Bill Text: TX SB2360 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the establishment of a pilot program to provide comprehensive whole child care for children with complex medical needs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-03-23 - Referred to Health & Human Services [SB2360 Detail]
Download: Texas-2023-SB2360-Introduced.html
88R4080 MM-D | ||
By: Parker | S.B. No. 2360 |
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relating to the establishment of a pilot program to provide | ||
comprehensive whole child care for children with complex medical | ||
needs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.06051 to read as follows: | ||
Sec. 531.06051. PILOT PROGRAM FOR COMPREHENSIVE WHOLE CHILD | ||
CARE FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. (a) In this section: | ||
(1) "Child with complex medical needs" means a child | ||
who has: | ||
(A) one or more chronic health conditions that: | ||
(i) affect three or more organ systems; and | ||
(ii) result in severe functional | ||
limitations, high health care needs or utilization, or the need for | ||
or use of medical technology; or | ||
(B) one life-limiting illness or rare pediatric | ||
disease as defined in Section 529(a)(3) of the Federal Food, Drug, | ||
and Cosmetic Act (21 U.S.C. 360ff(a)(3)). | ||
(2) "Pilot program" means the comprehensive whole | ||
child care for children with complex medical needs pilot program | ||
established under this section. | ||
(3) "Recipient" means a recipient of Medicaid. | ||
(4) "Specialty provider" means a person who provides | ||
health-related goods or services to a recipient, including a | ||
provider of medication, therapy services, or durable medical | ||
equipment or other equipment. | ||
(b) The commission shall enter into an agreement with the | ||
Dell Medical School at The University of Texas at Austin to develop | ||
and implement in one or more areas of this state a phased pilot | ||
program to establish an alternative model of care using existing | ||
capitated rates outside the managed care model to provide | ||
transformative, comprehensive multidisciplinary whole child care | ||
and fully integrated health homes for children with complex medical | ||
needs. | ||
(c) The pilot program shall be designed to: | ||
(1) develop, improve, and increase access to service | ||
delivery innovations and comprehensive care centers of excellence | ||
throughout this state for children with complex medical needs; | ||
(2) incorporate and develop increased capacity | ||
through a phased approach for children to receive: | ||
(A) intermediate and post-acute care services; | ||
(B) pediatric palliative and hospice care; and | ||
(C) transition services and continuity of care; | ||
(3) improve delivery and access in rural communities; | ||
(4) continue to build and improve capacity to provide | ||
health care services using telecommunications and information | ||
technology; | ||
(5) use existing electronic medical records systems to | ||
integrate and streamline technology to improve access to care and | ||
health outcomes for children participating in the program, track | ||
the use of funding and best practices for maximizing money spent | ||
under the pilot program, and better coordinate care, including with | ||
respect to: | ||
(A) diagnoses and cohesive care plans; | ||
(B) treatment plans; | ||
(C) telemedicine medical services and telehealth | ||
services; and | ||
(D) coordinated access and integration with home | ||
health providers; | ||
(6) develop and align targeted incentives to induce | ||
integration and true value-based care that will result in: | ||
(A) cohesive, coordinated multidisciplinary care | ||
with improved health outcomes for children participating in the | ||
program and long-term cost effectiveness; | ||
(B) continuity of care for children | ||
participating in the program; and | ||
(C) reduced emergency room visits and | ||
hospitalizations; | ||
(7) identify shared needs to improve health outcomes, | ||
including behavioral, social, and familial needs; | ||
(8) use and incentivize appropriate and meaningful | ||
quality outcome measures customized and tailored for children with | ||
complex medical needs, including: | ||
(A) improving coordination of care and access to | ||
services; | ||
(B) developing a shared plan of care; | ||
(C) reducing unscheduled hospitalizations; | ||
(D) reducing unmet needs; and | ||
(E) encouraging families to be shared decision | ||
makers; | ||
(9) allow physicians or the medical team of a child | ||
with complex medical needs to determine medical necessity of the | ||
services recommended or provided for the child; | ||
(10) allow the parent or guardian of a child with | ||
complex medical needs to opt the child out of receiving benefits | ||
through the STAR Kids managed care program and instead have the | ||
child receive benefits under the pilot program; and | ||
(11) be administered by a neutral board established by | ||
the Dell Medical School at The University of Texas at Austin. | ||
(d) Under the pilot program, the commission may take any | ||
measures permitted under federal law that are necessary to: | ||
(1) supersede and rework existing systemic and | ||
regulatory barriers to care and integration for children with | ||
complex medical needs under Medicaid; | ||
