Texas 2009 - 81st Regular

Texas House Bill HB3231 Compare Versions

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Old	New	Differences
1	1	H.B. No. 3231
2	2
3	3
4	4	AN ACT
5	5	relating to clarification of legislative intent regarding
6	6	enrollment of newborns in Medicaid managed care plans and
7	7	validating related acts and decisions.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. CLARIFICATION OF INTENT OF LEGISLATION. (a) In
10	10	1993, this state began the transition to managed care for certain
11	11	recipients of Medicaid services with pilot programs in Travis
12	12	County and the tri-county area of Jefferson, Chambers, and
13	13	Galveston Counties. Since that time, Medicaid managed care has
14	14	been implemented in six additional service areas consisting of
15	15	territory in Bexar, Tarrant, Lubbock, Harris, Dallas, El Paso, and
16	16	Nueces Counties. Total enrollment in Medicaid managed care is
17	17	currently more than 2.5 million.
18	18	(b) In 1999, the legislature enacted H.B. No. 2896 (Chapter
19	19	1447, Acts of the 76th Legislature, Regular Session, 1999) and H.B.
20	20	No. 2641 (Chapter 1460, Acts of the 76th Legislature, Regular
21	21	Session, 1999). Both bills included identical amendments to
22	22	Section 533.0075, Government Code, as originally enacted in 1997,
23	23	and addressed enrollment of Medicaid recipients in managed care
24	24	programs.
25	25	(c) The 1999 amendments added Subdivisions (4), (5), and (6)
26	26	to Section 533.0075, Government Code. Subdivision (4) required the
27	27	Health and Human Services Commission to develop and implement an
28	28	expedited process for determining eligibility for and enrolling
29	29	pregnant women and newborns in managed care plans. Subdivision (5)
30	30	required the commission to ensure immediate access to prenatal
31	31	services and newborn care for pregnant women and newborns enrolled
32	32	in managed care plans. Subdivision (6) required the commission to
33	33	temporarily assign newborns to the traditional fee-for-services
34	34	component of Medicaid for a period not to exceed 60 days or the date
35	35	on which the newborn's eligibility determination is completed.
36	36	(d) The legislature, in enacting Subdivisions (4), (5), and
37	37	(6) of Section 533.0075, Government Code, understood that the
38	38	Health and Human Services Commission had enrolled newborns in
39	39	Medicaid managed care plans and intended that the commission would
40	40	continue to enroll newborns in Medicaid managed care plans. In
41	41	particular, the legislature intended that, under the express terms
42	42	of Subdivision (4), the commission would expedite the enrollment of
43	43	newborns whose Medicaid eligibility is known at the time of birth
44	44	into managed care plans to ensure access to care and to avoid delays
45	45	in payment for services. The legislature has appropriated state
46	46	and federal funds to the commission for the payment of capitated
47	47	rates to managed care organizations that have contracted with the
48	48	commission to provide this coverage to newborns.
49	49	(e) Subdivision (6) of Section 533.0075, Government Code,
50	50	was intended to address delays in payment that health care
51	51	providers in Medicaid managed care pilot areas experienced at the
52	52	time of the subdivision's enactment for services provided to a
53	53	newborn who was ultimately enrolled in Medicaid but whose Medicaid
54	54	eligibility was not determined at the time of birth. The
55	55	legislature, in enacting Subdivision (6), did not intend to nullify
56	56	or supersede Subdivisions (4) and (5) or prohibit enrollment of
57	57	newborns in a Medicaid managed care plan. Rather, the legislature
58	58	intended to ensure that a newborn whose Medicaid eligibility was
59	59	not known or not determined at birth would receive medically
60	60	necessary care after the newborn's birth but before completion of
61	61	the Medicaid eligibility determination process, and that a provider
62	62	who provides care for the newborn receives reimbursement for the
63	63	provider's services.
64	64	(f) The legislature understands that the delays in payment
65	65	that prompted the enactment of Subdivision (6) have largely been
66	66	resolved by more efficient and timely enrollment processes and that
67	67	providers who supply services to newborns do not experience delays
68	68	or denials of payment solely because of a delay in Medicaid
69	69	eligibility determination. Accordingly, the legislature finds
70	70	that the purposes of Subdivision (6) have been fulfilled and the
71	71	requirements of that provision are no longer necessary to ensure
72	72	appropriate payment of providers of services to newborns.
