82R6630 EES-F
By: Alonzo H.B. No. 1653
A BILL TO BE ENTITLED
AN ACT
relating to the inclusion of optometrists, therapeutic
optometrists, and ophthalmologists in the health care provider
networks of Medicaid managed care organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0065 to read as follows:
Sec. 533.0065. EYE HEALTH CARE SERVICE PROVIDERS. Subject
to Section 32.047, Human Resources Code, but notwithstanding any
other law, the commission shall require that each managed care
organization that contracts with the commission under any Medicaid
managed care model or arrangement to provide health care services
to recipients in a region include in the organization's provider
network each optometrist, therapeutic optometrist, and
ophthalmologist who:
(1) agrees to comply with the terms and conditions of
the organization;
(2) agrees to accept the prevailing provider contract
rate of the organization;
(3) agrees to abide by the standards of care required
by the organization; and
(4) has the credentials required by the organization.
SECTION 2. (a) The Health and Human Services Commission
shall conduct a study of the fiscal impact on this state of
requiring each Medicaid managed care organization that contracts
with the commission under any Medicaid managed care model or
arrangement implemented under Chapter 533, Government Code, to
include in the organization's health care provider network each
optometrist, therapeutic optometrist, and ophthalmologist who
meets the requirements under Section 533.0065, Government Code, as
added by this Act.
(b) Not later than September 1, 2016, the Health and Human
Services Commission shall submit to the legislature a written
report containing the findings of the study conducted under
Subsection (a) of this section and the commission's recommendations
regarding the requirement addressed in the study.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a Medicaid managed
care organization under Chapter 533, Government Code, that is
entered into or renewed on or after the effective date of this Act,
require that the managed care organization comply with Section
533.0065, Government Code, as added by this Act.
(b) The Health and Human Services Commission shall seek to
amend each contract entered into with a Medicaid managed care
organization under Chapter 533, Government Code, before the
effective date of this Act to require those managed care
organizations to comply with Section 533.0065, Government Code, as
added by this Act. To the extent of a conflict between Section
533.0065, Government Code, as added by this Act, and a provision of
a contract with a managed care organization entered into before the
effective date of this Act, the contract provision prevails.
SECTION 4. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2011.