Texas 2015 - 84th Regular

Texas House Bill HB3672 Compare Versions

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1	1	84R8755 ADM-F
2	2	By: Naishtat, Raymond H.B. No. 3672
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to expedited credentialing for certain licensed clinical
8	8	social workers under the Medicaid managed care program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 533, Government Code, is amended by
11	11	adding Subchapter G to read as follows:
12	12	SUBCHAPTER G. EXPEDITED CREDENTIALING PROCESS
13	13	FOR CERTAIN LICENSED CLINICAL SOCIAL WORKERS
14	14	Sec. 533.121. DEFINITIONS. In this subchapter:
15	15	(1) "Applicant licensed clinical social worker" means
16	16	a licensed clinical social worker applying for expedited
17	17	credentialing under this subchapter.
18	18	(2) "Licensed clinical social worker" means an
19	19	individual licensed by the Texas State Board of Social Worker
20	20	Examiners as a licensed clinical social worker.
21	21	(3) "Social work medical group" means:
22	22	(A) a single legal entity owned by two or more
23	23	licensed clinical social workers;
24	24	(B) a professional association composed of
25	25	licensed clinical social workers; or
26	26	(C) any other entity composed of licensed
27	27	clinical social workers.
28	28	Sec. 533.122. APPLICABILITY. This subchapter applies only
29	29	to a licensed clinical social worker who joins an established
30	30	social work medical group that has a current contract in force with
31	31	a managed care organization.
32	32	Sec. 533.123. ELIGIBILITY REQUIREMENTS. To qualify for
33	33	expedited credentialing under this subchapter and payment under
34	34	Section 533.124, an applicant licensed clinical social worker must:
35	35	(1) be licensed in this state by, and in good standing
36	36	with, the Texas State Board of Social Worker Examiners;
37	37	(2) submit all necessary documentation and other
38	38	information required by the managed care organization to enable the
39	39	organization to begin the credentialing process required by the
40	40	organization to include a licensed clinical social worker as a
41	41	provider under the organization's provider network; and
42	42	(3) agree to comply with the terms of the managed care
43	43	organization's participating provider contract currently in force
44	44	with the applicant licensed clinical social worker's established
45	45	social work medical group.
46	46	Sec. 533.124. PAYMENT OF APPLICANT LICENSED CLINICAL SOCIAL
47	47	WORKER DURING CREDENTIALING PROCESS. On submission by the
48	48	applicant licensed clinical social worker of the information
49	49	required by the managed care organization under Section 533.123(2),
50	50	and for payment purposes only, the organization shall treat the
51	51	applicant licensed clinical social worker as if the licensed
52	52	clinical social worker were a participating provider in the
53	53	organization's provider network when the applicant licensed
54	54	clinical social worker provides services to recipients under the
55	55	managed care plan, including:
56	56	(1) authorizing the applicant licensed clinical
57	57	social worker to collect copayments from the recipients; and
58	58	(2) making payments to the applicant licensed clinical
59	59	social worker.
60	60	Sec. 533.125. DIRECTORY ENTRIES. Pending the approval of
61	61	an application submitted under Section 533.124, the managed care
62	62	plan may exclude the applicant licensed clinical social worker from
63	63	the managed care plan's directory of participating licensed
64	64	clinical social workers, the managed care plan's website listing of
65	65	participating licensed clinical social workers, or any other
66	66	listing of participating licensed clinical social workers.
67	67	Sec. 533.126. EFFECT OF FAILURE TO MEET CREDENTIALING
68	68	REQUIREMENTS. If, on completion of the credentialing process, the
69	69	managed care organization determines that the applicant licensed
70	70	clinical social worker does not meet the organization's
71	71	credentialing requirements:
72	72	(1) the managed care organization may recover from the
73	73	applicant licensed clinical social worker or the licensed clinical
74	74	social worker's social work medical group an amount equal to the
75	75	difference between payments for in-network benefits and
76	76	out-of-network benefits; and
77	77	(2) the applicant licensed clinical social worker or
78	78	the licensed clinical social worker's social work medical group may
79	79	retain any copayments collected or in the process of being
80	80	collected as of the date of the organization's determination.
81	81	Sec. 533.127. RECIPIENT HELD HARMLESS. A recipient under a
82	82	managed care plan is not responsible and shall be held harmless for
83	83	any portion of the licensed clinical social worker's fee that is not
84	84	paid or reimbursed by the recipient's managed care plan other than
85	85	any cost-sharing requirement imposed under the plan.
86	86	Sec. 533.128. LIMITATION ON MANAGED CARE ORGANIZATION
87	87	LIABILITY. A managed care organization that complies with this
88	88	subchapter is not subject to liability for damages arising out of or
89	89	in connection with, directly or indirectly, the payment by the
90	90	organization of an applicant licensed clinical social worker as if
91	91	the licensed clinical social worker were a participating provider
92	92	in the organization's provider network.
93	93	SECTION 2. The change in law made by this Act applies only
94	94	to credentialing of a licensed clinical social worker under a
95	95	contract entered into or renewed by a medical group and an issuer of
96	96	a Medicaid managed care plan on or after the effective date of this
97	97	Act. A contract entered into or renewed before the effective date
98	98	of this Act is governed by the law in effect immediately before that
99	99	date, and that law is continued in effect for that purpose.
100	100	SECTION 3. If before implementing any provision of this Act
101	101	a state agency determines that a waiver or authorization from a
102	102	federal agency is necessary for implementation of that provision,
103	103	the agency affected by the provision shall request the waiver or
104	104	authorization and may delay implementing that provision until the
105	105	waiver or authorization is granted.
106	106	SECTION 4. This Act takes effect September 1, 2015.