Bill Text: TX SB2028 | 2021-2022 | 87th Legislature | Engrossed


Bill Title: Relating to the Medicaid program, including the administration and operation of the Medicaid managed care program.

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2021-05-18 - Left pending in committee [SB2028 Detail]

Download: Texas-2021-SB2028-Engrossed.html
 
 
  By: Kolkhorst, et al. S.B. No. 2028
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the Medicaid program, including the administration and
  operation of the Medicaid managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.024142, 531.02493, 531.0501,
  531.0512, and 531.0605 to read as follows:
         Sec. 531.024142.  NONHOSPITAL AMBULANCE TRANSPORT AND
  TREATMENT PROGRAM. (a) The commission by rule shall develop and
  implement a program designed to improve quality of care and lower
  costs in Medicaid by:
               (1)  reducing avoidable transports to hospital
  emergency departments and unnecessary hospitalizations;
               (2)  encouraging transports to alternative care
  settings for appropriate care; and
               (3)  providing greater flexibility to ambulance care
  providers to address the emergency health care needs of Medicaid
  recipients following a 9-1-1 emergency services call.
         (b)  The program must be substantially similar to the Centers
  for Medicare and Medicaid Services' Emergency Triage, Treat, and
  Transport (ET3) model.
         Sec. 531.02493.  CERTIFIED NURSE AIDE PROGRAM. (a)  The
  commission shall study:
               (1)  the cost-effectiveness of providing, as a Medicaid
  benefit through a certified nurse aide trained in the Grand-Aide
  curriculum or a substantially similar training program, in-home
  support to a Medicaid recipient's care team after the recipient's
  discharge from a hospital; and
               (2)  the feasibility of allowing a Medicaid managed
  care organization to treat payments to certified nurse aides
  providing care as described by Subdivision (1) as quality
  improvement costs.
         (b)  Not later than December 1, 2022, the commission shall
  prepare and submit a report to the governor and the legislature that
  summarizes the commission's findings and conclusions from the
  study.
         (c)  This section expires September 1, 2023.
         Sec. 531.0501.  MEDICAID WAIVER PROGRAMS: INTEREST LIST
  MANAGEMENT. (a) The commission, in consultation with the
  Intellectual and Developmental Disability System Redesign Advisory
  Committee established under Section 534.053 and the STAR Kids
  Managed Care Advisory Committee, shall study the feasibility of
  creating an online portal for individuals to request to be placed
  and check the individual's placement on a Medicaid waiver program
  interest list.  As part of the study, the commission shall determine
  the most cost-effective automated method for determining the level
  of need of an individual seeking services through a Medicaid waiver
  program.
         (b)  Not later than January 1, 2023, the commission shall
  prepare and submit a report to the governor, the lieutenant
  governor, the speaker of the house of representatives, and the
  standing legislative committees with primary jurisdiction over
  health and human services that summarizes the commission's findings
  and conclusions from the study.
         (c)  Subsections (a) and (b) and this subsection expire
  September 1, 2023.
         (d)  The commission shall develop a protocol in the office of
  the ombudsman to improve the capture and updating of contact
  information for an individual who contacts the office of the
  ombudsman regarding Medicaid waiver programs or services.
         Sec. 531.0512.  NOTIFICATION REGARDING CONSUMER DIRECTION
  MODEL. The commission shall:
               (1)  develop a procedure to:
                     (A)  verify that a Medicaid recipient or the
  recipient's parent or legal guardian is informed regarding the
  consumer direction model and provided the option to choose to
  receive care under that model; and
                     (B)  if the individual declines to receive care
  under the consumer direction model, document the declination; and
               (2)  ensure that each Medicaid managed care
  organization implements the procedure.
         Sec. 531.0605.  ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
  PROGRAM. (a) The commission shall collaborate with Medicaid
  managed care organizations and the STAR Kids Managed Care Advisory
  Committee to develop and implement a pilot program that is
  substantially similar to the program described by Section 3,
  Medicaid Services Investment and Accountability Act of 2019 (Pub.
  L. No. 116-16), to provide coordinated care through a health home
  to children with complex medical conditions.
         (b)  The commission shall seek guidance from the Centers for
  Medicare and Medicaid Services and the United States Department of
  Health and Human Services regarding the design of the program and,
  based on the guidance, may actively seek and apply for federal
  funding to implement the program.
         (c)  Not later than December 31, 2024, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's implementation of
  the pilot program; and
               (2)  if the pilot program has been operating for a
  period sufficient to obtain necessary data, a summary of the
  commission's evaluation of the effect of the pilot program on the
  coordination of care for children with complex medical conditions
  and a recommendation as to whether the pilot program should be
  continued, expanded, or terminated.
