Bill Text: TX SB651 | 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: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2021-03-11 - Referred to Health & Human Services [SB651 Detail]

Download: Texas-2021-SB651-Introduced.html
  87R2189 MM-D
 
  By: Johnson S.B. No. 651
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  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.
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