Texas 2013 - 83rd Regular

Texas Senate Bill SB348 Compare Versions

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1	1	By: Schwertner, et al. S.B. No. 348
2	2	(Kolkhorst)
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a utilization review process for managed care
8	8	organizations participating in the STAR + PLUS Medicaid managed
9	9	care program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter A, Chapter 533, Government Code, is
12	12	amended by adding Section 533.00281 to read as follows:
13	13	Sec. 533.00281. UTILIZATION REVIEW FOR STAR + PLUS MEDICAID
14	14	MANAGED CARE ORGANIZATIONS. (a) The commission's office of
15	15	contract management shall establish an annual utilization review
16	16	process for managed care organizations participating in the STAR +
17	17	PLUS Medicaid managed care program. The commission shall determine
18	18	the topics to be examined in the review process, except that the
19	19	review process must include a thorough investigation of each
20	20	managed care organization's procedures for determining whether a
21	21	recipient should be enrolled in the STAR + PLUS home and
22	22	community-based services and supports (HCBS) program, including
23	23	the conduct of functional assessments for that purpose and records
24	24	relating to those assessments.
25	25	(b) The office of contract management shall use the
26	26	utilization review process to review each fiscal year:
27	27	(1) every managed care organization participating in
28	28	the STAR + PLUS Medicaid managed care program; or
29	29	(2) only the managed care organizations that, using a
30	30	risk-based assessment process, the office determines have a higher
31	31	likelihood of inappropriate client placement in the STAR + PLUS
32	32	home and community-based services and supports (HCBS) program.
33	33	(c) Notwithstanding Subsection (b), during the state fiscal
34	34	biennium ending August 31, 2015, the office of contract management
35	35	shall use the utilization review process to review every managed
36	36	care organization participating in the STAR + PLUS Medicaid managed
37	37	care program. This subsection expires September 1, 2016.
38	38	(d) In conjunction with the commission's office of contract
39	39	management, the commission shall provide a report to the standing
40	40	committees of the senate and house of representatives with
41	41	jurisdiction over the Medicaid program not later than December 1 of
42	42	each year. The report must:
43	43	(1) summarize the results of the utilization reviews
44	44	conducted under this section during the preceding fiscal year;
45	45	(2) provide analysis of errors committed by each
46	46	reviewed managed care organization; and
47	47	(3) extrapolate those findings and make
48	48	recommendations for improving the efficiency of the program.
49	49	(e) If a utilization review conducted under this section
50	50	results in a determination to recoup money from a managed care
51	51	organization, a service provider who contracts with the managed
52	52	care organization may not be held liable for the good faith
53	53	provision of services based on an authorization from the managed
54	54	care organization.
55	55	SECTION 2. The Health and Human Services Commission shall
56	56	provide the first report required by Subsection (d), Section
57	57	533.00281, Government Code, as added by this Act, not later than
58	58	December 1, 2014.
59	59	SECTION 3. If before implementing any provision of this Act
60	60	a state agency determines that a waiver or authorization from a
61	61	federal agency is necessary for implementation of that provision,
62	62	the agency affected by the provision shall request the waiver or
63	63	authorization and may delay implementing that provision until the
64	64	waiver or authorization is granted.
65	65	SECTION 4. This Act takes effect immediately if it receives
66	66	a vote of two-thirds of all the members elected to each house, as
67	67	provided by Section 39, Article III, Texas Constitution. If this
68	68	Act does not receive the vote necessary for immediate effect, this
69	69	Act takes effect September 1, 2013.