealth service" and "telemedicine medical
  service" have the meanings assigned by Section 111.001, Occupations
  Code.
         (b)  The commission, in consultation with the task force,
  shall develop a program to deliver prenatal and postpartum care
  through telehealth services or telemedicine medical services to
  pregnant women with a low risk of experiencing pregnancy-related
  complications, as determined by a physician. The commission shall
  implement the program in:
               (1)  at least two counties with populations of more
  than two million;
               (2)  at least one county with a population of more than
  100,000 and less than 500,000; and
               (3)  at least one rural county with high rates of
  maternal mortality and morbidity as determined by the commission in
  consultation with the task force.
         (c)  The commission shall develop criteria for selecting
  participants for the program by analyzing information in the
  reports prepared by the task force under this chapter and the
  outcomes of the study conducted under Section 531.02163, Government
  Code.
         (d)  In developing and administering the program, the
  commission shall endeavor to use innovative, durable medical
  equipment to monitor fetal and maternal health.
         (e)  Notwithstanding Section 531.02176, Government Code, and
  if the commission determines it is feasible and cost-effective, the
  commission may:
               (1)  provide home telemonitoring services and
  necessary durable medical equipment to women participating in the
  program to the extent the commission anticipates the services and
  equipment will reduce unnecessary emergency room visits or
  hospitalizations; and
               (2)  reimburse providers under Medicaid for the
  provision of home telemonitoring services and durable medical
  equipment under the program.
         (f)  Not later than January 1, 2021, the commission shall
  submit to the legislature a report on the program that evaluates the
  program's success in delivering prenatal and postpartum care
  through telehealth services or telemedicine medical services under
  Subsection (b). This subsection expires September 1, 2023.
         Sec. 34.021.  APPLICATION FOR FEDERAL GRANTS. (a) The
  executive commissioner shall apply to the United States Department
  of Health and Human Services for grants under the federal
  Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
         (b)  This section expires September 1, 2027.
         SECTION 7.  Section 81.090(c), Health and Safety Code, is
  amended to read as follows:
         (c)  A physician or other person in attendance at a delivery
  shall:
               (1)  take or cause to be taken a sample of blood or
  other appropriate specimen from the mother on admission for
  delivery; and
               (2)  submit the sample to an appropriately certified
  laboratory for diagnostic testing approved by the United States
  Food and Drug Administration for hepatitis B infection and
  syphilis.
         SECTION 8.  Section 241.183(a), Health and Safety Code, is
  amended to read as follows:
         (a)  The executive commissioner, in consultation with the
  department, shall adopt rules:
               (1)  establishing the levels of care for neonatal and
  maternal care to be assigned to hospitals;
               (2)  prescribing criteria for designating levels of
  neonatal and maternal care, respectively, including specifying the
  minimum requirements to qualify for each level designation;
               (3)  establishing a process for the assignment of
  levels of care to a hospital for neonatal and maternal care,
  respectively;
               (4)  establishing a process for amending the level of
  care designation requirements, including a process for assisting
  facilities in implementing any changes made necessary by the
  amendments;
               (5)  dividing the state into neonatal and maternal care
  regions;
               (6)  facilitating transfer agreements through regional
  coordination;
               (7)  requiring payment, other than quality or
  outcome-based funding, to be based on services provided by the
  facility, regardless of the hospital's [facility's] level of care
  designation; [and]
               (8)  prohibiting the denial of a neonatal or maternal
  level of care designation to a hospital that meets the minimum
  requirements for that level of care designation;
               (9)  establishing a process through which a hospital
  may obtain a limited follow-up survey by an independent third party
  to appeal the level of care designation assigned to the hospital;
               (10)  permitting a hospital to satisfy any requirement
  for a Level I or II level of care designation that relates to an
  obstetrics or gynecological physician by:
                     (A)  granting maternal care privileges to a family
  physician with obstetrics training or experience; and
                     (B)  developing and implementing a plan for
  responding to obstetrical emergencies that require services or
  procedures outside the scope of privileges granted to the family
  physician described by Paragraph (A);
               (11)  clarifying that, regardless of a hospital's level
  of care designation, a health care provider at a designated
  facility or hospital may provide the full range of health care
  services:
                     (A)  that the provider is authorized to provide
  under state law; and
                     (B)  for which the hospital has granted privileges
  to the provider; and
               (12)  requiring the department to provide to each
  hospital that receives a level of care designation a written
  explanation of the basis for the designation, including, as
  applicable, specific reasons that prevented the hospital from
  receiving a higher level of care designation.
         SECTION 9.  Subchapter H, Chapter 241, Health and Safety
  Code, is amended by adding Sections 241.1835, 241.1836, and
  241.1865 to read as follows:
         Sec. 241.1835.  USE OF TELEMEDICINE MEDICAL SERVICES.
  (a)  In this section, "telemedicine medical service" has the
  meaning assigned by Section 111.001, Occupations Code.
         (b)  The rules adopted under Section 241.183 must allow the
  use of telemedicine medical services by a physician providing
  on-call services to satisfy certain requirements identified by the
  executive commissioner in the rules for a Level I, II, or III level
  of care designation.
