Bill Text: TX SB750 | 2019-2020 | 86th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to maternal and newborn health care and the quality of services provided to women in this state under certain health care programs.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-10 - Effective immediately [SB750 Detail]
Download: Texas-2019-SB750-Introduced.html
Bill Title: Relating to maternal and newborn health care and the quality of services provided to women in this state under certain health care programs.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-10 - Effective immediately [SB750 Detail]
Download: Texas-2019-SB750-Introduced.html
2019S0166-1 02/07/19 | ||
By: Kolkhorst | S.B. No. 750 |
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relating to maternal and newborn health care and the quality of | ||
services provided to women in this state under certain health care | ||
programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter C, Chapter 61, Education Code, is | ||
amended by adding Section 61.05123 to read as follows: | ||
Sec. 61.05123. GUIDELINES FOR MATERNAL AND NEONATAL MEDICAL | ||
RESIDENCY TRAINING PROGRAMS. (a) The board shall develop best | ||
practice guidelines for maternal and neonatal medical residency | ||
training programs. | ||
(b) The board shall publish the guidelines developed under | ||
Subsection (a) on the board's Internet website. | ||
SECTION 2. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.0738 to read as follows: | ||
Sec. 531.0738. APPLICATION FOR FUNDING TO IMPLEMENT MODEL | ||
OF CARE FOR CERTAIN MEDICAID RECIPIENTS. (a) The commission shall | ||
apply to the Centers for Medicare and Medicaid Services to receive | ||
any federal money available to implement a model of care that | ||
improves the quality and accessibility of care for: | ||
(1) pregnant women with opioid use disorder enrolled | ||
in Medicaid during the prenatal and postpartum periods; and | ||
(2) their children after birth. | ||
(b) This section expires September 1, 2021. | ||
SECTION 3. Chapter 32, Health and Safety Code, is amended by | ||
adding Subchapters E and F to read as follows: | ||
SUBCHAPTER E. ENHANCED PRENATAL AND POSTPARTUM CARE SERVICES | ||
Sec. 32.101. ENHANCEMENT PROGRAM FOR PRENATAL CARE SERVICES | ||
FOR CERTAIN WOMEN. The commission, in collaboration with managed | ||
care organizations that contract with the commission under Chapter | ||
533, Government Code, shall develop and implement a cost-effective, | ||
evidence-based program to deliver enhanced prenatal care services | ||
to high-risk pregnant women covered under the medical assistance | ||
program. | ||
Sec. 32.102. EVALUATION AND ENHANCEMENT OF POSTPARTUM CARE | ||
SERVICES FOR CERTAIN WOMEN. (a) In this section, "Healthy Texas | ||
Women program" means a program operated by the commission that is | ||
substantially similar to the demonstration project operated under | ||
former Section 32.0248, Human Resources Code, and that is intended | ||
to expand access to preventive health and family planning services | ||
for women in this state. | ||
(b) The commission shall evaluate postpartum care services | ||
provided to women enrolled in the Healthy Texas Women program after | ||
the first 60 days of the postpartum period. | ||
(c) Based on the commission's evaluation under Subsection | ||
(b), the commission shall develop an enhanced, cost-effective, and | ||
limited postpartum care services package for women enrolled in the | ||
Healthy Texas Women program to be provided after the first 60 days | ||
of the postpartum period. | ||
SUBCHAPTER F. DELIVERY AND IMPROVEMENT OF MATERNAL HEALTH CARE | ||
SERVICES INVOLVING MANAGED CARE ORGANIZATIONS | ||
Sec. 32.151. DEFINITION. In this subchapter, "Healthy | ||
Texas Women program" means a program operated by the commission | ||
that is substantially similar to the demonstration project operated | ||
under former Section 32.0248, Human Resources Code, and that is | ||
intended to expand access to preventive health and family planning | ||
services for women in this state. | ||
Sec. 32.152. COORDINATION OF TRANSITION OF CARE. | ||
(a) Subject to the eligibility requirements of the Healthy Texas | ||
Women program, a managed care organization that contracts with the | ||
commission under Chapter 533, Government Code, to provide health | ||
care services under the medical assistance program shall coordinate | ||
the transition of care from the medical assistance program to the | ||
Healthy Texas Women program for women who will lose eligibility for | ||
benefits under the medical assistance program. | ||
(b) When possible, the commission shall seek to provide | ||
continuity of care during the transition described by Subsection | ||
(a) between health care providers in the provider network of a | ||
managed care organization described by that subsection and health | ||
