Bill Text: TX HB4111 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to access to and the provision of behavioral and mental health care services and trauma-informed care in the Medicaid managed care program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2023-03-21 - Referred to Human Services [HB4111 Detail]

Download: Texas-2023-HB4111-Introduced.html
  88R13754 MM-F
 
  By: Plesa H.B. No. 4111
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to access to and the provision of behavioral and mental
  health care services and trauma-informed care in the Medicaid
  managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Sections 533.0051(a) and (d), Government Code,
  are amended to read as follows:
         (a)  The commission shall establish outcome-based
  performance measures and incentives to include in each contract
  between a health maintenance organization and the commission for
  the provision of health care services, including behavioral and
  mental health care services, to recipients that is procured and
  managed under a value-based purchasing model.  The performance
  measures and incentives must:
               (1)  be designed to facilitate and increase recipients'
  access to appropriate health care services, including behavioral
  and mental health care services; [and]
               (2)  to the extent possible, align with other state and
  regional quality care improvement initiatives; and
               (3)  for contracts for the provision of behavioral and
  mental health care services to recipients under the STAR Health
  program, be designed to facilitate and increase recipients' access
  to trauma-informed care.
         (d)  Subject to Subsection (f), the commission shall assess
  the feasibility and cost-effectiveness of including provisions in a
  contract described by Subsection (a) that require the health
  maintenance organization to provide to the providers in the
  organization's provider network pay-for-performance opportunities
  that support quality improvements in the care of recipients.
  Pay-for-performance opportunities may include incentives for
  providers to provide care after normal business hours and to
  participate in the early and periodic screening, diagnosis, and
  treatment program and other activities that improve recipients'
  access to care, including trauma-informed care and behavioral and
  mental health care services. If the commission determines that the
  provisions are feasible and may be cost-effective, the commission
  shall develop and implement a pilot program in at least one health
  care service region under which the commission will include the
  provisions in contracts with health maintenance organizations
  offering managed care plans in the region.
         SECTION 2.  Section 533.0052, Government Code, is amended by
  amending Subsection (a) and adding Subsections (c), (d), and (e) to
  read as follows:
         (a)  A contract between a managed care organization and the
  commission for the organization to provide health care services,
  including behavioral and mental health care services, to recipients
  under the STAR Health program must include a requirement that
  [trauma-informed care training be offered to] each contracted
  physician or provider who diagnoses or provides treatment for a
  behavioral or mental health condition or prescribes psychotropic
  medication receive training regarding the impact of trauma on
  children and trauma-informed care.
         (c)  The commission shall determine the appropriate
  information to include in the training required by Subsection (a).
  The training must include information regarding:
               (1)  the effects of trauma, toxic stress, and adverse
  childhood experiences on a child's:
                     (A)  brain development; and
                     (B)  cognitive, emotional, psychological,
  physical, and behavioral functioning;
               (2)  trauma screening and accessing a child's trauma
  history;
               (3)  the management of traumatic memories and
  trauma-related symptoms;
               (4)  the overlap between symptoms of trauma and
  symptoms of mental health disorders, including
  attention-deficit/hyperactivity disorder, bipolar disorder, and
  oppositional defiant disorder;
               (5)  the potential risks of using psychotropic
  medication for children who have experienced trauma;
               (6)  the availability of research-supported or
  evidence-based, trauma-informed, non-pharmacological
  interventions;
               (7)  appropriate coding and billing procedures for
  reimbursement of trauma-informed care, treatments, and services;
  and
               (8)  the impact of trauma on children with an
  intellectual or developmental disability.
         (d)  The commission shall make at least one opportunity to
  receive the training required by Subsection (a) available at no
  cost to each physician or provider described by Subsection (a) with
  whom a contract is entered into or renewed.
         (e)  The commission may establish performance measures and
  incentives described by Section 533.0051 to encourage improved
  access to trauma-informed care and behavioral and mental health
  care services for recipients under the STAR Health program and to
  support contracted physicians or providers described by Subsection
  (a) in receiving:
               (1)  training required by Subsection (a); and
               (2)  additional training in research-supported or
  evidence-based, trauma-informed, non-pharmacological
  interventions.
         SECTION 3.  Not later than January 1, 2024, the executive
  commissioner of the Health and Human Services Commission shall
  adopt rules necessary to implement Sections 533.0051 and 533.0052,
  Government Code, as amended by this Act.
         SECTION 4.  (a)  Sections 533.0051 and 533.0052, Government
  Code, as amended by this Act, apply only to a contract between the
  Health and Human Services Commission and a managed care
  organization that is entered into or renewed on or after the
  effective date of this Act.
         (b)  To the extent permitted by law or the terms of the
  contract, the Health and Human Services Commission shall amend a
  contract entered into before the effective date of this Act with a
  managed care organization to comply with Sections 533.0051 and
  533.0052, Government Code, as amended by this Act.
         SECTION 5.  Notwithstanding Section 533.0052, Government
  Code, as amended by this Act, a physician or provider is not
  required to complete the training described by that section before
  September 1, 2027.
         SECTION 6.  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 7.  This Act takes effect September 1, 2023.
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