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A BILL TO BE ENTITLED
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AN ACT
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relating to improving health outcomes for pregnant women under |
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Medicaid and certain other public benefits programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. It is the intent of the legislature to improve |
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health outcomes for pregnant women and their children through the |
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case management for children and pregnant women program. In |
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recognizing that nonmedical factors impact health outcomes, this |
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legislation, in part, authorizes Medicaid to provide case |
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management services for nonmedical needs that will improve health |
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outcomes for pregnant women and their children. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.024183 to read as follows: |
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Sec. 531.024183. STANDARDIZED SCREENING QUESTIONS FOR |
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ASSESSING NONMEDICAL HEALTH-RELATED NEEDS OF CERTAIN PREGNANT |
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WOMEN; INFORMED CONSENT. (a) In this section, "alternatives to |
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abortion program" means the program established by the commission |
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to enhance and increase resources that promote childbirth for women |
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facing unplanned pregnancy, or a successor program. |
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(b) The commission shall adopt standardized screening |
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questions designed to screen for, identify, and aggregate data |
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regarding the nonmedical health-related needs of pregnant women |
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eligible for benefits under a public benefits program administered |
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by the commission or another health and human services agency, |
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including: |
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(1) Medicaid; and |
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(2) the alternatives to abortion program. |
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(c) Subject to Subsection (d), the standardized screening |
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questions must be used by Medicaid managed care organizations and |
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providers participating in the alternatives to abortion program. |
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(d) A managed care organization or provider participating |
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in a public benefits program described by Subsection (b), including |
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the alternatives to abortion program, may not perform a screening |
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of a pregnant woman using the standardized screening questions |
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required by this section unless the organization or provider: |
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(1) informs the woman: |
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(A) about the type of data that will be collected |
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during the screening and the purposes for which the data will be |
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used; and |
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(B) that the collected data will become part of |
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the woman's medical record or service plan; and |
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(2) obtains the woman's informed consent to perform |
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the screening. |
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(e) A managed care organization or provider participating |
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in a public benefits program described by Subsection (b), including |
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the alternatives to abortion program, must provide to the |
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commission, in the form and manner prescribed by the commission, |
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data the organization or provider collects using the standardized |
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screening questions required by this section. |
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(f) Not later than December 1 of each even-numbered year, |
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the commission shall prepare and submit to the legislature a report |
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that, using de-identified information, summarizes the data |
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collected and provided to the commission under Subsection (e) |
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during the previous biennium. In accordance with Section 531.014, |
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the commission may consolidate the report required under this |
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subsection with any other report to the legislature required under |
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this chapter or another law that relates to the same subject matter. |
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SECTION 3. Chapter 531, Government Code, is amended by |
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adding Subchapter Q to read as follows: |
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SUBCHAPTER Q. CASE MANAGEMENT SERVICES FOR CERTAIN PREGNANT WOMEN |
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Sec. 531.651. DEFINITIONS. In this subchapter: |
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(1) "Case management for children and pregnant women |
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program" means the "children and pregnant women program," as |
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defined by Section 533.002555. |
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(2) "Nonmedical health-related needs screening" means |
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a screening performed using the standardized screening questions |
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required under Section 531.024183. |
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(3) "Program services" means case management services |
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provided under the case management for children and pregnant women |
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program, including assistance provided to a Medicaid managed care |
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organization in coordinating the provision of benefits to a |
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recipient enrolled in the organization's managed care plan in a |
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manner that is consistent with the recipient's plan of care. |
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Sec. 531.652. MEDICAID MANAGED CARE ORGANIZATION SERVICE |
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COORDINATION BENEFITS NOT AFFECTED. The provision of program |
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services to a recipient does not preempt or otherwise affect a |
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Medicaid managed care organization's obligation to provide service |
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coordination benefits to the recipient. |
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Sec. 531.653. CASE MANAGEMENT FOR CHILDREN AND PREGNANT |
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WOMEN PROGRAM: PROVIDER QUALIFICATIONS. Program services may be |
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provided only by a provider who completes the standardized case |
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management training required by the commission under Section |
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531.654 and who is: |
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(1) an advanced practice nurse who holds a license, |
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other than a provisional or temporary license, under Chapter 301, |
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Occupations Code; |
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(2) a registered nurse who holds a license, other than |
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a provisional or temporary license, under Chapter 301, Occupations |
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Code, and: |
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(A) completed a baccalaureate degree program in |
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nursing; or |
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(B) completed an associate degree program in |
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nursing and has: |
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(i) at least two years of cumulative paid |
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full-time work experience; or |
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(ii) at least two years of cumulative, |
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supervised full-time educational internship or practicum |
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experience obtained in the last 10 years that included assessing |
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the psychosocial and health needs of and making community referrals |
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of: |
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(a) children who are 21 years of age |
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or younger; or |
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(b) pregnant women; |
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(3) a social worker who holds a license, other than a |
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provisional or temporary license, under Chapter 505, Occupations |
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Code, appropriate for the individual's practice, including the |