care providers participating in the Healthy Texas Women program. | ||
Sec. 32.153. POSTPARTUM DEPRESSION TREATMENT NETWORK. | ||
Using money from an available source designated by the commission, | ||
the commission, in collaboration with managed care organizations | ||
that contract with the commission under Chapter 533, Government | ||
Code, to provide health care services under the medical assistance | ||
program and providers participating in the Healthy Texas Women | ||
program, shall develop and implement a postpartum depression | ||
treatment network for women enrolled in the medical assistance or | ||
Healthy Texas Women program. | ||
Sec. 32.154. STATEWIDE INITIATIVES TO IMPROVE QUALITY OF | ||
MATERNAL HEALTH CARE. (a) The commission shall develop statewide | ||
initiatives to improve the quality of maternal health care services | ||
for women in this state. Each managed care organization that | ||
contracts with the commission to provide health care services in | ||
this state shall incorporate the initiatives in the organization's | ||
managed care plans. | ||
(b) A managed care organization required to incorporate the | ||
initiatives in the organization's managed care plans under | ||
Subsection (a) may incorporate any additional initiatives to | ||
improve the quality of maternal health care services for women | ||
receiving health care services through the organization. | ||
Sec. 32.155. TRAINING ON SOCIAL DETERMINANTS OF HEALTH AND | ||
USE OF COMMUNITY RESOURCES; REPORT. (a) In this section, "social | ||
determinants of health" means the environmental conditions in which | ||
an individual lives that affect the individual's health and quality | ||
of life. | ||
(b) The executive commissioner by rule shall require each | ||
managed care organization that contracts with the commission to | ||
provide health care services in this state to employ specialized | ||
staff who are trained on social determinants of health and to use | ||
available community resources to address maternal health care | ||
disparities that exist for minority women and other high-risk | ||
populations of women designated by the commission. | ||
(c) Not later than September 1 of each even-numbered year, | ||
the commission shall prepare and submit a report to the legislature | ||
that outlines the efforts made by managed care organizations to | ||
address maternal health care disparities under Subsection (b). | ||
Sec. 32.156. ENROLLMENT OF CERTAIN PARTICIPANTS IN MANAGED | ||
CARE. The commission shall immediately enroll a pregnant woman in a | ||
managed care plan offered by a managed care organization providing | ||
services under the program for which the woman is eligible instead | ||
of initially providing prenatal care services to the woman on a | ||
fee-for-service basis. | ||
SECTION 4. The heading to Chapter 34, Health and Safety | ||
Code, is amended to read as follows: | ||
CHAPTER 34. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW | ||
COMMITTEE [ |
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SECTION 5. Section 34.001, Health and Safety Code, is | ||
amended by adding Subdivision (12-a) to read as follows: | ||
(12-a) "Review committee" means the Texas Maternal | ||
Mortality and Morbidity Review Committee. | ||
SECTION 6. Sections 34.002, 34.003, 34.004, and 34.005, | ||
Health and Safety Code, are amended to read as follows: | ||
Sec. 34.002. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW | ||
COMMITTEE [ |
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Morbidity Review Committee [ |
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department. | ||
(b) The review committee [ |
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multidisciplinary advisory committee within the department and is | ||
composed of the following 17 members: | ||
(1) 15 members appointed by the commissioner as | ||
follows: | ||
(A) four physicians specializing in obstetrics, | ||
at least one of whom is a maternal fetal medicine specialist; | ||
(B) one certified nurse-midwife; | ||
(C) one registered nurse; | ||
(D) one nurse specializing in labor and delivery; | ||
(E) one physician specializing in family | ||
practice; | ||
(F) one physician specializing in psychiatry; | ||
(G) one physician specializing in pathology; | ||
(H) one epidemiologist, biostatistician, or | ||
researcher of pregnancy-related deaths; | ||
(I) one social worker or social service provider; | ||
(J) one community advocate in a relevant field; | ||
(K) one medical examiner or coroner responsible | ||
for recording deaths; and | ||
(L) one physician specializing in critical care; | ||
(2) a representative of the department's family and | ||
community health programs; and | ||
(3) the state epidemiologist for the department or the | ||
epidemiologist's designee. | ||
