By: Davis of Harris H.B. No. 3231
A BILL TO BE ENTITLED
AN ACT
relating to clarification of Section 533.0075, Government Code, and
validation of certain acts and decisions made by the Health and
Human Services Commission in construing a contract entered into
under that section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. CLARIFICATION OF INTENT OF LEGISLATION. (a) In
1993, Texas began the transition to managed care for certain
recipients of Medicaid services, with pilot programs in Travis
County and the tri-county area of Jefferson, Chambers, and
Galveston counties. Since that time, Medicaid managed care has
been implemented in six additional services areas: Bexar, Tarrant,
Lubbock, Harris, Dallas, El Paso, and Nueces bringing total
enrollment in Medicaid managed care to more than 2,500,000.
(b) In 1999, the Legislature enacted H.B. No. 2896 and H.B.
No. 2641. Both bills included identical amendments to Section
533.0075, Government Code, which was originally enacted in 1997 and
addressed recipient enrollment in managed care programs.
(c) The 1999 amendments added Subdivisions (4), (5), and (6)
to Section 533.0075, Government Code. Subdivision (4) required the
Health and Human Services Commission to develop and implement an
expedited process for determining eligibility for and enrolling
pregnant women and newborn infants in managed care plans.
Subdivision (5) required the commission to ensure immediate access
to prenatal services and newborn care for pregnant women and
newborn infants enrolled in managed care plans. Subdivision (6)
required the commission to temporarily assign newborn infants to
the traditional fee-for-services component of Medicaid for a period
not to exceed 60 days or the date on which the newborn's eligibility
determination is completed.
(d) The Legislature, in enacting subdivisions (4), (5), and
(6) of Section 533.0075, understood that the commission had
enrolled newborn infants in Medicaid managed care plans and
intended that the commission would continue to enroll newborn
infants in Medicaid managed care plans. In particular, the
Legislature intended that, under the express terms of Subdivision
(4), the commission would expedite the enrollment of newborn
infants whose Medicaid eligibility is known at the time of birth
into managed care plans to ensure access to care and to avoid delays
in payment for services. The Legislature has appropriated state
and federal funds to the commission for the payment of capitated
rates to managed care organizations that have contracted with the
commission to provide such coverage to newborn infants.
(e) Subdivision (6) of Section 533.0075 was intended to
address delays in payment that health care providers in Medicaid
managed care pilot areas experienced at the time of its enactment
for services provided to a newborn infant who was ultimately
enrolled in Medicaid but whose Medicaid eligibility was not
determined at the time of birth. The Legislature, in enacting
Subdivision (6), did not intend to nullify or supersede
Subdivisions (4) and (5) and prohibit enrollment of newborn infants
in a Medicaid managed care plan. Rather, the Legislature intended
to ensure that a newborn whose Medicaid eligibility was not known or
not determined at birth would receive medically necessary care
after its birth but before completion of the Medicaid eligibility
determination process and that providers who perform such care
receive reimbursement for such services.
(f) The Legislature understands that the delays in payment
that prompted the enactment of Subdivision (6) have largely been
resolved by more efficient and timely enrollment processes and that
providers who supply services to newborn infants do not experience
delays or denials of payment solely because of a delay in Medicaid
eligibility determination. Accordingly, the Legislature finds
that the purposes of Subdivision (6) have been fulfilled and its
requirements are no longer necessary to ensure appropriate payment
of providers of services to newborn infants.
SECTION 2. CLARIFYING AMENDMENT. Section 533.0075(6),
Government Code, is repealed.
SECTION 3. VALIDATION OF ACTS OR DECISIONS BY HEALTH AND
HUMAN SERVICES COMMISSION. (a) A governmental act taken or
decision made by the Health and Human Services Commission, to
enroll a newborn infant in a managed care organization under the
terms of a contract for managed care services authorized by Section
533.0075, Government Code, is conclusively presumed, as of the date
it occurred, to be valid and to have occurred in accordance with all
applicable law.
(b) This section does not apply to:
(1) an act or decision that was void at the time it
occurred;
(2) an act or decision that violates the terms of
federal law or a federal waiver; or
(2) an act or decision that, under a statute of this
state or the United States, was a misdemeanor or felony at the time
the act or decision occurred.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.