85R12082 KKR-F
By: Paddie H.B. No. 3675
A BILL TO BE ENTITLED
AN ACT
relating to the provision of eye health care by certain
professionals and institutions as providers in the Medicaid managed
care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.072(a), Human Resources Code, is
amended to read as follows:
(a) Notwithstanding any other law, a recipient of medical
assistance is entitled to:
(1) select an ophthalmologist or therapeutic
optometrist who is a medical assistance provider to provide eye
health care services, other than surgery, that are within the scope
of:
(A) services provided under the medical
assistance program; and
(B) the professional specialty practice for
which the ophthalmologist or therapeutic optometrist is licensed
[and credentialed]; and
(2) have direct access to the selected ophthalmologist
or therapeutic optometrist for the provision of the nonsurgical
services without any requirement that the patient or
ophthalmologist or therapeutic optometrist [to] obtain:
(A) a referral from a primary care physician or
other gatekeeper or health care coordinator; or
(B) any other prior authorization or
precertification.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.021191 to read as follows:
Sec. 531.021191. MEDICAID ENROLLMENT OF CERTAIN EYE HEALTH
CARE PROVIDERS. (a) This section applies only to:
(1) an optometrist who is licensed by the Texas
Optometry Board;
(2) a therapeutic optometrist who is licensed by the
Texas Optometry Board;
(3) an ophthalmologist who is licensed by the Texas
Medical Board; and
(4) an institution of higher education that provides
an accredited program for:
(A) training as a Doctor of Optometry or an
optometrist residency; or
(B) training as an ophthalmologist or an
ophthalmologist residency.
(b) The commission may not prevent a provider to whom this
section applies from enrolling as a Medicaid provider if the
provider:
(1) either:
(A) joins an established practice of a health
care provider or provider group that has a contract with a managed
care organization to provide health care services to recipients
under Chapter 533; or
(B) is employed by or otherwise compensated for
providing training at an institution of higher education described
by Subsection (a)(4);
(2) applies to be an enrolled provider under the
Medicaid program;
(3) if applicable, complies with the requirements of
the contract between the provider or the provider's group and the
applicable managed care organization; and
(4) complies with all other applicable requirements
related to being a Medicaid provider.
(c) The commission may not prevent an institution of higher
education from enrolling as a Medicaid provider if the institution:
(1) has a contract with a managed care organization to
provide health care services to recipients under Chapter 533;
(2) applies to be an enrolled provider under the
Medicaid program;
(3) complies with the requirements of the contract
between the provider and the applicable managed care organization;
and
(4) complies with all other applicable requirements
related to being a Medicaid provider.
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0067 to read as follows:
Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject
to Section 32.047, Human Resources Code, but notwithstanding any
other law, the commission shall require that each managed care
organization that contracts with the commission under any Medicaid
managed care model or arrangement to provide health care services
to recipients in a region include in the organization's provider
network each optometrist, therapeutic optometrist, and
ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
and an institution of higher education described by Section
531.021191(a)(4) in the region who:
(1) agrees to comply with the terms and conditions of
the organization;
(2) agrees to accept the prevailing provider contract
rate of the organization; and
(3) agrees to abide by the standards of care required
by the organization.
SECTION 4. (a) The Health and Human Services Commission
shall, in a contract between the commission and a Medicaid managed
care organization under Chapter 533, Government Code, that is
entered into or renewed on or after the effective date of this Act,
require that the managed care organization comply with Section
533.0067, Government Code, as added by this Act.
(b) The Health and Human Services Commission shall seek to
amend each contract entered into with a Medicaid managed care
organization under Chapter 533, Government Code, before the
effective date of this Act to require those managed care
organizations to comply with Section 533.0067, Government Code, as
added by this Act. To the extent of a conflict between Section
533.0067, Government Code, as added by this Act, and a provision of
a contract with a managed care organization entered into before the
effective date of this Act, the contract provision prevails.
SECTION 5. This Act may not be construed as authorizing or
requiring implementation of Medicaid managed care delivery models
in regions in this state in which those models are not used on the
effective date of this Act for the delivery of Medicaid services.
SECTION 6. 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 7. This Act takes effect September 1, 2017.