(c) In appointing members to the review committee [ |
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(1) include members: | ||
(A) working in and representing communities that | ||
are diverse with regard to race, ethnicity, immigration status, and | ||
English proficiency; and | ||
(B) from differing geographic regions in the | ||
state, including both rural and urban areas; | ||
(2) endeavor to include members who are working in and | ||
representing communities that are affected by pregnancy-related | ||
deaths and severe maternal morbidity and by a lack of access to | ||
relevant perinatal and intrapartum care services; and | ||
(3) ensure that the composition of the review | ||
committee [ |
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diversity of this state. | ||
(d) The commissioner shall appoint from among the review | ||
committee [ |
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(e) A member of the review committee [ |
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under Subsection (b)(1) is not entitled to compensation for service | ||
on the review committee [ |
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other expenses incurred by the member while conducting the business | ||
of the review committee [ |
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(f) In carrying out its duties, the review committee [ |
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videoconferencing, to eliminate travel expenses. | ||
Sec. 34.003. TERMS; VACANCY. (a) Review committee [ |
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six-year terms, with the terms of four or five members, as | ||
appropriate, expiring February 1 of each odd-numbered year. | ||
(b) A review committee [ |
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than one term. | ||
(c) A vacancy on the review committee [ |
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filled for the unexpired term in the same manner as the original | ||
appointment. | ||
Sec. 34.004. MEETINGS. (a) The review committee [ |
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(b) Meetings of the review committee [ |
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subject to Chapter 551, Government Code, except that the review | ||
committee [ |
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cases under Section 34.007. | ||
(c) The review committee [ |
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(1) allow for public comment during at least one | ||
public meeting each year; | ||
(2) present in open session recommendations made under | ||
Section 34.005 to help reduce the incidence of pregnancy-related | ||
deaths and severe maternal morbidity in this state; and | ||
(3) post public notice for meetings conducted for the | ||
sole purpose of reviewing cases for selection under Section 34.007. | ||
Sec. 34.005. DUTIES OF REVIEW COMMITTEE [ |
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review committee [ |
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(1) study and review: | ||
(A) cases of pregnancy-related deaths; | ||
(B) trends, rates, or disparities in | ||
pregnancy-related deaths and severe maternal morbidity; | ||
(C) health conditions and factors that | ||
disproportionately affect the most at-risk population as | ||
determined in the joint biennial report required under Section | ||
34.015; and | ||
(D) best practices and programs operating in | ||
other states that have reduced rates of pregnancy-related deaths; | ||
(2) compare rates of pregnancy-related deaths based on | ||
the socioeconomic status of the mother; | ||
(3) determine the feasibility of the review committee | ||
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(4) in consultation with the Perinatal Advisory | ||
Council, make recommendations to help reduce the incidence of | ||
pregnancy-related deaths and severe maternal morbidity in this | ||
state. | ||
SECTION 7. Section 34.0055(a), Health and Safety Code, is | ||
amended to read as follows: | ||
(a) Using existing resources, the commission, in | ||
consultation with the review committee [ |
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(1) make available to physicians and other persons | ||
licensed or certified to conduct a substance use screening and | ||
domestic violence screening of pregnant women information that | ||
includes: | ||
(A) guidance regarding best practices for | ||
verbally screening a pregnant woman for substance use and verbally | ||
screening a pregnant woman for domestic violence using a validated | ||
screening tool; and | ||
(B) a list of substance use treatment resources | ||
and domestic violence prevention and intervention resources in each | ||
geographic region of this state; and | ||
(2) review and promote the use of educational | ||
materials on the consequences of opioid drug use and on domestic | ||
