2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 532 - Medicaid Administration and Operation in General › Subchapter J. Cost-Saving Initiatives › Section 532.0451. Hospital Emergency Room Use Reduction Initiatives

Text of section effective on April 01, 2025
Sec. 532.0451.  HOSPITAL EMERGENCY ROOM USE REDUCTION INITIATIVES.  (a)  The commission shall develop and implement a comprehensive plan to reduce recipients' use of hospital emergency room services.  The plan may include:
(1)  a pilot program that is designed to assist a program participant in accessing an appropriate level of health care and that may include as components:
(A)  providing a program participant access to bilingual health services providers; and
(B)  giving a program participant information on how to access primary care physicians, advanced practice registered nurses, and local health clinics;
(2)  a pilot program under which a health care provider other than a hospital is given a financial incentive for treating a recipient outside of normal business hours to divert the recipient from a hospital emergency room;
(3)  payment of a nominal referral fee to a hospital emergency room that performs an initial medical evaluation of a recipient and subsequently refers 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 Medicaid managed care organization 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 a hospital emergency room;
(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 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 their children's health care needs 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 a hospital emergency room.
(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 Social Security Act (42 U.S.C. Section 1315) to identify and implement initiatives based on best practices and models that are designed to reduce 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.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.