(2) reduce administrative burdens inherent in the | ||
current Medicaid system while maintaining high accountability | ||
standards; | ||
(3) adopt a specific procedure or other billing code | ||
under Medicaid for a health care provider to diagnose or treat | ||
conditions specific to children with complex medical needs, | ||
including for: | ||
(A) a value-based whole child visit to include a | ||
bundled payment for multidisciplinary whole child complex care; | ||
(B) care coordination; | ||
(C) family support; | ||
(D) intermediate and post-acute care; | ||
(E) transition services; | ||
(F) mid-tier caregiver workforce providers, | ||
including certified nursing assistant care; and | ||
(G) parents as paid caregivers; and | ||
(4) allow a third-party payor to act in the capacity of | ||
a preferred provider organization operating under Chapter 1301, | ||
Insurance Code. | ||
(e) The commission, in coordination with the Dell Medical | ||
School at The University of Texas at Austin, shall develop a | ||
statewide, neutral third-party de-identified data collection | ||
registry to: | ||
(1) improve access to care and recipient outcomes | ||
under the pilot program; | ||
(2) track funding and cost effectiveness, | ||
utilization, clinical practices, safety and effectiveness, and the | ||
allocation of resources under the pilot program; and | ||
(3) identify best practices for the provision of care | ||
to children with complex medical needs. | ||
(e-1) The registry developed under Subsection (e) must be | ||
integrated and coordinated with the all payor claims database | ||
established under Subchapter I, Chapter 38, Insurance Code. | ||
(f) For purposes of funding the pilot program, the | ||
commission may: | ||
(1) establish a Medicaid directed provider payment | ||
program for children with complex medical needs who are enrolled in | ||
the STAR Kids managed care program and make a portion of the | ||
directed provider payment program funds available for the pilot | ||
program based on the recipient's anticipated or actual | ||
participation in the pilot program; | ||
(2) obtain additional federal money under the | ||
Advancing Care for Exceptional (ACE) Kids Act of 2019 enacted as | ||
part of the Medicaid Services Investment and Accountability Act of | ||
2019 (Pub. L. No. 116-16); | ||
(3) leverage enhanced federal medical assistance | ||
percentage funding related to establishing health homes available | ||
under the Patient Protection and Affordable Care Act (Pub. L. | ||
No. 111-148) as amended by the Health Care and Education | ||
Reconciliation Act of 2010 (Pub. L. No. 111-152); and | ||
(4) make funds available from a portion of STAR Kids | ||
managed care program experience rebates. | ||
(g) Not later than March 1, 2025, the commission, in | ||
coordination with the Dell Medical School at The University of | ||
Texas at Austin, shall prepare and submit to the governor, | ||
lieutenant governor, and speaker of the house of representatives a | ||
written report that includes: | ||
(1) a summary of the pilot program's progress; | ||
(2) an assessment of the impact of providing | ||
transformative, comprehensive multidisciplinary whole child care | ||
and fully integrated health homes for children with complex medical | ||
needs; | ||
(3) an update on any waiver or amendment request | ||
necessary to modify the state Medicaid plan to provide the level of | ||
care and health homes for children with complex medical needs | ||
necessary under the pilot program; | ||
(4) a description of the level of care and status of | ||
health homes being provided to children with complex medical needs | ||
at the time the report is prepared; | ||
(5) an analysis of the effectiveness of providing the | ||
level of care and health homes for children with complex medical | ||
needs at the level at which those services are provided at the time | ||
the report is prepared; | ||
(6) estimates of the costs and potential savings of | ||
expanding health programs administered by the commission to meet | ||
the needs of children with complex medical needs; | ||
(7) proposed modification to eligibility criteria for | ||
providing the level of care and health homes for children with | ||
complex medical needs under the pilot program; and | ||
(8) any legislative recommendations. | ||
(h) Not later than September 1, 2028, the commission shall | ||
prepare and submit to the governor, lieutenant governor, and | ||
speaker of the house of representatives a final written report on | ||
the pilot program that includes: | ||
(1) a summary of the results of the pilot program; | ||
(2) a statement on the pilot program's success in | ||
providing transformative, comprehensive multidisciplinary whole | ||
child care and fully integrated health homes for children with | ||
complex medical needs; | ||
(3) a recommendation as to whether the pilot program | ||
should be continued as a pilot program or permanent program; and | ||
(4) any legislative recommendations. | ||
(i) The pilot program established under this section | ||
concludes September 1, 2028. | ||
(j) This section expires September 1, 2029. | ||
SECTION 2. Section 531.0605, Government Code, is repealed. | ||
SECTION 3. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization, including | ||
a state plan amendment, 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, 2023. |