violence prevention and intervention during pregnancy. | ||
SECTION 8. Section 34.006, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 34.006. CONSULTATIONS AND AGREEMENTS WITH OUTSIDE | ||
PARTIES. (a) The department and review committee [ |
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consult with any relevant experts and stakeholders, including: | ||
(1) anesthesiologists; | ||
(2) intensivists or critical care physicians; | ||
(3) nutritionists; | ||
(4) substance abuse treatment specialists; | ||
(5) hospital staff or employees; | ||
(6) representatives of the state Medicaid program; | ||
(7) paramedics or other emergency medical response | ||
personnel; | ||
(8) hospital-based risk management specialists; | ||
(9) representatives of local health departments and | ||
public health districts in this state; | ||
(10) public health experts; | ||
(11) government representatives or officials; and | ||
(12) law enforcement officials. | ||
(b) In gathering information, the department and review | ||
committee [ |
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relevant state professional associations and organizations, | ||
including: | ||
(1) District XI of the American Congress of | ||
Obstetricians and Gynecologists; | ||
(2) the Texas Association of Obstetricians and | ||
Gynecologists; | ||
(3) the Texas Nurses Association; | ||
(4) the Texas Section of the Association of Women's | ||
Health, Obstetric and Neonatal Nurses; | ||
(5) the Texas Academy of Family Physicians; | ||
(6) the Texas Pediatric Society; | ||
(7) the Consortium of Texas Certified Nurse-Midwives; | ||
(8) the Association of Texas Midwives; | ||
(9) the Texas Hospital Association; | ||
(10) the Texas Medical Association; and | ||
(11) the Texas Public Health Association. | ||
(c) In consulting with individuals or organizations under | ||
Subsection (a) or (b), a member of the review committee [ |
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or employee of the department may not disclose any identifying | ||
information of a patient or health care provider. | ||
(d) The department on behalf of the review committee [ |
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education or other organizations consistent with the duties of the | ||
department or review committee [ |
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SECTION 9. Sections 34.007(a) and (c), Health and Safety | ||
Code, are amended to read as follows: | ||
(a) The department shall determine a statistically | ||
significant number of cases of pregnancy-related deaths for review. | ||
The department shall either randomly select cases or select all | ||
cases for the review committee [ |
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subsection to reflect a cross-section of pregnancy-related deaths | ||
in this state. | ||
(c) If feasible, the department may select cases of severe | ||
maternal morbidity for review. In selecting cases under this | ||
subsection, the department shall randomly select cases for the | ||
review committee [ |
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identified under Subsection (b). | ||
SECTION 10. Sections 34.008(a) and (b), Health and Safety | ||
Code, are amended to read as follows: | ||
(a) On selecting a case of pregnancy-related death or severe | ||
maternal morbidity for review, the department shall, in accordance | ||
with this section, obtain information relevant to the case to | ||
enable the review committee [ |
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department shall provide the information to the review committee | ||
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(b) The information provided to the review committee [ |
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health care provider, including: | ||
(1) the name, address, or date of birth of the patient | ||
or a member of the patient's family; or | ||
(2) the name or specific location of a health care | ||
provider that treated the patient. | ||
SECTION 11. Sections 34.009(c), (d), (e), and (h), Health | ||
and Safety Code, are amended to read as follows: | ||
(c) Review committee [ |
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information obtained by the department under this chapter, | ||
including information contained in an electronic database | ||
established and maintained under Section 34.012, or any other | ||
document or record, is confidential. This subsection does not | ||
prevent the review committee [ |
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releasing information described by Subsection (d) or (e) or from | ||
submitting the report required by Section 34.015. | ||
(d) Information is not confidential under this section if | ||
the information is general information that cannot be connected | ||
with any specific individual, case, or health care provider, such | ||
as: | ||
