|
|
|
|
AN ACT
|
|
relating to maternal and newborn health care, including the newborn |
|
screening preservation account. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. 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 2. 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. 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. |
|
(b) On November 1 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. |
|
(c) The account is composed of: |
|
(1) money transferred to the account under Subsection |
|
(b); |
|
(2) gifts, grants, donations, and legislative |
|
appropriations; and |
|
(3) interest earned on the investment of money in the |
|
account. |
|
(d) Section 403.0956, Government Code, does not apply to the |
|
account. |
|
(e) 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 the costs of offering 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; and |
|
(2) pay for capital assets, equipment, and renovations |
|
for the laboratory established by the department to ensure the |
|
continuous operation of the newborn screening program. |
|
(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 |
|
September 1 of each even-numbered year, prepare and submit to the |
|
governor, the lieutenant governor, the speaker of the house of |
|
representatives, and each standing committee of the legislature |
|
having primary jurisdiction over the department a written report |
|
that: |
|
(1) summarizes the implementation plan for the test, |
|
including anticipated completion dates for implementing the test |
|
and potential barriers to conducting the test; and |
|
(2) summarizes the actions taken by the department to |
|
fund and implement the test during the preceding two years. |
|
SECTION 3. 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 4. 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 department, 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, as determined by a physician. The commission shall |
|
implement the program in: |
|
(1) at least two counties with populations of more |
|
than two million; |
|
(2) at least one county with a population of more than |
|
100,000 and less than 500,000; and |
|
(3) 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) In developing and administering the program, the |
|
commission shall endeavor to use innovative, durable medical |
|
equipment to monitor fetal and maternal health. |
|
(e) Notwithstanding Section 531.02176, Government Code, and |
|
if the commission determines it is feasible and cost-effective, the |
|
commission may: |
|
(1) provide home telemonitoring services and |
|
necessary durable medical equipment to women participating in the |
|
program to the extent the commission anticipates the services and |
|
equipment will reduce unnecessary emergency room visits or |
|
hospitalizations; and |
|
(2) reimburse providers under Medicaid for the |
|
provision of home telemonitoring services and durable medical |
|
equipment under the program. |
|
(f) 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 5. Section 81.090(c), Health and Safety Code, is |
|
amended to read as follows: |
|
(c) A physician or other person in attendance at a delivery |
|
shall: |
|
(1) take or cause to be taken a sample of blood or |
|
other appropriate specimen from the mother on admission for |
|
delivery; and |
|
(2) submit the sample to an appropriately certified |
|
laboratory for diagnostic testing approved by the United States |
|
Food and Drug Administration for hepatitis B infection and |
|
syphilis. |
|
SECTION 6. 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 7. 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 8. 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; |
|
(2) at least one county with a population of more than |
|
100,000 and less than 500,000; and |
|
(3) 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) The commission may waive a requirement of this section |
|
for a pregnancy medical home located in a rural county. |
|
(e) Notwithstanding Section 531.02176, the commission may: |
|
(1) provide home telemonitoring services and |
|
necessary durable medical equipment to pilot program participants |
|
who are at risk of experiencing pregnancy-related complications, as |
|
determined by a physician, to the extent the commission anticipates |
|
the services and equipment will reduce unnecessary emergency room |
|
visits or hospitalizations; and |
|
(2) reimburse providers under Medicaid for the |
|
provision of home telemonitoring services and durable medical |
|
equipment under the pilot program. |
|
(f) 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. |
|
(g) The executive commissioner may adopt rules to implement |
|
this section. |
|
(h) This section expires September 1, 2023. |
|
SECTION 9. Notwithstanding Section 33.054, Health and |
|
Safety Code, as added by this Act, the Department of State Health |
|
Services shall submit the first report required by that section not |
|
later than December 1, 2019. |
|
SECTION 10. 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 11. 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 12. 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 13. As soon as practicable after the effective date |
|
of this Act, 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. |
|
SECTION 14. This Act takes effect September 1, 2019. |
|
|
|
|
|
|
|
|
______________________________ |
______________________________ |
|
President of the Senate |
Speaker of the House |
|
|
I hereby certify that S.B. No. 748 passed the Senate on |
|
March 19, 2019, by the following vote: Yeas 31, Nays 0; and that |
|
the Senate concurred in House amendment on May 23, 2019, by the |
|
following vote: Yeas 31, Nays 0. |
|
|
|
|
______________________________ |
|
Secretary of the Senate |
|
|
I hereby certify that S.B. No. 748 passed the House, with |
|
amendment, on May 21, 2019, by the following vote: Yeas 140, |
|
Nays 5, one present not voting. |
|
|
|
|
______________________________ |
|
Chief Clerk of the House |
|
|
|
|
|
Approved: |
|
|
|
______________________________ |
|
Date |
|
|
|
|
|
______________________________ |
|
Governor |