Bill Text: TX HB4365 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to a pilot project to improve health care outcomes and reduce costs under Medicaid by providing participating recipients with enhanced case management and other services to address certain social determinants of health.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2021-04-20 - Left pending in committee [HB4365 Detail]
Download: Texas-2021-HB4365-Introduced.html
87R2189 MM-D | ||
By: Oliverson | H.B. No. 4365 |
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relating to a pilot project to improve health care outcomes and | ||
reduce costs under Medicaid by providing participating recipients | ||
with enhanced case management and other services to address certain | ||
social determinants of health. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 533, Government Code, is amended by | ||
adding Subchapter F to read as follows: | ||
SUBCHAPTER F. PILOT PROJECT TO ADDRESS CERTAIN SOCIAL DETERMINANTS | ||
OF HEALTH | ||
Sec. 533.101. DEFINITIONS. In this subchapter: | ||
(1) "Pilot project" means the pilot project | ||
established under Section 533.102. | ||
(2) "Project participant" means an individual who | ||
participates in the pilot project. | ||
(2) "Social determinants of health" means the | ||
environmental conditions in which an individual lives that affect | ||
the individual's health and quality of life. | ||
Sec. 533.102. PILOT PROJECT FOR PROVIDING ENHANCED CASE | ||
MANAGEMENT AND OTHER SERVICES TO ADDRESS SOCIAL DETERMINANTS OF | ||
HEALTH. (a) The executive commissioner shall seek a waiver under | ||
Section 1115 of the federal Social Security Act (42 U.S.C. Section | ||
1315) to the state Medicaid plan to develop and implement a | ||
five-year pilot project to improve the health care outcomes of | ||
Medicaid recipients and reduce associated health care costs by | ||
providing enhanced case management and other coordinated, | ||
evidence-based, nonmedical intervention services designed to | ||
directly address recipient needs related to the following social | ||
determinants of health: | ||
(1) housing instability; | ||
(2) food insecurity; | ||
(3) transportation insecurity; | ||
(4) interpersonal violence; and | ||
(5) toxic stress. | ||
(b) The commission shall develop and implement the pilot | ||
project with the assistance and involvement of Medicaid managed | ||
care organizations, public or private stakeholders, and other | ||
persons the commission determines appropriate. | ||
(c) A pilot project established under this section shall be | ||
conducted in one or more regions of this state as selected by the | ||
commission. | ||
Sec. 533.103. BENEFITS: CASE MANAGEMENT AND INTERVENTION | ||
SERVICES. (a) The pilot project must assign a case manager to each | ||
project participant. The case manager will determine, authorize, | ||
and coordinate individualized nonmedical intervention services for | ||
participants that directly address and improve the participants' | ||
quality of life respecting one or more of the social determinants of | ||
health described by Section 533.102. | ||
(b) The commission shall prescribe the nonmedical | ||
intervention services that may be provided to project participants, | ||
which may include: | ||
(1) the following services to address housing | ||
instability: | ||
(A) tenancy support and sustaining services; | ||
(B) housing quality and safety improvement | ||
services; | ||
(C) legal assistance with connecting | ||
participants to community resources to address legal issues, other | ||
than providing legal representation or paying for legal | ||
representation; | ||
(D) one-time financial assistance to secure | ||
housing; and | ||
(E) short-term post-hospitalization housing; | ||
(2) the following services to address food insecurity: | ||
(A) assistance applying for benefits under the | ||
supplemental nutrition assistance program or the federal special | ||
supplemental nutrition program for women, infants, and children | ||
administered by 42 U.S.C. Section 1786; | ||
(B) assistance accessing school-based meal | ||
programs; | ||
(C) assistance locating and accessing food banks | ||
or community-based summer and after-school food programs; | ||
(D) nutrition counseling; and | ||
(E) financial assistance for targeted nutritious | ||
food or meal delivery services for individuals with medically | ||
related special dietary needs if funding cannot be obtained through | ||
other sources; | ||
(3) the following services to address transportation | ||
insecurity: | ||
(A) educational assistance to gain access to | ||
public and private forms of transportation, including | ||
ride-sharing; and | ||
(B) financial assistance for public | ||
transportation or, if public transportation is not available, | ||
private transportation to support participants' ability to access | ||
pilot project services; and | ||
(4) the following services to address interpersonal | ||
violence and toxic stress: | ||
(A) assistance with locating and accessing | ||
community-based social services and mental health agencies with | ||
expertise in addressing interpersonal violence; | ||
(B) assistance with locating and accessing | ||
high-quality child-care and after-school programs; | ||
(C) assistance with locating and accessing | ||
community engagement activities; | ||
(D) navigational services focused on identifying | ||
and improving existing factors posing a risk to the safety and | ||
health of victims transitioning from traumatic situations, | ||
including: | ||
(i) obtaining a new phone number or mailing | ||
address; | ||
(ii) securing immediate shelter and | ||
long-term housing; | ||
(iii) making school arrangements to | ||
minimize disruption of school schedules; and | ||
(iv) connecting participants to | ||
medical-legal partnerships to address overlap between health care | ||
and legal needs; | ||
(E) legal assistance for interpersonal | ||
violence-related issues, including assistance securing a | ||
protection order, other than providing legal representation or | ||
paying for legal representation; | ||
(F) assistance accessing evidence-based | ||
parenting support; and | ||
(G) assistance accessing evidence-based | ||
maternal, infant, and early home visiting services. | ||
Sec. 533.104. PARTICIPANT ELIGIBILITY. An individual is | ||
eligible to participate in the pilot project if the individual: | ||
(1) is a Medicaid recipient and receives benefits | ||
through a Medicaid managed care model or arrangement under this | ||
chapter; | ||
(2) resides in a region in which the pilot project is | ||
implemented; and | ||
(3) meets other eligibility criteria established by | ||
the commission for project participation, including: | ||
(A) having or being at a higher risk than the | ||
general population of developing a chronic or serious health | ||
condition; and | ||
(B) experiencing at least one of the social | ||
determinants of health described by Section 533.102. | ||
Sec. 533.105. RULES. The executive commissioner may adopt | ||
rules to implement this subchapter. | ||
Sec. 533.106. REPORT. Not later than September 1 of each | ||
even-numbered year, the commission shall submit to the legislature | ||
a report on the pilot project. The report must include: | ||
(1) an evaluation of the pilot project's success in | ||
reducing or eliminating poor health outcomes and reducing | ||
associated health care costs; and | ||
(2) a recommendation on whether the pilot project | ||
should be continued, expanded, or terminated. | ||
Sec. 533.107. EXPIRATION. This subchapter expires | ||
September 1, 2027. | ||
SECTION 2. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall apply for and actively pursue a waiver | ||
under Section 1115 of the federal Social Security Act (42 U.S.C. | ||
Section 1315) to the state Medicaid plan from the federal Centers | ||
for Medicare and Medicaid Services or any other federal agency to | ||
implement Subchapter F, Chapter 533, Government Code, as added by | ||
this Act. The commission may delay implementing Subchapter F, | ||
Chapter 533, Government Code, as added by this Act, until the waiver | ||
applied for under this section is granted. | ||
SECTION 3. 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, 2021. |