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practice of independent social work; |
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(4) a community health worker as defined by Section |
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48.001, Health and Safety Code, who is certified by the Department |
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of State Health Services; or |
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(5) a doula who is certified by a recognized national |
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certification program, as determined by the commission, unless the |
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doula qualifies as a certified community health worker under |
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Subdivision (4). |
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Sec. 531.654. CASE MANAGEMENT FOR CHILDREN AND PREGNANT |
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WOMEN PROGRAM: PROVIDER TRAINING. The commission shall require |
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that each provider of program services complete training prescribed |
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by the commission. The training must be trauma-informed and include |
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instruction on: |
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(1) social services provided by this state and local |
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governments in this state; |
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(2) community assistance programs, including programs |
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providing: |
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(A) nutrition and housing assistance; |
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(B) counseling and parenting services; |
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(C) substance use disorder treatment; and |
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(D) domestic violence assistance and shelter; |
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(3) domestic violence and coercive control dynamics; |
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(4) methods for explaining and eliciting an eligible |
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recipient's informed consent to receive: |
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(A) program services screening; and |
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(B) any services that may be offered as a result |
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of the screening; and |
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(5) procedures for: |
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(A) an eligible recipient to: |
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(i) decline program services screening; or |
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(ii) withdraw consent for offered services; |
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and |
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(B) ensuring that the recipient is not subject to |
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any retaliatory action for declining or discontinuing any |
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screenings or services. |
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Sec. 531.655. INITIAL MEDICAL AND NONMEDICAL |
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HEALTH-RELATED SCREENINGS OF CERTAIN RECIPIENTS. (a) A Medicaid |
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managed care organization that provides health care services to a |
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pregnant woman under the STAR Medicaid managed care program shall |
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conduct an initial health needs screening and nonmedical |
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health-related needs screening of each pregnant recipient to |
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determine, regardless of whether the recipient is considered to |
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have a high-risk pregnancy, if the recipient: |
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(1) is eligible for service coordination benefits to |
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be provided by the managed care organization; or |
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(2) should be referred for program services. |
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(b) Service coordination benefits described by Subsection |
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(a) must include identifying and coordinating the provision of |
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non-covered services, community supports, and other resources the |
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Medicaid managed care organization determines will improve the |
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recipient's health outcomes. |
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(c) A Medicaid managed care organization must use the |
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results of the screenings conducted under Subsection (a) to |
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determine if a recipient requires a more comprehensive assessment |
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for purposes of determining whether the recipient is eligible for |
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service coordination benefits or program services. |
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Sec. 531.656. SCREENING AND PROGRAM SERVICES OPTIONAL. A |
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Medicaid managed care organization providing screenings under |
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Section 531.655 must inform each pregnant woman who is referred for |
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program services or for whom screening is conducted under that |
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section that: |
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(1) the woman has a right to decline the screening or |
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services or choose to discontinue the screening or services at any |
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time; and |
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(2) declining or discontinuing the screening or |
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services will not result in retaliatory action against the woman in |
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the provision of other services. |
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SECTION 4. Section 32.024, Human Resources Code, is amended |
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by adding Subsections (pp) and (qq) to read as follows: |
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(pp) For purposes of enrollment as a provider and |
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reimbursement under the medical assistance program, the commission |
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shall establish a separate provider type for a community health |
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worker, as defined by Section 48.001, Health and Safety Code, who |
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provides case management services under the children and pregnant |
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women program, as defined by Section 533.002555, Government Code. |
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(qq) For purposes of enrollment as a provider and |
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reimbursement under the medical assistance program, the commission |
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shall establish a separate provider type for a doula who is |
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certified by a recognized national doula certification program |
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approved by the commission. |
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SECTION 5. (a) In this section: |
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(1) "Case management for children and pregnant women |
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program" has the meaning assigned by Section 531.651, Government |
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Code, as added by this Act. |
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(2) "Commission" means the Health and Human Services |
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Commission. |
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(b) Not later than December 1, 2024, the commission shall |
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prepare and submit to the legislature a status report on the |
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implementation of case management services provided to pregnant |
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women under the case management for children and pregnant women |
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program during the preceding fiscal year. The report must include |
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de-identified information about: |
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(1) the nonmedical health-related needs of the women |
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receiving case management services; |
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(2) the number and types of referrals made of women to |
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nonmedical community assistance programs and providers; and |
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(3) the birth outcomes for the women. |
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SECTION 6. As soon as practicable after the effective date |
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of this Act, the Health and Human Services Commission shall: |
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(1) develop the standardized screening questions as |
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required by Section 531.024183, Government Code, as added by this |
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Act; and |
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(2) revise the commission's standardized case |
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management training for children and pregnant women program |
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providers to comply with Section 531.654, Government Code, as added |
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by this Act. |
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SECTION 7. 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 8. This Act takes effect September 1, 2023. |