Texas 2013 - 83rd Regular

Texas House Bill HB3158 Compare Versions

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Old	New	Differences
1	1	83R21986 KFF-F
2	2	By: Zerwas, Rose H.B. No. 3158
3	3	Substitute the following for H.B. No. 3158:
4	4	By: Raymond C.S.H.B. No. 3158
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to Medicaid managed care pilot programs for contracts with
10	10	provider-directed managed care organizations, including
11	11	organizations that delegate to health care collaboratives, and to
12	12	the establishment of those collaboratives.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Subchapter A, Chapter 533, Government Code, is
15	15	amended by adding Section 533.0045 to read as follows:
16	16	Sec. 533.0045. PILOT PROGRAMS FOR CONTRACTS WITH
17	17	PROVIDER-DIRECTED MANAGED CARE ORGANIZATIONS. (a) In this section:
18	18	(1) "Delegation agreement" has the meaning assigned by
19	19	Section 1272.001, Insurance Code.
20	20	(2) "Health care collaborative" has the meaning
21	21	assigned by Section 848.001, Insurance Code, and includes an entity
22	22	described by Section 316.001, Health and Safety Code.
23	23	(3) "Medical assistance" has the meaning assigned by
24	24	Section 32.003, Human Resources Code.
25	25	(b) If cost-effective and feasible, the commission shall
26	26	develop and implement pilot programs under which the commission
27	27	contracts with provider-directed managed care organizations for
28	28	purposes of:
29	29	(1) promoting the efficient utilization of medical
30	30	assistance services by recipients; and
31	31	(2) determining the ability of the organizations to
32	32	improve patient outcomes and contain costs associated with
33	33	providing medical assistance to recipients within each
34	34	organization's service delivery area.
35	35	(c) The commission may develop and implement pilot programs
36	36	under this section to test one or more service delivery models
37	37	designed to provide medical assistance for acute care through a
38	38	health maintenance organization that executes a delegation
39	39	agreement with a health care collaborative, provided that:
40	40	(1) the delegation agreement between the health care
41	41	collaborative and the health maintenance organization is subject to
42	42	the requirements of Chapter 1272, Insurance Code, and other
43	43	applicable state and federal law; and
44	44	(2) at least one of the pilot programs established as
45	45	provided by this subsection is conducted with a provider-managed
46	46	health maintenance organization that is owned by a not-for-profit
47	47	pediatric facility.
48	48	(d) If the commission implements pilot programs under this
49	49	section, the commission shall:
50	50	(1) implement those programs not later than September
51	51	1, 2015;
52	52	(2) operate each program for at least 36 months and be
53	53	permitted to extend the period if the commission determines an
54	54	extension is appropriate; and
55	55	(3) establish each program only in a service delivery
56	56	area that:
57	57	(A) has more than 400,000 individuals who, in the
58	58	aggregate, are eligible for benefits under the STAR + PLUS Medicaid
59	59	managed care program or the child health plan program;
60	60	(B) is served by three or fewer managed care
61	61	organizations; and
62	62	(C) is served by a managed care organization that
63	63	provides services to more than 40 percent of recipients in the
64	64	service delivery area under the STAR + PLUS Medicaid managed
65	65	program or enrollees in the service delivery area under the child
66	66	health plan program.
67	67	(e) On the conclusion of a pilot program, the commission:
68	68	(1) shall evaluate the strengths and weaknesses of the
69	69	program and determine, based on the commission's evaluation, the
70	70	feasibility of expanding the program or implementing elements of
71	71	the program statewide; and
72	72	(2) if the commission determines it feasible and
73	73	likely to result in the effective provision of medical assistance
74	74	to recipients statewide, shall, not later than December 31, 2018,
75	75	submit a report to the governor and the legislature that makes
76	76	recommendations regarding improved policies and procedures with
77	77	statewide applicability.
78	78	(f) This section expires September 1, 2019.
79	79	SECTION 2. Section 316.001, Health and Safety Code, is
80	80	amended to read as follows:
81	81	Sec. 316.001. AUTHORITY TO ESTABLISH HEALTH CARE
82	82	COLLABORATIVE. A public hospital created under Subtitle C or D, a
83	83	facility that is owned or operated by a public or not-for-profit
84	84	hospital and that includes an academic health center, or a hospital
85	85	district created under general or special law may form and sponsor a
86	86	nonprofit health care collaborative that is certified under Chapter
87	87	848, Insurance Code, or is otherwise exempt from obtaining a
88	88	certificate of authority or determination of approval under Section
89	89	848.002, Insurance Code.
90	90	SECTION 3. If before implementing any provision of this Act
91	91	a state agency determines that a waiver or authorization from a
92	92	federal agency is necessary for implementation of that provision,
93	93	the agency affected by the provision shall request the waiver or
94	94	authorization and may delay implementing that provision until the
95	95	waiver or authorization is granted.
96	96	SECTION 4. This Act takes effect September 1, 2013.