H.B. No. 3231
AN ACT
relating to clarification of legislative intent regarding
enrollment of newborns in Medicaid managed care plans and
validating related acts and decisions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. CLARIFICATION OF INTENT OF LEGISLATION. (a) In
1993, this state 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 service areas consisting of
territory in Bexar, Tarrant, Lubbock, Harris, Dallas, El Paso, and
Nueces Counties. Total enrollment in Medicaid managed care is
currently more than 2.5 million.
(b) In 1999, the legislature enacted H.B. No. 2896 (Chapter
1447, Acts of the 76th Legislature, Regular Session, 1999) and H.B.
No. 2641 (Chapter 1460, Acts of the 76th Legislature, Regular
Session, 1999). Both bills included identical amendments to
Section 533.0075, Government Code, as originally enacted in 1997,
and addressed enrollment of Medicaid recipients 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 newborns in managed care plans. Subdivision (5)
required the commission to ensure immediate access to prenatal
services and newborn care for pregnant women and newborns enrolled
in managed care plans. Subdivision (6) required the commission to
temporarily assign newborns 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, Government Code, understood that the
Health and Human Services Commission had enrolled newborns in
Medicaid managed care plans and intended that the commission would
continue to enroll newborns 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
newborns 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 this coverage to newborns.
(e) Subdivision (6) of Section 533.0075, Government Code,
was intended to address delays in payment that health care
providers in Medicaid managed care pilot areas experienced at the
time of the subdivision's enactment for services provided to a
newborn 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) or prohibit enrollment of
newborns 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 the newborn's birth but before completion of
the Medicaid eligibility determination process, and that a provider
who provides care for the newborn receives reimbursement for the
provider's 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 newborns 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 the
requirements of that provision are no longer necessary to ensure
appropriate payment of providers of services to newborns.
SECTION 2. CLARIFYING AMENDMENT. Section 533.0075,
Government Code, is amended to read as follows:
Sec. 533.0075. RECIPIENT ENROLLMENT. The commission
shall:
(1) encourage recipients to choose appropriate
managed care plans and primary health care providers by:
(A) providing initial information to recipients
and providers in a region about the need for recipients to choose
plans and providers not later than the 90th day before the date on
which the commission plans to begin to provide health care services
to recipients in that region through managed care;
(B) providing follow-up information before
assignment of plans and providers and after assignment, if
necessary, to recipients who delay in choosing plans and providers;
and
(C) allowing plans and providers to provide
information to recipients or engage in marketing activities under
marketing guidelines established by the commission under Section
533.008 after the commission approves the information or
activities;
(2) consider the following factors in assigning
managed care plans and primary health care providers to recipients
who fail to choose plans and providers:
(A) the importance of maintaining existing
provider-patient and physician-patient relationships, including
relationships with specialists, public health clinics, and
community health centers;
(B) to the extent possible, the need to assign
family members to the same providers and plans; and
(C) geographic convenience of plans and
providers for recipients;
(3) retain responsibility for enrollment and
disenrollment of recipients in managed care plans, except that the
commission may delegate the responsibility to an independent
contractor who receives no form of payment from, and has no
financial ties to, any managed care organization;
(4) develop and implement an expedited process for
determining eligibility for and enrolling pregnant women and
newborn infants in managed care plans; and
(5) ensure immediate access to prenatal services and
newborn care for pregnant women and newborn infants enrolled in
managed care plans, including ensuring that a pregnant woman may
obtain an appointment with an obstetrical care provider for an
initial maternity evaluation not later than the 30th day after the
date the woman applies for Medicaid[; and
[(6) temporarily assign Medicaid-eligible newborn
infants to the traditional fee-for-service component of the state
Medicaid program for a period not to exceed the earlier of:
[(A) 60 days; or
[(B) the date on which the Texas Department of
Human Services has completed the newborn's Medicaid eligibility
determination, including assignment of the newborn's Medicaid
eligibility number].
SECTION 3. VALIDATION OF ACTS OR DECISIONS BY HEALTH AND
HUMAN SERVICES COMMISSION. (a) A governmental act taken or a
decision made by the Health and Human Services Commission before
the effective date of this Act 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 the act or decision 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 the
act or decision occurred;
(2) an act or decision that violates the terms of
federal law or a federal waiver; or
(3) 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. EFFECTIVE DATE. 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.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 3231 was passed by the House on April
28, 2009, by the following vote: Yeas 149, Nays 0, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 3231 was passed by the Senate on May
21, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor