Texas 2015 - 84th Regular

Texas Senate Bill SB1475 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R11113 KFF-F
2	2	By: Garcia S.B. No. 1475
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to establishing an enhanced Medicaid managed care consumer
8	8	support system.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 531, Government Code, is
11	11	amended by adding Section 531.02132 to read as follows:
12	12	Sec. 531.02132. MEDICAID MANAGED CARE CONSUMER SUPPORT
13	13	SYSTEM. (a) In this section, "enhanced system" means the Medicaid
14	14	managed care consumer support system established by this section.
15	15	(b) The commission shall develop and establish an enhanced
16	16	Medicaid managed care consumer support system consisting of a
17	17	connected network of Medicaid managed care consumer support staff
18	18	that is organized for the purpose of:
19	19	(1) educating Medicaid managed care recipients
20	20	regarding:
21	21	(A) the concept of managed care;
22	22	(B) their rights under the Medicaid program,
23	23	including grievance and appeal procedures; and
24	24	(C) how to advocate for themselves; and
25	25	(2) ultimately reducing the need for the internal
26	26	appeals process of managed care organizations under the Medicaid
27	27	program and for the Medicaid fair hearing process.
28	28	(c) The enhanced system must be designed to:
29	29	(1) be fully integrated with:
30	30	(A) the unit of the commission's office of the
31	31	ombudsman responsible for providing the Medicaid Managed Care
32	32	Helpline; and
33	33	(B) the office of the state long-term care
34	34	ombudsman established under Chapter 101, Human Resources Code;
35	35	(2) include specialized capacity to meet the needs of
36	36	all current and future Medicaid managed care recipients, including
37	37	children receiving dental benefits and other recipients receiving
38	38	benefits, under the:
39	39	(A) STAR Medicaid managed care program;
40	40	(B) STAR + PLUS Medicaid managed care program,
41	41	including the Texas Dual Eligibles Integrated Care Demonstration
42	42	Project provided under that program;
43	43	(C) STAR Kids managed care program established
44	44	under Section 533.00253;
45	45	(D) STAR Health program; and
46	46	(E) child health plan established under Chapter
47	47	62, Health and Safety Code;
48	48	(3) include adequate staffing to support timely access
49	49	to the enhanced system by all Medicaid managed care recipients in
50	50	this state;
51	51	(4) ensure that the enhanced system staff:
52	52	(A) receives sufficient training, including
53	53	training in the Medicare program for the purpose of assisting
54	54	recipients who are dually eligible for Medicare and Medicaid, and
55	55	has sufficient authority to resolve barriers experienced by
56	56	recipients to health care and long-term services and supports;
57	57	(B) has the capacity to actively refer recipients
58	58	to community-based organizations that can assist the recipients
59	59	with the appeals process, including preparation for appeals and
60	60	representation, as needed, whether the appeal is an internal
61	61	appeal provided by a managed care organization or an appeal under
62	62	the Medicaid fair hearing process;
63	63	(C) is locally accessible through satellite
64	64	offices in a network of regional hub sites with at least one office
65	65	in each Medicaid managed care service area, patterned after similar
66	66	satellite offices operated by:
67	67	(i) the following partners in the Health
68	68	Information, Counseling, and Advocacy Program:
69	69	(a) area agencies on aging; and
70	70	(b) aging and disability resource
71	71	centers established under the Aging and Disability Resource Center
72	72	initiative funded in part by the federal Administration on Aging
73	73	and the Centers for Medicare and Medicaid Services; and
74	74	(ii) the office of the state long-term care
75	75	ombudsman; and
76	76	(D) has ready access to the upper management of
77	77	the commission and managed care organizations participating in the
78	78	Medicaid program that will enable staff to promptly identify and
79	79	resolve both recipient-specific and systemic issues; and
80	80	(5) include an advisory interface with nonprofit,
81	81	community-based organizations that routinely assist recipients in
82	82	resolving Medicaid managed care issues, for purposes of timely
83	83	identifying recurring, systemic issues.
84	84	(d) Enhanced system staff may include the employees of
85	85	appropriate health and human services agencies and the staff of
86	86	appropriate community partners under contract with the state.
87	87	(e) The commission's office of the ombudsman, or other
88	88	division of the commission in which the enhanced system is
89	89	established, must be:
90	90	(1) sufficiently independent from other aspects of the
91	91	Medicaid managed care system and have no financial interest in the
92	92	outcome of recipient grievances; and
93	93	(2) empowered to represent the best interests of
94	94	recipients in problem resolution.
95	95	(f) The enhanced system staff shall collect and maintain
96	96	statistical information on a Medicaid managed care service area
97	97	basis and publish quarterly reports that:
98	98	(1) track the incidence of complaints and barriers
99	99	identified by the enhanced system;
100	100	(2) identify trends and recurring barriers in delivery
101	101	and access to Medicaid managed care in this state; and
102	102	(3) identify other problems occurring in the Medicaid
103	103	managed care system.
104	104	SECTION 2. Not later than January 1, 2016, the Health and
105	105	Human Services Commission shall establish the Medicaid managed care
106	106	consumer support system required under Section 531.02132,
107	107	Government Code, as added by this Act.
108	108	SECTION 3. If before implementing any provision of this Act
109	109	a state agency determines that a waiver or authorization from a
110	110	federal agency is necessary for implementation of that provision,
111	111	the agency affected by the provision shall request the waiver or
112	112	authorization and may delay implementing that provision until the
113	113	waiver or authorization is granted.
114	114	SECTION 4. This Act takes effect immediately if it receives
115	115	a vote of two-thirds of all the members elected to each house, as
116	116	provided by Section 39, Article III, Texas Constitution. If this
117	117	Act does not receive the vote necessary for immediate effect, this
118	118	Act takes effect September 1, 2015.