bill requiring Medicaid plans to screen for family violence

The text as introduced · 1,090 words

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.