Texas 2013 - 83rd Regular

Texas House Bill HB1159 Compare Versions

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Old	New	Differences
1	1	83R19626 ADM-F
2	2	By: Kolkhorst H.B. No. 1159
3	3	Substitute the following for H.B. No. 1159:
4	4	By: Naishtat C.S.H.B. No. 1159
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to a utilization review process for managed care
10	10	organizations participating in the STAR + PLUS Medicaid managed
11	11	care program.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subchapter A, Chapter 533, Government Code, is
14	14	amended by adding Section 533.00281 to read as follows:
15	15	Sec. 533.00281. UTILIZATION REVIEW FOR STAR + PLUS MEDICAID
16	16	MANAGED CARE ORGANIZATIONS. (a) The commission's office of
17	17	contract management shall establish an annual utilization review
18	18	process for managed care organizations participating in the STAR +
19	19	PLUS Medicaid managed care program. The commission shall determine
20	20	the topics to be examined in the review process, except that the
21	21	review process must include a thorough investigation of each
22	22	managed care organization's procedures for determining whether a
23	23	recipient should be enrolled in the STAR + PLUS home and
24	24	community-based services and supports (HCBS) program, including
25	25	the conduct of functional assessments for that purpose and records
26	26	relating to those assessments.
27	27	(b) The office of contract management shall use the
28	28	utilization review process to review each fiscal year:
29	29	(1) every managed care organization participating in
30	30	the STAR + PLUS Medicaid managed care program; or
31	31	(2) only the managed care organizations that, using a
32	32	risk-based assessment process, the office determines have a higher
33	33	likelihood of inappropriate client placement in the STAR + PLUS
34	34	home and community-based services and supports (HCBS) program.
35	35	(c) Notwithstanding Subsection (b), during the state fiscal
36	36	biennium ending August 31, 2015, the office of contract management
37	37	shall use the utilization review process to review every managed
38	38	care organization participating in the STAR + PLUS Medicaid managed
39	39	care program. This subsection expires September 1, 2016.
40	40	(d) In conjunction with the commission's office of contract
41	41	management, the commission shall provide a report to the standing
42	42	committees of the senate and house of representatives with
43	43	jurisdiction over the Medicaid program not later than December 1 of
44	44	each year. The report must:
45	45	(1) summarize the results of the utilization reviews
46	46	conducted under this section during the preceding fiscal year;
47	47	(2) provide analysis of errors committed by each
48	48	reviewed managed care organization; and
49	49	(3) extrapolate those findings and make
50	50	recommendations for improving the efficiency of the program.
51	51	(e) If a utilization review conducted under this section
52	52	results in a determination to recoup money from a managed care
53	53	organization, a service provider who contracts with the managed
54	54	care organization may not be held liable for the good faith
55	55	provision of services based on an authorization from the managed
56	56	care organization.
57	57	SECTION 2. The Health and Human Services Commission shall
58	58	provide the first report required by Section 533.00281(d),
59	59	Government Code, as added by this Act, not later than December 1,
60	60	2014.
61	61	SECTION 3. If before implementing any provision of this Act
62	62	a state agency determines that a waiver or authorization from a
63	63	federal agency is necessary for implementation of that provision,
64	64	the agency affected by the provision shall request the waiver or
65	65	authorization and may delay implementing that provision until the
66	66	waiver or authorization is granted.
67	67	SECTION 4. This Act takes effect immediately if it receives
68	68	a vote of two-thirds of all the members elected to each house, as
69	69	provided by Section 39, Article III, Texas Constitution. If this
70	70	Act does not receive the vote necessary for immediate effect, this
71	71	Act takes effect September 1, 2013.