Bill Text: TX HB1111 | 2019-2020 | 86th Legislature | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to maternal and newborn health care.

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2019-05-22 - Not again placed on intent calendar [HB1111 Detail]

Download: Texas-2019-HB1111-Introduced.html

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86R3943 JG-D
By: Davis of Harris H.B. No. 1111

A BILL TO BE ENTITLED
AN ACT
relating to maternal and newborn health care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02163 to read as follows:
Sec. 531.02163. STUDY ON PROVIDING CERTAIN MATERNAL CARE
MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND
TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the
commission shall conduct a study on the benefits and costs of
permitting reimbursement under Medicaid for prenatal and
postpartum care delivered through telemedicine medical services
and telehealth services.
(b) This section expires September 1, 2021.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0996 to read as follows:
Sec. 531.0996. PREGNANCY MEDICAL HOME PILOT PROGRAM. (a)
The commission shall develop a pilot program to establish pregnancy
medical homes that provide coordinated evidence-based maternity
care management to women who reside in a pilot program area and are
recipients of Medicaid through a Medicaid managed care model or
arrangement under Chapter 533. The commission shall implement the
pilot program in:
(1) at least two counties with populations of more
than two million; and
(2) at least one rural county with high rates of
maternal mortality and morbidity as determined by the commission in
consultation with the Maternal Mortality and Morbidity Task Force
established under Chapter 34, Health and Safety Code.
(b) In implementing the pilot program, the commission shall
ensure each pregnancy medical home provides a maternity management
team that:
(1) consists of health care providers, including
obstetricians, gynecologists, family physicians, physician
assistants, certified nurse midwives, nurse practitioners, and
social workers, who provide health care services at the same
location;
(2) conducts a risk assessment of each pilot program
participant on her entry into the program to determine the risk
classification for her pregnancy;
(3) based on the assessment conducted under
Subdivision (2), establishes an individual pregnancy care plan for
each participant; and
(4) follows each participant throughout her pregnancy
to reduce poor birth outcomes.
(c) The commission may incorporate as a component of the
pilot program financial incentives for health care providers who
participate in a maternity management team.
(d) Not later than January 1, 2021, the commission shall
submit to the legislature a report on the pilot program. The report
must include:
(1) an evaluation of the pilot program's success in
reducing poor birth outcomes; and
(2) a recommendation on whether the pilot program
should continue, be expanded, or be terminated.
(e) The executive commissioner may adopt rules to implement
this section.
(f) This section expires September 1, 2023.
SECTION 3. Section 33.004(f), Health and Safety Code, is
amended to read as follows:
(f) The executive commissioner by rule shall [may]
establish the amounts charged for newborn screening fees, including
fees assessed for follow-up services, tracking confirmatory
testing, and diagnosis. In adopting rules under this subsection,
the executive commissioner shall ensure that amounts charged for
newborn screening fees are sufficient to cover the costs of
performing the screening.
SECTION 4. Chapter 33, Health and Safety Code, is amended by
adding Subchapter D to read as follows:
SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT
Sec. 33.051. DEFINITION. In this subchapter, "account"
means the newborn screening preservation account established under
Section 33.052.
Sec. 33.052. CREATION OF ACCOUNT. (a) The newborn
screening preservation account is a dedicated account in the
general revenue fund. The account is created solely for the
perpetual care and preservation of newborn screening in this state.
(b) Money in the account may be appropriated only to the
department and only for the purpose of carrying out the newborn
screening program established under this chapter.
(c) On September 30 of each year, the comptroller shall
transfer to the account any unexpended and unencumbered money from
Medicaid reimbursements collected by the department for newborn
screening services during the preceding state fiscal year.
(d) The account is composed of:
(1) money transferred to the account under Subsection
(c);
(2) newborn screening fees collected by the department
under this chapter;
(3) gifts, grants, donations, and legislative
appropriations; and
(4) interest earned on the investment of money in the
account.
(e) Section 403.0956, Government Code, does not apply to the
account.
(f) The department administers the account. The department
may solicit and receive gifts, grants, and donations from any
source for the benefit of the account.
Sec. 33.053. DEDICATED USE. (a) The department may use any
money remaining in the account after paying the costs of operating
the newborn screening program established under this chapter only
to:
(1) pay for capital assets, improvements, equipment,
and renovations for the laboratory established by the department to
ensure the continuous operation of the newborn screening program;
and
(2) pay for necessary renovations, construction,
capital assets, equipment, supplies, staff, and training
associated with providing additional newborn screening tests not
offered under this chapter before September 1, 2019, including the
operational costs incurred during the first year of implementing
the additional tests.
