Bill Text: TX SB1136 | 2021-2022 | 87th Legislature | Engrossed


Bill Title: Relating to implementation of certain health care provider initiatives and measures designed to reduce costs and improve recipient health outcomes under Medicaid.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Engrossed) 2021-05-11 - Reported favorably w/o amendment(s) [SB1136 Detail]

Download: Texas-2021-SB1136-Engrossed.html
 
 
  By: Kolkhorst S.B. No. 1136
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to implementation of certain health care provider
  initiatives and measures designed to reduce costs and improve
  recipient health outcomes under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.085, Government Code, is amended to
  read as follows:
         Sec. 531.085.  HOSPITAL EMERGENCY ROOM USE REDUCTION
  INITIATIVES. (a) The commission shall develop and implement a
  comprehensive plan to reduce the use of hospital emergency room
  services by recipients under Medicaid. The plan may include:
               (1)  a pilot program designed to facilitate program
  participants in accessing an appropriate level of health care,
  which may include as components:
                     (A)  providing program participants access to
  bilingual health services providers; and
                     (B)  giving program participants information on
  how to access primary care physicians, advanced practice registered
  nurses, and local health clinics;
               (2)  a pilot program under which health care providers,
  other than hospitals, are given financial incentives for treating
  recipients outside of normal business hours to divert those
  recipients from hospital emergency rooms;
               (3)  payment of a nominal referral fee to hospital
  emergency rooms that perform an initial medical evaluation of a
  recipient and subsequently refer the recipient, if medically
  stable, to an appropriate level of health care, such as care
  provided by a primary care physician, advanced practice registered
  nurse, or local clinic;
               (4)  a program under which the commission or a managed
  care organization that enters into a contract with the commission
  under Chapter 533 contacts, by telephone or mail, a recipient who
  accesses a hospital emergency room three times during a six-month
  period and provides the recipient with information on ways the
  recipient may secure a medical home to avoid unnecessary treatment
  at hospital emergency rooms;
               (5)  a health care literacy program under which the
  commission develops partnerships with other state agencies and
  private entities to:
                     (A)  assist the commission in developing
  materials that:
                           (i)  contain basic health care information
  for parents of young children who are recipients under Medicaid and
  who are participating in public or private child-care or
  prekindergarten programs, including federal Head Start programs;
  and
                           (ii)  are written in a language
  understandable to those parents and specifically tailored to be
  applicable to the needs of those parents;
                     (B)  distribute the materials developed under
  Paragraph (A) to those parents; and
                     (C)  otherwise teach those parents about the
  health care needs of their children and ways to address those needs;
  and
               (6)  other initiatives developed and implemented in
  other states that have shown success in reducing the incidence of
  unnecessary treatment in hospital emergency rooms.
         (b)  The commission shall coordinate with hospitals and
  other providers that receive supplemental payments under the
  uncompensated care payment program operated under the Texas Health
  Care Transformation and Quality Improvement Program waiver issued
  under Section 1115 of the federal Social Security Act (42 U.S.C.
  Section 1315) to identify and implement initiatives based on best
  practices and models that are designed to reduce Medicaid
  recipients' use of hospital emergency room services as a primary
  means of receiving health care benefits, including initiatives
  designed to improve recipients' access to and use of primary care
  providers.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0862 to read as follows:
         Sec. 531.0862.  CONTINUED IMPLEMENTATION OF CERTAIN
  INTERVENTIONS AND BEST PRACTICES BY PROVIDERS; BIANNUAL REPORT.
  (a)  The commission shall encourage Medicaid providers to continue
  implementing effective interventions and best practices associated
  with improvements in the health outcomes of Medicaid recipients
  that were developed and achieved under the Delivery System Reform
  Incentive Payment (DSRIP) program previously operated under the
  Texas Health Care Transformation and Quality Improvement Program
  waiver issued under Section 1115 of the federal Social Security Act
  (42 U.S.C. Section 1315), through: 
               (1)  existing provider incentive programs and the
  creation of new provider incentive programs;
               (2)  the terms included in contracts with Medicaid
  managed care organizations;
               (3)  implementation of alternative payment models; or
               (4)  adoption of other cost-effective measures.
         (b)  The commission shall biannually prepare and submit a
  report to the legislature that contains a summary of the
  commission's efforts under this section and Section 531.085(b).
         SECTION 3.  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 4.  This Act takes effect September 1, 2021.
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