(a) The commission shall develop and implement a comprehensive plan to reduce the use of hospital emergency room services by recipients under Medicaid. The plan may include:
(1) a pilot program designed to facilitate program participants in accessing an appropriate level of health care, which may include as components:
(A) providing program participants access to bilingual health services providers; and
(B) giving program participants information on how to access primary care physicians, advanced practice registered nurses, and local health clinics;
(2) a pilot program under which health care providers, other than hospitals, are given financial incentives for treating recipients outside of normal business hours to divert those recipients from hospital emergency rooms;
(3) payment of a nominal referral fee to hospital emergency rooms that perform an initial medical evaluation of a recipient and subsequently refer the recipient, if medically stable, to an appropriate level of health care, such as care provided by a primary care physician, advanced practice registered nurse, or local clinic;
(4) a program under which the commission or a managed care organization that enters into a contract with the commission under Chapter 533 contacts, by telephone or mail, a recipient who accesses a hospital emergency room three times during a six-month period and provides the recipient with information on ways the recipient may secure a medical home to avoid unnecessary treatment at hospital emergency rooms;
(5) a health care literacy program under which the commission develops partnerships with other state agencies and private entities to:
(A) assist the commission in developing materials that:
(i) contain basic health care information for parents of young children who are recipients under Medicaid and who are participating in public or private child-care or prekindergarten programs, including federal Head Start programs; and
(ii) are written in a language understandable to those parents and specifically tailored to be applicable to the needs of those parents;
(B) distribute the materials developed under Paragraph (A) to those parents; and
(C) otherwise teach those parents about the health care needs of their children and ways to address those needs; and
(6) other initiatives developed and implemented in other states that have shown success in reducing the incidence of unnecessary treatment in hospital emergency rooms.
(b) The commission shall coordinate with hospitals and other providers that receive supplemental payments under the uncompensated care payment program operated under the Texas Health Care Transformation and Quality Improvement Program waiver issued under Section 1115 of the federal Social Security Act (42 U.S.C. § 1315) to identify and implement initiatives based on best practices and models that are designed to reduce Medicaid recipients’ use of hospital emergency room services as a primary means of receiving health care benefits, including initiatives designed to improve recipients’ access to and use of primary care providers.

Text of section effective until April 01, 2025