Texas 2017 - 85th Regular

Texas House Bill HB3675 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 3675
	1	+	By: Paddie, Raymond, Rose H.B. No. 3675
	2	+	(Senate Sponsor - Hinojosa)
	3	+	(In the Senate - Received from the House May 3, 2017;
	4	+	May 8, 2017, read first time and referred to Committee on Health &
	5	+	Human Services; May 22, 2017, reported adversely, with favorable
	6	+	Committee Substitute by the following vote: Yeas 9, Nays 0;
	7	+	May 22, 2017, sent to printer.)
	8	+	Click here to see the committee vote
	9	+	COMMITTEE SUBSTITUTE FOR H.B. No. 3675 By: Watson
2	10
3	11
	12	+	A BILL TO BE ENTITLED
4	13		AN ACT
5	14		relating to the provision of eye health care by certain
6	15		professionals and institutions as providers in the Medicaid managed
7	16		care program.
8	17		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	18		SECTION 1. Section 32.072(a), Human Resources Code, is
10	19		amended to read as follows:
11	20		(a) Notwithstanding any other law, a recipient of medical
12	21		assistance is entitled to:
13	22		(1) select an ophthalmologist or therapeutic
14	23		optometrist who is a medical assistance provider to provide eye
15	24		health care services, other than surgery, that are within the scope
16	25		of:
17	26		(A) services provided under the medical
18	27		assistance program; and
19	28		(B) the professional specialty practice for
20	29		which the ophthalmologist or therapeutic optometrist is licensed
21	30		[and credentialed]; and
22	31		(2) have direct access to the selected ophthalmologist
23	32		or therapeutic optometrist for the provision of the nonsurgical
24	33		services without any requirement that the patient or
25	34		ophthalmologist or therapeutic optometrist [to] obtain:
26	35		(A) a referral from a primary care physician or
27	36		other gatekeeper or health care coordinator; or
28	37		(B) any other prior authorization or
29	38		precertification.
30	39		SECTION 2. Subchapter B, Chapter 531, Government Code, is
31	40		amended by adding Section 531.021191 to read as follows:
32	41		Sec. 531.021191. MEDICAID ENROLLMENT OF CERTAIN EYE HEALTH
33	42		CARE PROVIDERS. (a) This section applies only to:
34	43		(1) an optometrist who is licensed by the Texas
35	44		Optometry Board;
36	45		(2) a therapeutic optometrist who is licensed by the
37	46		Texas Optometry Board;
38	47		(3) an ophthalmologist who is licensed by the Texas
39	48		Medical Board; and
40	49		(4) an institution of higher education that provides
41	50		an accredited program for:
42	51		(A) training as a Doctor of Optometry or an
43	52		optometrist residency; or
44	53		(B) training as an ophthalmologist or an
45	54		ophthalmologist residency.
46	55		(b) The commission may not prevent a provider to whom this
47	56		section applies from enrolling as a Medicaid provider if the
48	57		provider:
49	58		(1) either:
50	59		(A) joins an established practice of a health
51	60		care provider or provider group that has a contract with a managed
52	61		care organization to provide health care services to recipients
53	62		under Chapter 533; or
54	63		(B) is employed by or otherwise compensated for
55	64		providing training at an institution of higher education described
56	65		by Subsection (a)(4);
57	66		(2) applies to be an enrolled provider under Medicaid;
58	67		(3) if applicable, complies with the requirements of
59	68		the contract between the provider or the provider's group and the
60	69		applicable managed care organization; and
61	70		(4) complies with all other applicable requirements
62	71		related to being a Medicaid provider.
63	72		(c) The commission may not prevent an institution of higher
64	73		education from enrolling as a Medicaid provider if the institution:
65	74		(1) has a contract with a managed care organization to
66	75		provide health care services to recipients under Chapter 533;
67	76		(2) applies to be an enrolled provider under Medicaid;
68	77		(3) complies with the requirements of the contract
69	78		between the provider and the applicable managed care organization;
70	79		and
71	80		(4) complies with all other applicable requirements
72	81		related to being a Medicaid provider.
73	82		SECTION 3. Subchapter A, Chapter 533, Government Code, is
74	83		amended by adding Section 533.0067 to read as follows:
75	84		Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject
76	85		to Section 32.047, Human Resources Code, but notwithstanding any
77	86		other law, the commission shall require that each managed care
78	87		organization that contracts with the commission under any Medicaid
79	88		managed care model or arrangement to provide health care services
80	89		to recipients in a region include in the organization's provider
81	90		network each optometrist, therapeutic optometrist, and
82	91		ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
83	92		and an institution of higher education described by Section
84	93		531.021191(a)(4) in the region who:
85	94		(1) agrees to comply with the terms and conditions of
86	95		the organization;
87	96		(2) agrees to accept the prevailing provider contract
88	97		rate of the organization;
89	98		(3) agrees to abide by the standards of care required
90	99		by the organization; and
91	100		(4) is an enrolled provider under Medicaid.
92	101		SECTION 4. (a) The Health and Human Services Commission
93	102		shall, in a contract between the commission and a Medicaid managed
94	103		care organization under Chapter 533, Government Code, that is
95	104		entered into or renewed on or after the effective date of this Act,
96	105		require that the managed care organization comply with Section
97	106		533.0067, Government Code, as added by this Act.
98	107		(b) The Health and Human Services Commission shall seek to
99	108		amend each contract entered into with a Medicaid managed care
100	109		organization under Chapter 533, Government Code, before the
101	110		effective date of this Act to require those managed care
102	111		organizations to comply with Section 533.0067, Government Code, as
103	112		added by this Act. To the extent of a conflict between Section
104	113		533.0067, Government Code, as added by this Act, and a provision of
105	114		a contract with a managed care organization entered into before the
106	115		effective date of this Act, the contract provision prevails.
107	116		SECTION 5. This Act may not be construed as authorizing or
108	117		requiring implementation of Medicaid managed care delivery models
109	118		in regions in this state in which those models are not used on the
110	119		effective date of this Act for the delivery of Medicaid services.
111	120		SECTION 6. If before implementing any provision of this Act
112	121		a state agency determines that a waiver or authorization from a
113	122		federal agency is necessary for implementation of that provision,
114	123		the agency affected by the provision shall request the waiver or
115	124		authorization and may delay implementing that provision until the
116	125		waiver or authorization is granted.
117	126		SECTION 7. This Act takes effect September 1, 2017.
118		-	______________________________ ______________________________
119		-	President of the Senate Speaker of the House
120		-	I certify that H.B. No. 3675 was passed by the House on May 3,
121		-	2017, by the following vote: Yeas 144, Nays 0, 2 present, not
122		-	voting; and that the House concurred in Senate amendments to H.B.
123		-	No. 3675 on May 26, 2017, by the following vote: Yeas 142, Nays 0,
124		-	2
125		-	present, not voting.
126		-	______________________________
127		-	Chief Clerk of the House
128		-	I certify that H.B. No. 3675 was passed by the Senate, with
129		-	amendments, on May 24, 2017, by the following vote: Yeas 31, Nays
130		-	0.
131		-	______________________________
132		-	Secretary of the Senate
133		-	APPROVED: __________________
134		-	Date
135		-	__________________
136		-	Governor
	127	+	* * * * *