(b) The department may not use money from the account for
the department's general operating expenses.
Sec. 33.054. REPORT. If the department requires an
additional newborn screening test under Subchapter B the costs of
which are funded with money appropriated from the newborn screening
preservation account, the department shall, not later than December
31 of the first even-numbered year following the addition of the
test, prepare and submit a written report regarding the actions
taken by the department to fund and implement the test during the
preceding two years to:
(1) the governor;
(2) the lieutenant governor;
(3) the speaker of the house of representatives; and
(4) each standing committee of the legislature having
primary jurisdiction over the department.
SECTION 5. Chapter 34, Health and Safety Code, is amended by
adding Sections 34.0158 and 34.0159 to read as follows:
Sec. 34.0158. REPORT ON ACTIONS TO ADDRESS MATERNAL
MORTALITY RATES. Not later than December 1 of each even-numbered
year, the commission shall 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 summarizing the actions taken
to address maternal morbidity and reduce maternal mortality rates.
The report must include information from programs and initiatives
created to address maternal morbidity and reduce maternal mortality
rates in this state, including:
(1) Medicaid;
(2) the children's health insurance program, including
the perinatal program;
(3) the Healthy Texas Women program;
(4) the Family Planning Program;
(5) this state's program under the Maternal and Child
Health Services Block Grant Act (42 U.S.C. Section 701 et seq.);
(6) the Perinatal Advisory Council;
(7) state health plans; and
(8) the Healthy Texas Babies program.
Sec. 34.0159. PROGRAM EVALUATIONS. The commission, in
collaboration with the task force and other interested parties,
shall:
(1) explore options for expanding the pilot program
for pregnancy medical homes established under Section 531.0996,
Government Code;
(2) explore methods for increasing the benefits
provided under Medicaid, including specialty care and
prescriptions, for women at greater risk of a high-risk pregnancy
or premature delivery;
(3) evaluate the impact of supplemental payments made
to obstetrics providers for pregnancy risk assessments on
increasing access to maternal health services;
(4) evaluate a waiver to fund managed care
organization payments for case management and care coordination
services for women at high risk of severe maternal morbidity on
conclusion of their eligibility for Medicaid;
(5) evaluate the average time required for pregnant
women to complete the Medicaid enrollment process;
(6) evaluate the use of Medicare codes for Medicaid
care coordination;
(7) study the impact of programs funded from the Teen
Pregnancy Prevention Program federal grant and evaluate whether the
state should continue funding the programs; and
(8) evaluate the use of telemedicine medical services
for women during pregnancy and the postpartum period.
SECTION 6. Chapter 34, Health and Safety Code, is amended by
adding Sections 34.019, 34.020, and 34.021 to read as follows:
Sec. 34.019. DATA COLLECTION. The task force, under the
direction of the commission, shall annually collect information
relating to maternity care and postpartum depression in this state.
The information must be based on statistics for the preceding year
and include the:
(1) number of births by Medicaid recipients;
(2) number of births by women with health benefit plan
coverage;
(3) number of Medicaid recipients screened for
postpartum depression;
(4) number of women screened for postpartum depression
under health benefit plan coverage;
(5) number of women treated for postpartum depression
under health benefit plan coverage;
(6) number of women screened for postpartum depression
under the Healthy Texas Women program;
(7) number of women treated for postpartum depression
under the Healthy Texas Women program;
(8) number of claims for postpartum depression
treatment paid by the Healthy Texas Women program;
(9) number of claims for postpartum depression
treatment rejected by the Healthy Texas Women program;
(10) postpartum depression screening and treatment
billing codes and the number of claims for each billing code under
the Healthy Texas Women program;
(11) average number of days from the date of a
postpartum depression screening to the date the patient begins
treatment under Medicaid;
(12) average number of days from the date of a
postpartum depression screening to the date the patient begins
treatment under the Healthy Texas Women program;
(13) number of women who screened positive for
postpartum depression under Medicaid and the average number of days
following childbirth for the screening to occur;
(14) number of women who screened positive for
postpartum depression under health benefit plan coverage and the
average number of days following childbirth for the screening to
occur; and
(15) number of women who screened positive for
postpartum depression under the Healthy Texas Women program and the
average number of days following childbirth for the screening to
occur.
Sec. 34.020. PROGRAM TO DELIVER PRENATAL AND POSTPARTUM
CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN
COUNTIES. (a) In this section:
(1) "Postpartum care" and "prenatal care" have the
meanings assigned by Section 32.002.