(1) total expenditures made for specified purposes; | ||
(2) the number of families served by particular health | ||
care providers or agencies; | ||
(3) aggregated data on social and economic conditions; | ||
(4) medical data and information related to health | ||
care services that do not include any identifying information | ||
relating to a patient or the patient's family; | ||
(5) information, including the source, value, and | ||
purpose, related to gifts, grants, or donations to or for use by the | ||
review committee [ |
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(6) other statistical information. | ||
(e) The review committee [ |
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statistical studies and research reports based on information that | ||
is confidential under this section, provided that the information: | ||
(1) is published in the aggregate; | ||
(2) does not identify a patient or the patient's | ||
family; | ||
(3) does not include any information that could be | ||
used to identify a patient or the patient's family; and | ||
(4) does not identify a health care provider. | ||
(h) The review committee [ |
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shall comply with all state and federal laws and rules relating to | ||
the transmission of health information, including the Health | ||
Insurance Portability and Accountability Act of 1996 (Pub. L. | ||
No. 104-191) and rules adopted under that Act. | ||
SECTION 12. Section 34.010, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 34.010. SUBPOENA AND DISCOVERY. Review committee | ||
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Section 34.009 is privileged, is not subject to subpoena or | ||
discovery, and may not be introduced into evidence in any | ||
administrative, civil, or criminal proceeding against a patient, a | ||
member of the family of a patient, or a health care provider. | ||
SECTION 13. Section 34.011(a), Health and Safety Code, is | ||
amended to read as follows: | ||
(a) A member of the review committee [ |
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person employed by or acting in an advisory capacity to the review | ||
committee [ |
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services to the review committee [ |
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damages for an action taken within the scope of the functions of the | ||
review committee [ |
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SECTION 14. Sections 34.012(a) and (c), Health and Safety | ||
Code, are amended to read as follows: | ||
(a) The department may establish and maintain an electronic | ||
database to track cases of pregnancy-related deaths and severe | ||
maternal morbidity to assist the department and review committee | ||
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(c) The database may be accessed only by the department and | ||
the review committee [ |
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this chapter. | ||
SECTION 15. Section 34.014, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 34.014. FUNDING. The department may accept gifts and | ||
grants from any source to fund the duties of the department and the | ||
review committee [ |
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SECTION 16. Sections 34.015(a) and (b), Health and Safety | ||
Code, are amended to read as follows: | ||
(a) Not later than September 1 of each even-numbered year, | ||
the review committee [ |
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joint report on the findings of the review committee [ |
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under this chapter to the governor, lieutenant governor, speaker of | ||
the house of representatives, and appropriate committees of the | ||
legislature. | ||
(b) The report must include the review committee's [ |
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SECTION 17. Section 34.0155, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 34.0155. REPORT ON PREGNANCY-RELATED DEATHS, SEVERE | ||
MATERNAL MORBIDITY, AND POSTPARTUM DEPRESSION. The commission | ||
shall: | ||
(1) evaluate options for reducing pregnancy-related | ||
deaths, focusing on the most prevalent causes of pregnancy-related | ||
deaths as identified in the joint biennial report required under | ||
Section 34.015, and for treating postpartum depression in | ||
economically disadvantaged women; | ||
(2) in coordination with the department and the review | ||
committee [ |
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(A) lower costs of providing medical assistance | ||
under Chapter 32, Human Resources Code, related to severe maternal | ||
morbidity and chronic illness; and | ||
(B) improve quality outcomes related to the | ||
underlying causes of severe maternal morbidity and chronic illness; | ||
and | ||