         (c)  In identifying a requirement for a level of care
  designation that may be satisfied through the use of telemedicine
  medical services under Subsection (b), the executive commissioner,
  in consultation with the department, physicians of appropriate
  specialties, statewide hospital associations, and other
  appropriate interested persons, must ensure that the provision of a
  service or procedure through the use of telemedicine medical
  services is in accordance with the standard of care applicable to
  the provision of the same service or procedure in an in-person
  setting.
         (d)  Telemedicine medical services must be administered
  under this section by a physician licensed to practice medicine
  under Subtitle B, Title 3, Occupations Code.
         (e)  This section does not waive other requirements for a
  level of care designation.
         Sec. 241.1836.  APPEAL PROCESS. (a)  The rules adopted
  under Section 241.183 establishing the appeal process for a level
  of care designation assigned to a hospital must allow a hospital to
  appeal to a three-person panel that includes:
               (1)  a representative of the department;
               (2)  a representative of the commission; and
               (3)  an independent person who:
                     (A)  has expertise in the specialty area for which
  the hospital is seeking a level of care designation;
                     (B)  is not an employee of or affiliated with
  either the department or the commission; and
                     (C)  does not have a conflict of interest with the
  hospital, department, or commission.
         (b)  The independent person on the panel described by
  Subsection (a) must rotate after each appeal from a list of five to
  seven similarly qualified persons. The department shall solicit
  persons to be included on the list. A person must apply to the
  department on a form prescribed by the department and be approved by
  the commissioner to be included on the list.
         Sec. 241.1865.  WAIVER FROM LEVEL OF CARE DESIGNATION
  REQUIREMENTS; CONDITIONAL DESIGNATION. (a)  The department shall
  develop and implement a process through which a hospital may
  request and enter into an agreement with the department to:
               (1)  receive or maintain a level of care designation
  for which the hospital does not meet all requirements conditioned
  on the hospital, in accordance with a plan approved by the
  department and outlined under the agreement, satisfying all
  requirements for the level of care designation within a time
  specified under the agreement, which may not exceed the first
  anniversary of the effective date of the agreement; or
               (2)  waive one specific requirement for a level of care
  designation in accordance with Subsection (c).
         (b)  A hospital may submit a written request under Subsection
  (a) at any time. The department may make a determination on a
  request submitted under that subsection at any time.
         (c)  The department may enter into an agreement with a
  hospital to waive a requirement under Subsection (a)(2) only if the
  department determines the waiver is justified considering:
               (1)  the expected impact on the accessibility of care
  in the geographical area served by the hospital if the waiver is not
  granted;
               (2)  the expected impact on quality of care;
               (3)  the expected impact on patient safety; and
               (4)  whether health care services related to the
  requirement can be provided through telemedicine medical services
  under Section 241.1835.
         (d)  A waiver agreement entered into under Subsection (a):
               (1)  must expire not later than at the end of each
  designation cycle but may be renewed on expiration by the
  department under the same or different terms; and
               (2)  may specify any conditions for ongoing reporting
  and monitoring during the agreement.
         (e)  A hospital that enters into a waiver agreement under
  Subsection (a) is required to satisfy all other requirements for a
  level of care designation that are not waived in the agreement.
         (f)  The department shall post on the department's Internet
  website and periodically update:
               (1)  a list of hospitals that enter into an agreement
  with the department under this section; and
               (2)  an aggregated list of the requirements
  conditionally met or waived in agreements entered into under this
  section.
         (g)  A hospital that enters into an agreement with the
  department under this section shall post on the hospital's Internet
  website the nature and general terms of the agreement.
         SECTION 10.  Section 241.187, Health and Safety Code, is
  amended by amending Subsection (l) and adding Subsections (m) and
  (n) to read as follows:
         (l)  The advisory council is subject to Chapter 325,
  Government Code (Texas Sunset Act). The advisory council shall be
  reviewed during the period in which the Department of State Health
  Services is reviewed [Unless continued in existence as provided by
  that chapter, the advisory council is abolished and this section
  expires September 1, 2025].
         (m)  The department, in consultation with the advisory
  council, shall:
               (1)  conduct a strategic review of the practical
  implementation of rules adopted in consultation with the department
  under this subchapter that at a minimum identifies:
                     (A)  barriers to a hospital obtaining its
  requested level of care designation;
                     (B)  whether the barriers identified under
  Paragraph (A) are appropriate to ensure and improve neonatal and
  maternal care;
                     (C)  requirements for a level of care designation
  that relate to gestational age; and
                     (D)  whether, in making a level of care
  designation for a hospital, the department or the perinatal
  advisory council should consider:
                           (i)  the geographic area in which the
  hospital is located; and
                           (ii)  regardless of the number of patients
  of a particular gestational age treated by the hospital, the
  hospital's capabilities in providing care to patients of a
  particular gestational age;
               (2)  based on the review conducted under Subdivision
  (1), recommend a modification of rules adopted under this
  subchapter, as appropriate, to improve the process and methodology
  of assigning level of care designations; and
               (3)  prepare and submit to the legislature:
                     (A)  not later than December 31, 2019, a written
  report that summarizes the department's review of neonatal care
  conducted under Subdivision (1) and on actions taken by the
  department and executive commissioner based on that review; and
                     (B)  not later than December 31, 2020, a written
  report that summarizes the department's review of maternal care
  conducted under Subdivision (1) and on actions taken by the
  department and executive commissioner based on that review.