(2) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
(b) The commission, in consultation with the task force,
shall develop a program to deliver prenatal and postpartum care
through telehealth services or telemedicine medical services to
pregnant women with a low risk of experiencing pregnancy-related
complications. The commission shall implement the program in:
(1) at least two counties with populations of more
than two million; and
(2) at least one rural county with high rates of
maternal mortality and morbidity as determined by the commission in
consultation with the task force.
(c) The commission shall develop criteria for selecting
participants for the program by analyzing information in the
reports prepared by the task force under this chapter and the
outcomes of the study conducted under Section 531.02163, Government
Code.
(d) Not later than January 1, 2021, the commission shall
submit to the legislature a report on the program that evaluates the
program's success in delivering prenatal and postpartum care
through telehealth services or telemedicine medical services under
Subsection (b).
Sec. 34.021. APPLICATION FOR FEDERAL GRANTS. (a) The
executive commissioner shall apply to the United States Department
of Health and Human Services for grants under the federal
Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
(b) This section expires September 1, 2027.
SECTION 7. Chapter 1001, Health and Safety Code, is amended
by adding Subchapter K to read as follows:
SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT
PROGRAM
Sec. 1001.261. DEFINITIONS. In this subchapter:
(1) "Pilot program" means the high-risk maternal care
coordination services pilot program established under this
subchapter.
(2) "Promotora" or "community health worker" has the
meaning assigned by Section 48.001.
Sec. 1001.262. ESTABLISHMENT OF PILOT PROGRAM; RULES. (a)
The department shall develop and implement a high-risk maternal
care coordination services pilot program in one or more geographic
areas in this state.
(b) In implementing the pilot program, the department
shall:
(1) conduct a statewide assessment of training courses
provided by promotoras or community health workers that target
women of childbearing age;
(2) study existing models of high-risk maternal care
coordination services;
(3) identify, adapt, or create a risk assessment tool
to identify pregnant women who are at a higher risk for poor
pregnancy, birth, or postpartum outcomes; and
(4) create educational materials for promotoras and
community health workers that include information on the:
(A) assessment tool described by Subdivision
(3); and
(B) best practices for high-risk maternal care.
(c) The executive commissioner shall adopt rules as
necessary to implement this subchapter and prescribe the types of
information to be collected during the course of the pilot program
and included in the report described by Section 1001.264.
Sec. 1001.263. DUTIES OF DEPARTMENT. (a) The department
shall provide to each geographic area selected for the pilot
program the support, resources, technical assistance, training,
and guidance necessary to:
(1) screen all or a sample of pregnant patients with
the assessment tool described by Section 1001.262(b)(3); and
(2) integrate community health worker services for
women with high-risk pregnancies in:
(A) providing patient education on
health-enhancing behaviors and chronic disease management and
prevention;
(B) facilitating care coordination and
navigation activities; and
(C) identifying and reducing barriers to the
women's access to health care.
(b) The department shall develop training courses to
prepare promotoras and community health workers in educating and
supporting women at high risk for serious complications during the
pregnancy and postpartum periods.
Sec. 1001.264. PILOT PROGRAM REPORT. (a) Not later than
December 1 of each even-numbered year, the department shall prepare
and submit a report on the pilot program to the executive
commissioner and the chairs of the standing committees of the
senate and the house of representatives with primary jurisdiction
over public health and human services. The report may be submitted
with the report required under Section 34.0156.
(b) The report submitted under this section must include an
evaluation from the commissioner of the pilot program's
effectiveness.
(c) The report submitted under this section must include a
recommendation from the department on whether the pilot program
should continue, be expanded, or be terminated.
Sec. 1001.265. EXPIRATION. This subchapter expires
September 1, 2023.
SECTION 8. (a) Except as provided by Subsection (b) of this
section, not later than December 1, 2019, the executive
commissioner of the Health and Human Services Commission shall
adopt the rules required under Section 33.004(f), Health and Safety
Code, as amended by this Act, and Section 1001.262(c), Health and
Safety Code, as added by this Act.
(b) Notwithstanding Subchapter K, Chapter 1001, Health and
Safety Code, as added by this Act, the Department of State Health
Services and the executive commissioner of the Health and Human
Services Commission are not required to comply with that subchapter
unless a specific appropriation for the implementation of the
subchapter is provided in a general appropriations act of the 86th
Legislature.
SECTION 9. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall apply to the United States Department of
Health and Human Services for grants as required by Section 34.021,
Health and Safety Code, as added by this Act.
SECTION 10. 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 11. 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.