(3) not later than December 1 of each even-numbered | ||
year, submit to the governor, the lieutenant governor, the speaker | ||
of the house of representatives, the Legislative Budget Board, and | ||
the appropriate standing committees of the legislature a written | ||
report that includes: | ||
(A) a summary of the commission's and | ||
department's efforts to accomplish the tasks described by | ||
Subdivisions (1) and (2); and | ||
(B) a summary of the report required by Section | ||
34.0156. | ||
SECTION 18. Section 34.0156(a), Health and Safety Code, is | ||
amended to read as follows: | ||
(a) Using existing resources, the department, in | ||
collaboration with the review committee [ |
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and facilitate the use among health care providers in this state of | ||
maternal health and safety informational materials, including | ||
tools and procedures related to best practices in maternal health | ||
and safety. | ||
SECTION 19. Section 34.017(b), Health and Safety Code, is | ||
amended to read as follows: | ||
(b) The department may not disclose the information | ||
described by Subsection (a) to the review committee [ |
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any other person. | ||
SECTION 20. Section 34.018, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 34.018. SUNSET PROVISION. (a) The review committee | ||
[ |
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Sunset Act). Unless continued in existence as provided by that | ||
chapter, the review committee [ |
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chapter expires September 1, 2027 [ |
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(b) The Sunset Advisory Commission shall review the review | ||
committee during the two-year period preceding the date the | ||
department is scheduled for abolition under Section 1001.003, but | ||
the review committee is continued in existence until the date | ||
provided by Subsection (a). This subsection expires September 1, | ||
2025. | ||
SECTION 21. Section 1001.0712(c), Health and Safety Code, | ||
is amended to read as follows: | ||
(c) The department, in consultation with the Texas Maternal | ||
Mortality and Morbidity Review Committee [ |
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examine national standards regarding the collection of death | ||
information and may convene a panel of experts to advise the | ||
department and the review committee [ |
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recommendations for improving the collection of accurate | ||
information related to cause of death. | ||
SECTION 22. Section 34.001(14), Health and Safety Code, is | ||
repealed. | ||
SECTION 23. (a) In this section, "Healthy Texas Women | ||
program" means a program operated by the Health and Human Services | ||
Commission that is substantially similar to the demonstration | ||
project operated under former Section 32.0248, Human Resources | ||
Code, and that is intended to expand access to preventive health and | ||
family planning services for women in this state. | ||
(b) If the Centers for Medicare and Medicaid Services | ||
approves the waiver submitted by the executive commissioner of the | ||
Health and Human Services Commission under Section 1115 of the | ||
federal Social Security Act (42 U.S.C. Section 1315) for the | ||
Healthy Texas Women Section 1115 Demonstration Waiver, the | ||
executive commissioner shall, as soon as practicable after the | ||
waiver is granted, seek an amendment to the waiver to provide | ||
enhanced services under the Healthy Texas Women program. | ||
SECTION 24. The Health and Human Services Commission shall | ||
submit the first report required under Section 32.155(c), Health | ||
and Safety Code, as added by this Act, not later than September 1, | ||
2020. | ||
SECTION 25. As soon as practicable after the effective date | ||
of this Act: | ||
(1) the Texas Higher Education Coordinating Board | ||
shall develop and publish the guidelines required under Section | ||
61.05123, Education Code, as added by this Act; | ||
(2) the executive commissioner of the Health and Human | ||
Services Commission shall adopt rules as necessary to implement the | ||
changes in law made by this Act; and | ||
(3) the Health and Human Services Commission shall | ||
apply for any federal money available to implement the model of care | ||
described by Section 531.0738, Government Code, as added by this | ||
Act. | ||
SECTION 26. On the effective date of this Act: | ||
(1) the Maternal Mortality and Morbidity Task Force is | ||
renamed the Texas Maternal Mortality and Morbidity Review | ||
Committee; and | ||
(2) a reference in law to the task force means the | ||
review committee. | ||
SECTION 27. 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 28. 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, 2019. |