HB4459 - Relating to the provision of certain services under the Medicaid managed care program to recipients who are victims of family violence.

  89R6229 KKR-D     By: Bhojani H.B. No. 4459       A BILL TO BE ENTITLED   AN ACT   relating to the provision of certain services under the Medicaid   managed care program to recipients who are victims of family   violence.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 540, Government Code, as effective April   1, 2025, is amended by adding Subchapter T to read as follows:   SUBCHAPTER T.   FAMILY VIOLENCE SERVICES           Sec. 540.0951.  DEFINITIONS. In this subchapter:                 (1)     "Family violence" has the meaning assigned by   Section 71.004, Family Code.                 (2)     "Family violence services provider" means a   licensed health care provider, licensed mental health or behavioral   health provider, or other provider designated by commission rule   who provides family violence services.                 (3)     "Family violence services" means services that   provide trauma-informed care to a recipient who is a survivor of   family violence, including health care services, mental and   behavioral health services, and other services designated by   commission rule as family violence services.                 (4)  "Service coordination" includes:                       (A)     contact between a recipient and a service   coordinator for a Medicaid managed care organization;                       (B)     coordination, including with providers, to   assist a recipient in accessing benefits provided by the   organization; and                       (C)     coordination, including with providers as   appropriate, to assist a recipient in accessing services provided   by other entities or service providers in the recipient's   community.           Sec.   540.0952.     FAMILY VIOLENCE SERVICES; SERVICE   COORDINATION.   (a)   A contract between a Medicaid managed care   organization and the commission to provide health care services to   recipients must:                 (1)     require the contracting Medicaid managed care   organization to:                       (A)     ensure recipients who are survivors of family   violence have access to family violence services providers and   family violence services; and                       (B)     provide family violence services   coordination to those recipients; and                 (2)     include performance metrics designed to assist the   commission in evaluating the organization's coordination and   provision of those services, including metrics related to:                       (A)     the number of family violence screenings   conducted;                       (B)     the number and types of referrals for family   violence services; and                       (C)     the organization's engagement with family   violence services providers.           (b)     In implementing family violence services coordination   for recipients, a Medicaid managed care organization must:                 (1)     establish partnerships with licensed family   violence services providers to develop service coordination   pathways for recipients who are survivors of family violence;                 (2)     develop protocols for integrating the provision of   trauma-informed family violence services with health care and   mental health services provided to recipients in a manner that   meets a recipient's specific needs;                 (3)     require health care and mental health providers   participating in the organization's provider network to conduct   screenings of recipients to identify signs that a recipient is a   survivor of family violence that:                       (A)     use evidence-based screening methods   sensitive to a recipient's needs; and                       (B)     are conducted by personnel with appropriate   training about trauma-informed care, family violence awareness,   and culturally competent support practices;                 (4)     develop a streamlined process for referring   recipients to domestic violence services providers that ensures   continuity of care and provides access to specialized services and   family violence resources, including emergency shelters and   organizations providing legal support; and                 (5)     ensure recipients have access to mental and   behavioral health services that specifically address trauma   experienced by survivors of domestic violence, including:                       (A)     counseling to address the immediate and   long-term mental health needs of a recipient; and                       (B)  group counseling or support groups.           Sec.   540.0953.     SERVICE COORDINATOR TRAINING. A Medicaid   managed care organization must ensure that each individual who   provides family violence service coordination to recipients under   this subchapter receive training on trauma-informed care, family   violence awareness, and culturally competent support practices.           Sec.   540.0954.     MEDICAID MANAGED CARE ORGANIZATION ANNUAL   REPORT. A Medicaid managed care organization shall annually submit   to the commission a written report detailing the organization's   efforts to comply with this subchapter during the preceding year.     The report must include data on:                 (1)     the number of family violence screenings conducted   by providers included in the organization's provider network;                 (2)     the number and type of recipient referrals for   family violence services made by providers; and                 (3)     the scope of family violence mental health and   behavioral health services provided to recipients.           Sec.   540.0955.     ANNUAL AUDIT. (a)   The commission shall   annually conduct a performance audit of a Medicaid managed care   organization to:                 (1)     ensure the organization is providing family   violence services coordination; and                 (2)     evaluate the organization's performance in   providing family violence services and service coordination to   recipients under this subchapter.           (b)     In evaluating a Medicaid managed care organization's   performance under Subsection (a), the commission shall:                 (1)     use the metrics included in the organization's   contract with the commission; and                 (2)     assess the quality of care and service   coordination provided to recipients by the organization.           Sec.   540.0956.     RULES. The executive commissioner shall   adopt rules necessary to implement this subchapter, including rules   designating:                 (1)     services that are considered family violence   services; and                 (2)     health care providers that may receive Medicaid   reimbursement for providing family violence services.          SECTION 2.  Section 32.024, Human Resources Code, is amended   by adding Subsection (ss) to read as follows:           (ss) The commission shall ensure that medical assistance   reimbursement is provided to a family violence services provider   for providing family violence services to a recipient under   Subchapter T, Chapter 540, Government Code.          SECTION 3.  (a) The Health and Human Services Commission   shall, in a contract between the commission and a managed care   organization under Chapter 540, Government Code, as effective April   1, 2025, that is entered into or renewed on or after the effective   date of this Act, require that the managed care organization comply   with Subchapter T, Chapter 540, Government Code, as added by this   Act.          (b)  The Health and Human Services Commission shall seek to   amend contracts entered into with managed care organizations under   Chapter 533, Government Code, or under Chapter 540, Government   Code, as effective April 1, 2025, before the effective date of this   Act to require those managed care organizations to comply with   Subchapter T, Chapter 540, Government Code, as added by this Act.   To the extent of a conflict between Subchapter T, Chapter 540,   Government Code, as added by this Act, and a provision of a contract   with a managed care organization entered into before the effective   date of this Act, the contract provision prevails.          SECTION 4.  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 5.  This Act takes effect September 1, 2025.