S.B. No. 748
 
 
 
 
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