82R13806 EES-F
By: Alonzo H.B. No. 3191
A BILL TO BE ENTITLED
AN ACT
relating to the inclusion of optometrists, therapeutic
optometrists, and ophthalmologists in Medicaid managed care
provider networks providing services in the Texas-Mexico border
region and other regions of the state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. EXPANSION OF PROVIDER NETWORKS OF MANAGED CARE
ORGANIZATIONS IN TEXAS-MEXICO BORDER REGION AND OTHER AREAS OF
STATE. 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. (a) In
this section, "Texas-Mexico border region" has the meaning assigned
by Section 2056.002.
(b) 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, including a region
consisting of all or part of the Texas-Mexico border 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. STUDY IN TEXAS-MEXICO BORDER REGION. (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 providing services in all or part of the
Texas-Mexico border region, as defined by Section 2056.002,
Government Code, 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. CONTRACTS. (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. WAIVER. 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. EFFECTIVE DATE. This Act takes effect September
1, 2011.