Bill Text: TX SB1136 | 2021-2022 | 87th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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 2-0)
Status: (Passed) 2021-06-07 - Effective on 9/1/21 [SB1136 Detail]
Download: Texas-2021-SB1136-Introduced.html
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 2-0)
Status: (Passed) 2021-06-07 - Effective on 9/1/21 [SB1136 Detail]
Download: Texas-2021-SB1136-Introduced.html
87R9389 KFF-D | ||
By: Kolkhorst | S.B. No. 1136 |
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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. |