84R8755 ADM-F
By: Naishtat, Raymond H.B. No. 3672
A BILL TO BE ENTITLED
AN ACT
relating to expedited credentialing for certain licensed clinical
social workers under the Medicaid managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 533, Government Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G. EXPEDITED CREDENTIALING PROCESS
FOR CERTAIN LICENSED CLINICAL SOCIAL WORKERS
Sec. 533.121. DEFINITIONS. In this subchapter:
(1) "Applicant licensed clinical social worker" means
a licensed clinical social worker applying for expedited
credentialing under this subchapter.
(2) "Licensed clinical social worker" means an
individual licensed by the Texas State Board of Social Worker
Examiners as a licensed clinical social worker.
(3) "Social work medical group" means:
(A) a single legal entity owned by two or more
licensed clinical social workers;
(B) a professional association composed of
licensed clinical social workers; or
(C) any other entity composed of licensed
clinical social workers.
Sec. 533.122. APPLICABILITY. This subchapter applies only
to a licensed clinical social worker who joins an established
social work medical group that has a current contract in force with
a managed care organization.
Sec. 533.123. ELIGIBILITY REQUIREMENTS. To qualify for
expedited credentialing under this subchapter and payment under
Section 533.124, an applicant licensed clinical social worker must:
(1) be licensed in this state by, and in good standing
with, the Texas State Board of Social Worker Examiners;
(2) submit all necessary documentation and other
information required by the managed care organization to enable the
organization to begin the credentialing process required by the
organization to include a licensed clinical social worker as a
provider under the organization's provider network; and
(3) agree to comply with the terms of the managed care
organization's participating provider contract currently in force
with the applicant licensed clinical social worker's established
social work medical group.
Sec. 533.124. PAYMENT OF APPLICANT LICENSED CLINICAL SOCIAL
WORKER DURING CREDENTIALING PROCESS. On submission by the
applicant licensed clinical social worker of the information
required by the managed care organization under Section 533.123(2),
and for payment purposes only, the organization shall treat the
applicant licensed clinical social worker as if the licensed
clinical social worker were a participating provider in the
organization's provider network when the applicant licensed
clinical social worker provides services to recipients under the
managed care plan, including:
(1) authorizing the applicant licensed clinical
social worker to collect copayments from the recipients; and
(2) making payments to the applicant licensed clinical
social worker.
Sec. 533.125. DIRECTORY ENTRIES. Pending the approval of
an application submitted under Section 533.124, the managed care
plan may exclude the applicant licensed clinical social worker from
the managed care plan's directory of participating licensed
clinical social workers, the managed care plan's website listing of
participating licensed clinical social workers, or any other
listing of participating licensed clinical social workers.
Sec. 533.126. EFFECT OF FAILURE TO MEET CREDENTIALING
REQUIREMENTS. If, on completion of the credentialing process, the
managed care organization determines that the applicant licensed
clinical social worker does not meet the organization's
credentialing requirements:
(1) the managed care organization may recover from the
applicant licensed clinical social worker or the licensed clinical
social worker's social work medical group an amount equal to the
difference between payments for in-network benefits and
out-of-network benefits; and
(2) the applicant licensed clinical social worker or
the licensed clinical social worker's social work medical group may
retain any copayments collected or in the process of being
collected as of the date of the organization's determination.
Sec. 533.127. RECIPIENT HELD HARMLESS. A recipient under a
managed care plan is not responsible and shall be held harmless for
any portion of the licensed clinical social worker's fee that is not
paid or reimbursed by the recipient's managed care plan other than
any cost-sharing requirement imposed under the plan.
Sec. 533.128. LIMITATION ON MANAGED CARE ORGANIZATION
LIABILITY. A managed care organization that complies with this
subchapter is not subject to liability for damages arising out of or
in connection with, directly or indirectly, the payment by the
organization of an applicant licensed clinical social worker as if
the licensed clinical social worker were a participating provider
in the organization's provider network.
SECTION 2. The change in law made by this Act applies only
to credentialing of a licensed clinical social worker under a
contract entered into or renewed by a medical group and an issuer of
a Medicaid managed care plan on or after the effective date of this
Act. A contract entered into or renewed before the effective date
of this Act is governed by the law in effect immediately before that
date, and that law is continued in effect for that purpose.
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, 2015.