         (d)  The pilot program terminates and this section expires
  September 1, 2025.
         SECTION 2.  Section 533.00251, Government Code, is amended
  by adding Subsection (h) to read as follows:
         (h)  In addition to the minimum performance standards the
  commission establishes for nursing facility providers seeking to
  participate in the STAR+PLUS Medicaid managed care program, the
  executive commissioner shall adopt rules establishing minimum
  performance standards applicable to nursing facility providers
  that participate in the program. The commission is responsible for
  monitoring provider performance in accordance with the standards
  and requiring corrective actions, as the commission determines
  necessary, from providers that do not meet the standards. The
  commission shall share data regarding the requirements of this
  subsection with STAR+PLUS Medicaid managed care organizations as
  appropriate.
         SECTION 3.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.00515 to read as follows:
         Sec. 533.00515.  MEDICATION THERAPY MANAGEMENT. The
  executive commissioner shall collaborate with Medicaid managed
  care organizations to implement medication therapy management
  services to lower costs and improve quality outcomes for recipients
  by reducing adverse drug events.
         SECTION 4.  Section 533.009(c), Government Code, is amended
  to read as follows:
         (c)  The executive commissioner, by rule, shall prescribe
  the minimum requirements that a managed care organization, in
  providing a disease management program, must meet to be eligible to
  receive a contract under this section. The managed care
  organization must, at a minimum, be required to:
               (1)  provide disease management services that have
  performance measures for particular diseases that are comparable to
  the relevant performance measures applicable to a provider of
  disease management services under Section 32.057, Human Resources
  Code; [and]
               (2)  show evidence of ability to manage complex
  diseases in the Medicaid population; and
               (3)  if a disease management program provided by the
  organization has low active participation rates, identify the
  reason for the low rates and develop an approach to increase active
  participation in disease management programs for high-risk
  recipients.
         SECTION 5.  Section 32.028, Human Resources Code, is amended
  by adding Subsection (p) to read as follows:
         (p)  The executive commissioner shall establish a
  reimbursement rate for medication therapy management services.
         SECTION 6.  Section 32.054, Human Resources Code, is amended
  by adding Subsection (f) to read as follows:
         (f)  To prevent serious medical conditions and reduce
  emergency room visits necessitated by complications resulting from
  a lack of access to dental care, the commission shall provide
  medical assistance reimbursement for preventive dental services,
  including reimbursement for at least one preventive dental care
  visit per year, for an adult recipient with a disability who is
  enrolled in the STAR+PLUS Medicaid managed care program. This
  subsection does not apply to an adult recipient who is enrolled in
  the STAR+PLUS home and community-based services (HCBS) waiver
  program.  This subsection may not be construed to reduce dental
  services available to persons with disabilities that are otherwise
  reimbursable under the medical assistance program.
         SECTION 7.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Sections 32.0317 and 32.0611 to read as
  follows:
         Sec. 32.0317.  REIMBURSEMENT FOR SERVICES PROVIDED UNDER
  SCHOOL HEALTH AND RELATED SERVICES PROGRAM. The executive
  commissioner shall adopt rules requiring parental consent for
  services provided under the school health and related services
  program in order for a school district to receive reimbursement for
  the services. The rules must allow a school district to seek a
  waiver to receive reimbursement for services provided to a student
  who does not have a parent or legal guardian who can provide
  consent.
         Sec. 32.0611.  COMMUNITY ATTENDANT SERVICES: QUALITY
  INITIATIVES AND EDUCATION INCENTIVES. (a) The commission shall
  develop specific quality initiatives for attendants providing
  community attendant services to improve quality outcomes for
  recipients.
         (b)  The commission shall coordinate with the Texas Higher
  Education Coordinating Board and the Texas Workforce Commission to
  develop a program to facilitate the award of academic or workforce
  education credit for programs of study or courses of instruction
  leading to a degree, certificate, or credential in a health-related
  field based on an attendant's work experience providing community
  attendant services.
         SECTION 8.  (a) In this section, "commission," "executive
  commissioner," and "Medicaid" have the meanings assigned by Section
  531.001, Government Code.