         (n)  Subsection (m) and this subsection expire September 1,
  2021.
         SECTION 11.  Chapter 1001, Health and Safety Code, is
  amended by adding Subchapter K to read as follows:
  SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT
  PROGRAM
         Sec. 1001.261.  DEFINITIONS. In this subchapter:
               (1)  "Pilot program" means the high-risk maternal care
  coordination services pilot program established under this
  subchapter.
               (2)  "Promotora" or "community health worker" has the
  meaning assigned by Section 48.001.
         Sec. 1001.262.  ESTABLISHMENT OF PILOT PROGRAM; RULES. (a)
  The department shall develop and implement a high-risk maternal
  care coordination services pilot program in one or more geographic
  areas in this state.
         (b)  In implementing the pilot program, the department
  shall:
               (1)  conduct a statewide assessment of training courses
  provided by promotoras or community health workers that target
  women of childbearing age;
               (2)  study existing models of high-risk maternal care
  coordination services;
               (3)  identify, adapt, or create a risk assessment tool
  to identify pregnant women who are at a higher risk for poor
  pregnancy, birth, or postpartum outcomes; and
               (4)  create educational materials for promotoras and
  community health workers that include information on the:
                     (A)  assessment tool described by Subdivision
  (3); and
                     (B)  best practices for high-risk maternal care.
         (c)  The executive commissioner shall adopt rules as
  necessary to implement this subchapter and prescribe the types of
  information to be collected during the course of the pilot program
  and included in the report described by Section 1001.264.
         Sec. 1001.263.  DUTIES OF DEPARTMENT. (a) The department
  shall provide to each geographic area selected for the pilot
  program the support, resources, technical assistance, training,
  and guidance necessary to:
               (1)  screen all or a sample of pregnant patients with
  the assessment tool described by Section 1001.262(b)(3); and
               (2)  integrate community health worker services for
  women with high-risk pregnancies in:
                     (A)  providing patient education on
  health-enhancing behaviors and chronic disease management and
  prevention;
                     (B)  facilitating care coordination and
  navigation activities; and
                     (C)  identifying and reducing barriers to the
  women's access to health care.
         (b)  The department shall develop training courses to
  prepare promotoras and community health workers in educating and
  supporting women at high risk for serious complications during the
  pregnancy and postpartum periods.
         Sec. 1001.264.  PILOT PROGRAM REPORT. (a) Not later than
  December 1 of each even-numbered year, the department shall prepare
  and submit a report on the pilot program to the executive
  commissioner and the chairs of the standing committees of the
  senate and the house of representatives with primary jurisdiction
  over public health and human services. The report may be submitted
  with the report required under Section 34.0156.
         (b)  The report submitted under this section must include an
  evaluation from the commissioner of the pilot program's
  effectiveness.
         (c)  The report submitted under this section must include a
  recommendation from the department on whether the pilot program
  should continue, be expanded, or be terminated.
         Sec. 1001.265.  EXPIRATION. This subchapter expires
  September 1, 2023.
         SECTION 12.  (a)  The executive commissioner of the Health
  and Human Services Commission shall adopt the rules required by:
               (1)  Section 33.004(f), Health and Safety Code, as
  amended by this Act, and Section 1001.262(c), Health and Safety
  Code, as added by this Act, not later than December 1, 2019, subject
  to Subsection (b) of this section; and
               (2)  Section 241.183, Health and Safety Code, as
  amended by this Act, as soon as practicable after the effective date
  of this Act.
         (b)  Notwithstanding Subchapter K, Chapter 1001, Health and
  Safety Code, as added by this Act, the Department of State Health
  Services and the executive commissioner of the Health and Human
  Services Commission are not required to comply with that subchapter
  unless a specific appropriation for the implementation of the
  subchapter is provided in a general appropriations act of the 86th
  Legislature.
         SECTION 13.  (a)  The executive commissioner of the Health
  and Human Services Commission shall complete for each hospital in
  this state the maternal level of care designation required under
  Subchapter H, Chapter 241, Health and Safety Code, as amended by
  this Act, not later than August 31, 2021.
         (b)  Notwithstanding Section 241.186, Health and Safety
  Code, a hospital is not required to have a maternal level of care
  designation as a condition of reimbursement for maternal services
  through the Medicaid program before September 1, 2021.
         (c)  A hospital that submits an application to the Department
  of State Health Services for a maternal level of care designation
  under Subchapter H, Chapter 241, Health and Safety Code, before the
  effective date of this Act may amend the application to reflect the
  applicable changes in law made by this Act.
         SECTION 14.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall apply to the United States Department of
  Health and Human Services for grants as required by Section 34.021,
  Health and Safety Code, as added by this Act.
         SECTION 15.  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 16.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2019.
 
  * * * * *
feedback