73	73	SECTION 2. CLARIFYING AMENDMENT. Section 533.0075,
74	74	Government Code, is amended to read as follows:
75	75	Sec. 533.0075. RECIPIENT ENROLLMENT. The commission
76	76	shall:
77	77	(1) encourage recipients to choose appropriate
78	78	managed care plans and primary health care providers by:
79	79	(A) providing initial information to recipients
80	80	and providers in a region about the need for recipients to choose
81	81	plans and providers not later than the 90th day before the date on
82	82	which the commission plans to begin to provide health care services
83	83	to recipients in that region through managed care;
84	84	(B) providing follow-up information before
85	85	assignment of plans and providers and after assignment, if
86	86	necessary, to recipients who delay in choosing plans and providers;
87	87	and
88	88	(C) allowing plans and providers to provide
89	89	information to recipients or engage in marketing activities under
90	90	marketing guidelines established by the commission under Section
91	91	533.008 after the commission approves the information or
92	92	activities;
93	93	(2) consider the following factors in assigning
94	94	managed care plans and primary health care providers to recipients
95	95	who fail to choose plans and providers:
96	96	(A) the importance of maintaining existing
97	97	provider-patient and physician-patient relationships, including
98	98	relationships with specialists, public health clinics, and
99	99	community health centers;
100	100	(B) to the extent possible, the need to assign
101	101	family members to the same providers and plans; and
102	102	(C) geographic convenience of plans and
103	103	providers for recipients;
104	104	(3) retain responsibility for enrollment and
105	105	disenrollment of recipients in managed care plans, except that the
106	106	commission may delegate the responsibility to an independent
107	107	contractor who receives no form of payment from, and has no
108	108	financial ties to, any managed care organization;
109	109	(4) develop and implement an expedited process for
110	110	determining eligibility for and enrolling pregnant women and
111	111	newborn infants in managed care plans; and
112	112	(5) ensure immediate access to prenatal services and
113	113	newborn care for pregnant women and newborn infants enrolled in
114	114	managed care plans, including ensuring that a pregnant woman may
115	115	obtain an appointment with an obstetrical care provider for an
116	116	initial maternity evaluation not later than the 30th day after the
117	117	date the woman applies for Medicaid[; and
118	118	[(6) temporarily assign Medicaid-eligible newborn
119	119	infants to the traditional fee-for-service component of the state
120	120	Medicaid program for a period not to exceed the earlier of:
121	121	[(A) 60 days; or
122	122	[(B) the date on which the Texas Department of
123	123	Human Services has completed the newborn's Medicaid eligibility
124	124	determination, including assignment of the newborn's Medicaid
125	125	eligibility number].
126	126	SECTION 3. VALIDATION OF ACTS OR DECISIONS BY HEALTH AND
127	127	HUMAN SERVICES COMMISSION. (a) A governmental act taken or a
128	128	decision made by the Health and Human Services Commission before
129	129	the effective date of this Act to enroll a newborn infant in a
130	130	managed care organization under the terms of a contract for managed
131	131	care services authorized by Section 533.0075, Government Code, is
132	132	conclusively presumed, as of the date the act or decision occurred,
133	133	to be valid and to have occurred in accordance with all applicable
134	134	law.
135	135	(b) This section does not apply to:
136	136	(1) an act or decision that was void at the time the
137	137	act or decision occurred;
138	138	(2) an act or decision that violates the terms of
139	139	federal law or a federal waiver; or
140	140	(3) an act or decision that, under a statute of this
141	141	state or the United States, was a misdemeanor or felony at the time
142	142	the act or decision occurred.
143	143	SECTION 4. EFFECTIVE DATE. This Act takes effect
144	144	immediately if it receives a vote of two-thirds of all the members
145	145	elected to each house, as provided by Section 39, Article III, Texas
146	146	Constitution. If this Act does not receive the vote necessary for
147	147	immediate effect, this Act takes effect September 1, 2009.
148	148	______________________________ ______________________________
149	149	President of the Senate Speaker of the House
150	150	I certify that H.B. No. 3231 was passed by the House on April
151	151	28, 2009, by the following vote: Yeas 149, Nays 0, 1 present, not
152	152	voting.
153	153	______________________________
154	154	Chief Clerk of the House
155	155	I certify that H.B. No. 3231 was passed by the Senate on May
156	156	21, 2009, by the following vote: Yeas 31, Nays 0.
157	157	______________________________
158	158	Secretary of the Senate
159	159	APPROVED: _____________________
160	160	Date
161	161	_____________________
162	162	Governor