         (b)  Using existing resources, the commission shall:
               (1)  review the commission's staff rate enhancement
  programs to:
                     (A)  identify and evaluate methods for improving
  administration of those programs to reduce administrative barriers
  that prevent an increase in direct care staffing and direct care
  wages and benefits in nursing homes; and
                     (B)  develop recommendations for increasing
  participation in the programs;
               (2)  revise the commission's policies regarding the
  quality incentive payment program (QIPP) to require improvements to
  staff-to-patient ratios in nursing facilities participating in the
  program by January 1, 2023;
               (3)  examine, in collaboration with the Department of
  Family and Protective Services, implementation in other states of
  the Centers for Medicare and Medicaid Services' Integrated Care for
  Kids (InCK) Model to determine whether implementing the model could
  benefit children in this state, including children enrolled in the
  STAR Health Medicaid managed care program; and
               (4)  identify factors influencing active participation
  by Medicaid recipients in disease management programs by examining
  variations in:
                     (A)  eligibility criteria for the programs; and
                     (B)  participation rates by health plan, disease
  management program, and year.
         (c)  The executive commissioner may approve a capitation
  payment system that provides for reimbursement for physicians under
  a primary care capitation model or total care capitation model.
         SECTION 9.  (a) In this section, "commission" and
  "Medicaid" have the meanings assigned by Section 531.001,
  Government Code.
         (b)  As soon as practicable after the effective date of this
  Act, the commission shall conduct a study to determine the
  cost-effectiveness and feasibility of providing to Medicaid
  recipients who have been diagnosed with diabetes, including Type 1
  diabetes, Type 2 diabetes, and gestational diabetes:
               (1)  diabetes self-management education and support
  services that follow the National Standards for Diabetes
  Self-Management Education and Support and that may be delivered by
  a certified diabetes educator; and
               (2)  medical nutrition therapy services.
         (c)  If the commission determines that providing one or both
  of the types of services described by Subsection (b) of this section
  would improve health outcomes for Medicaid recipients and lower
  Medicaid costs, the commission shall, notwithstanding Section
  32.057, Human Resources Code, or Section 533.009, Government Code,
  and to the extent allowed by federal law develop a program to
  provide the benefits and seek prior approval from the Legislative
  Budget Board before implementing the program.
         SECTION 10.  (a) In this section, "commission," "Medicaid,"
  and "Medicaid managed care organization" have the meanings assigned
  by Section 531.001, Government Code.
         (b)  As soon as practicable after the effective date of this
  Act, the commission shall conduct a study to:
               (1)  identify benefits and services, other than
  long-term services and supports, provided under Medicaid that are
  not provided in this state under the Medicaid managed care model;
  and
               (2)  evaluate the feasibility, cost-effectiveness, and
  impact on Medicaid recipients of providing the benefits and
  services identified under Subdivision (1) of this subsection
  through the Medicaid managed care model.
         (c)  Not later than December 1, 2022, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's evaluation under
  Subsection (b)(2) of this section; and
               (2)  a recommendation as to whether the commission
  should implement providing benefits and services identified under
  Subsection (b)(1) of this section through the Medicaid managed care
  model.
         SECTION 11.  (a) In this section:
               (1)  "Commission," "Medicaid," and "Medicaid managed
  care organization" have the meanings assigned by Section 531.001,
  Government Code.
               (2)  "Dually eligible individual" has the meaning
  assigned by Section 531.0392, Government Code.
         (b)  The commission shall conduct a study regarding dually
  eligible individuals who are enrolled in the Medicaid managed care
  program. The study must include an evaluation of:
               (1)  Medicare cost-sharing requirements for those
  individuals;
               (2)  the cost-effectiveness for a Medicaid managed care
  organization to provide all Medicaid-eligible services not covered
  under Medicare and require cost-sharing for those services; and
               (3)  the impact on dually eligible individuals and
  Medicaid providers that would result from the implementation of
  Subdivision (2) of this subsection.
         (c)  Not later than September 1, 2022, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's findings from the
  study conducted under Subsection (b) of this section; and
               (2)  a recommendation as to whether the commission
  should implement Subsection (b)(2) of this section.
         SECTION 12.  Notwithstanding Section 2, Chapter 1117 (H.B.
  3523), Acts of the 84th Legislature, Regular Session, 2015, Section
  533.00251(c), Government Code, as amended by Section 2 of that Act,
  takes effect September 1, 2023.
         SECTION 13.  As soon as practicable after the effective date
  of this Act, the Health and Human Services Commission shall conduct
  the study and make the determination required by Section
  531.0501(a), Government Code, as added by this Act.
         SECTION 14.  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 15.  The Health and Human Services Commission is
  required to implement this Act only if the legislature appropriates
  money specifically for that purpose. If the legislature does not
  appropriate money specifically for that purpose, the commission
  may, but is not required to, implement this Act using other
  appropriations available for the purpose.
         SECTION 16.  This Act takes effect September 1, 2021.
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