83R21986 KFF-F
By: Zerwas, Rose H.B. No. 3158
Substitute the following for H.B. No. 3158:
By: Raymond C.S.H.B. No. 3158
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid managed care pilot programs for contracts with
provider-directed managed care organizations, including
organizations that delegate to health care collaboratives, and to
the establishment of those collaboratives.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0045 to read as follows:
Sec. 533.0045. PILOT PROGRAMS FOR CONTRACTS WITH
PROVIDER-DIRECTED MANAGED CARE ORGANIZATIONS. (a) In this section:
(1) "Delegation agreement" has the meaning assigned by
Section 1272.001, Insurance Code.
(2) "Health care collaborative" has the meaning
assigned by Section 848.001, Insurance Code, and includes an entity
described by Section 316.001, Health and Safety Code.
(3) "Medical assistance" has the meaning assigned by
Section 32.003, Human Resources Code.
(b) If cost-effective and feasible, the commission shall
develop and implement pilot programs under which the commission
contracts with provider-directed managed care organizations for
purposes of:
(1) promoting the efficient utilization of medical
assistance services by recipients; and
(2) determining the ability of the organizations to
improve patient outcomes and contain costs associated with
providing medical assistance to recipients within each
organization's service delivery area.
(c) The commission may develop and implement pilot programs
under this section to test one or more service delivery models
designed to provide medical assistance for acute care through a
health maintenance organization that executes a delegation
agreement with a health care collaborative, provided that:
(1) the delegation agreement between the health care
collaborative and the health maintenance organization is subject to
the requirements of Chapter 1272, Insurance Code, and other
applicable state and federal law; and
(2) at least one of the pilot programs established as
provided by this subsection is conducted with a provider-managed
health maintenance organization that is owned by a not-for-profit
pediatric facility.
(d) If the commission implements pilot programs under this
section, the commission shall:
(1) implement those programs not later than September
1, 2015;
(2) operate each program for at least 36 months and be
permitted to extend the period if the commission determines an
extension is appropriate; and
(3) establish each program only in a service delivery
area that:
(A) has more than 400,000 individuals who, in the
aggregate, are eligible for benefits under the STAR + PLUS Medicaid
managed care program or the child health plan program;
(B) is served by three or fewer managed care
organizations; and
(C) is served by a managed care organization that
provides services to more than 40 percent of recipients in the
service delivery area under the STAR + PLUS Medicaid managed
program or enrollees in the service delivery area under the child
health plan program.
(e) On the conclusion of a pilot program, the commission:
(1) shall evaluate the strengths and weaknesses of the
program and determine, based on the commission's evaluation, the
feasibility of expanding the program or implementing elements of
the program statewide; and
(2) if the commission determines it feasible and
likely to result in the effective provision of medical assistance
to recipients statewide, shall, not later than December 31, 2018,
submit a report to the governor and the legislature that makes
recommendations regarding improved policies and procedures with
statewide applicability.
(f) This section expires September 1, 2019.
SECTION 2. Section 316.001, Health and Safety Code, is
amended to read as follows:
Sec. 316.001. AUTHORITY TO ESTABLISH HEALTH CARE
COLLABORATIVE. A public hospital created under Subtitle C or D, a
facility that is owned or operated by a public or not-for-profit
hospital and that includes an academic health center, or a hospital
district created under general or special law may form and sponsor a
nonprofit health care collaborative that is certified under Chapter
848, Insurance Code, or is otherwise exempt from obtaining a
certificate of authority or determination of approval under Section
848.002, Insurance Code.
SECTION 3. 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 4. This Act takes effect September 1, 2013.