bill making Medicaid pay for nurse home visits

The text as introduced · 625 words

By: Rose
H.B. No. 5152

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid reimbursement for services provided to certain

recipients under a nurse home visiting program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.02482 to read as follows:

Sec. 32.02482. REIMBURSEMENT FOR SERVICES PROVIDED UNDER

NURSE HOME VISITING PROGRAM. (a) In this section:

(1) "Nurse home visiting program" means a program

that:

(A) provides through a registered nurse weekly or

monthly pregnancy- and postpartum-related services to certain

individuals primarily in the home;

(B) offers individualized health and education

services to promote healthy birth outcomes and positive child

health and development outcomes; and

(C) conforms to a nurse home visit model that:

(i) is research-based and grounded in

empirical knowledge;

(ii) is associated with a national

organization, higher education institution, or other organization

with comprehensive home visit program standards to ensure superior

service delivery and program improvement; and

(iii) satisfies evidence of effectiveness

criteria based on a Home Visiting Evidence of Effectiveness review

administered by the United States Department of Health and Human

Services.

(2) "Recipient" means a medical assistance program

recipient.

(b) The commission shall provide medical assistance

reimbursement to a provider who provides services under a nurse

home visiting program to a recipient who:

(1) is pregnant;

(2) is not more than 24 months postpartum; or

(3) is a child 24 months of age or younger.

(c) The executive commissioner by rule shall establish a

bundled medical assistance program reimbursement rate for the

reimbursement of services provided to a recipient under a nurse

home visiting program, including education, screening, counseling,

and resource referral services related to:

(1) healthy pregnancy;

(2) child development;

(3) diet and nutrition;

(4) stress management;

(5) sexually transmitted diseases;

(6) tobacco use screening and cessation;

(7) alcohol and substance use;

(8) antenatal and postpartum depression;

(9) domestic and intimate partner violence;

(10) breastfeeding support;

(11) annual well woman visits and recommended

preventive services;

(12) maternal-infant safety assessment;

(13) postpartum recovery, family planning, and

newborn needs;

(14) selection of a primary care provider;

(15) development of parenting skills, parent-child

relationship building, and confidence building;

(16) child development screening at major

developmental milestones from birth to two years of age;

(17) maternal vitals sign screening, including blood

pressure;

(18) well newborn care; and

(19) facilitation of access to community or other

resources, including:

(A) transportation;

(B) housing; and

(C) assistance under:

(i) the child health plan program under

Chapters 62 and 63, Health and Safety Code;

(ii) the financial assistance program under

Chapter 31;

(iii) the nutritional assistance programs

under Chapter 33, including the supplemental nutrition assistance

program under that chapter; and

(iv) any other public assistance program

the commission administers.

(d) If a recipient described by Subsection (b) becomes

ineligible for medical assistance, the managed care organization

through which the recipient received benefits under the medical

assistance program shall coordinate with the nurse home visiting

program providing services to the recipient to:

(1) arrange for the transfer of the recipient's plan of

care; and

(2) ensure the recipient continues to receive coverage

for the nurse home visiting program services.

(e) Any telehealth services provided to a recipient under a

nurse home visiting program must be provided in a manner that

complies with telehealth requirements the commission establishes.

SECTION 2. 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 3. This Act takes effect September 1, 2025.