Texas 2015 - 84th Regular

Texas Senate Bill SB1602 Compare Versions

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

Old	New	Differences
1	1	84R10168 KFF-F
2	2	By: Kolkhorst S.B. No. 1602
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the delivery of certain Medicaid managed care benefits
8	8	and reimbursement rates for certain of those services.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 533.00251(c) and (d), Government Code,
11	11	are amended to read as follows:
12	12	(c) Subject to Section 533.0025 and notwithstanding any
13	13	other law, the commission, in consultation with the advisory
14	14	committee, shall provide benefits under the medical assistance
15	15	program to recipients who reside in nursing facilities through the
16	16	STAR + PLUS Medicaid managed care program. In implementing this
17	17	subsection, the commission shall ensure:
18	18	(1) that, subject to Section 533.002511, the
19	19	commission is responsible for setting the minimum reimbursement
20	20	rate paid to a nursing facility under the managed care program,
21	21	including the staff rate enhancement paid to a nursing facility
22	22	that qualifies for the enhancement;
23	23	(2) that a nursing facility is paid not later than the
24	24	10th day after the date the facility submits a clean claim;
25	25	(3) the appropriate utilization of services
26	26	consistent with criteria adopted by the commission;
27	27	(4) a reduction in the incidence of potentially
28	28	preventable events and unnecessary institutionalizations;
29	29	(5) that a managed care organization providing
30	30	services under the managed care program provides discharge
31	31	planning, transitional care, and other education programs to
32	32	physicians and hospitals regarding all available long-term care
33	33	settings;
34	34	(6) that a managed care organization providing
35	35	services under the managed care program:
36	36	(A) assists in collecting applied income from
37	37	recipients; and
38	38	(B) provides payment incentives to nursing
39	39	facility providers that reward reductions in preventable acute care
40	40	costs and encourage transformative efforts in the delivery of
41	41	nursing facility services, including efforts to promote a
42	42	resident-centered care culture through facility design and
43	43	services provided;
44	44	(7) the establishment of a portal that is in
45	45	compliance with state and federal regulations, including standard
46	46	coding requirements, through which nursing facility providers
47	47	participating in the STAR + PLUS Medicaid managed care program may
48	48	submit claims to any participating managed care organization;
49	49	(8) that rules and procedures relating to the
50	50	certification and decertification of nursing facility beds under
51	51	the medical assistance program are not affected; and
52	52	(9) that a managed care organization providing
53	53	services under the managed care program, to the greatest extent
54	54	possible, offers nursing facility providers access to:
55	55	(A) acute care professionals; and
56	56	(B) telemedicine, when feasible and in
57	57	accordance with state law, including rules adopted by the Texas
58	58	Medical Board.
59	59	(d) Subject to Subsection (e), the commission shall ensure
60	60	that a nursing facility provider authorized to provide services
61	61	under the medical assistance program on September 1, 2015 [2013],
62	62	is allowed to participate in the STAR + PLUS Medicaid managed care
63	63	program through August 31, 2019 [2017].
64	64	SECTION 2. Subchapter A, Chapter 533, Government Code, is
65	65	amended by adding Section 533.002511 to read as follows:
66	66	Sec. 533.002511. MINIMUM NURSING FACILITY REIMBURSEMENT
67	67	RATES FOR RECIPIENTS ALSO ELIGIBLE FOR MEDICARE. A contract
68	68	between a managed care organization and the commission for the
69	69	organization to provide health care services to recipients must
70	70	contain a requirement that the minimum reimbursement rate paid by
71	71	the organization to a nursing facility for services provided to a
72	72	recipient who is also eligible to receive services under the
73	73	Medicare program is the prevailing reimbursement rate for nursing
74	74	facilities under the Medicare program.
75	75	SECTION 3. Section 533.005(a-1), Government Code, is
76	76	amended to read as follows:
77	77	(a-1) The requirements imposed by Subsections (a)(23)(A),
78	78	(B), and (C) do not apply, and may not be enforced, on and after
79	79	August 31, 2019 [2018].
80	80	SECTION 4. If before implementing any provision of this Act
81	81	a state agency determines that a waiver or authorization from a
82	82	federal agency is necessary for implementation of that provision,
83	83	the agency affected by the provision shall request the waiver or
84	84	authorization and may delay implementing that provision until the
85	85	waiver or authorization is granted.
86	86	SECTION 5. This Act takes effect immediately if it receives
87	87	a vote of two-thirds of all the members elected to each house, as
88	88	provided by Section 39, Article III, Texas Constitution. If this
89	89	Act does not receive the vote necessary for immediate effect, this
90	90	Act takes effect September 1, 2015.