84R10168 KFF-F
By: Kolkhorst S.B. No. 1602
A BILL TO BE ENTITLED
AN ACT
relating to the delivery of certain Medicaid managed care benefits
and reimbursement rates for certain of those services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 533.00251(c) and (d), Government Code,
are amended to read as follows:
(c) Subject to Section 533.0025 and notwithstanding any
other law, the commission, in consultation with the advisory
committee, shall provide benefits under the medical assistance
program to recipients who reside in nursing facilities through the
STAR + PLUS Medicaid managed care program. In implementing this
subsection, the commission shall ensure:
(1) that, subject to Section 533.002511, the
commission is responsible for setting the minimum reimbursement
rate paid to a nursing facility under the managed care program,
including the staff rate enhancement paid to a nursing facility
that qualifies for the enhancement;
(2) that a nursing facility is paid not later than the
10th day after the date the facility submits a clean claim;
(3) the appropriate utilization of services
consistent with criteria adopted by the commission;
(4) a reduction in the incidence of potentially
preventable events and unnecessary institutionalizations;
(5) that a managed care organization providing
services under the managed care program provides discharge
planning, transitional care, and other education programs to
physicians and hospitals regarding all available long-term care
settings;
(6) that a managed care organization providing
services under the managed care program:
(A) assists in collecting applied income from
recipients; and
(B) provides payment incentives to nursing
facility providers that reward reductions in preventable acute care
costs and encourage transformative efforts in the delivery of
nursing facility services, including efforts to promote a
resident-centered care culture through facility design and
services provided;
(7) the establishment of a portal that is in
compliance with state and federal regulations, including standard
coding requirements, through which nursing facility providers
participating in the STAR + PLUS Medicaid managed care program may
submit claims to any participating managed care organization;
(8) that rules and procedures relating to the
certification and decertification of nursing facility beds under
the medical assistance program are not affected; and
(9) that a managed care organization providing
services under the managed care program, to the greatest extent
possible, offers nursing facility providers access to:
(A) acute care professionals; and
(B) telemedicine, when feasible and in
accordance with state law, including rules adopted by the Texas
Medical Board.
(d) Subject to Subsection (e), the commission shall ensure
that a nursing facility provider authorized to provide services
under the medical assistance program on September 1, 2015 [2013],
is allowed to participate in the STAR + PLUS Medicaid managed care
program through August 31, 2019 [2017].
SECTION 2. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.002511 to read as follows:
Sec. 533.002511. MINIMUM NURSING FACILITY REIMBURSEMENT
RATES FOR RECIPIENTS ALSO ELIGIBLE FOR MEDICARE. A contract
between a managed care organization and the commission for the
organization to provide health care services to recipients must
contain a requirement that the minimum reimbursement rate paid by
the organization to a nursing facility for services provided to a
recipient who is also eligible to receive services under the
Medicare program is the prevailing reimbursement rate for nursing
facilities under the Medicare program.
SECTION 3. Section 533.005(a-1), Government Code, is
amended to read as follows:
(a-1) The requirements imposed by Subsections (a)(23)(A),
(B), and (C) do not apply, and may not be enforced, on and after
August 31, 2019 [2018].
SECTION 4. 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 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.