Texas 2017 - 85th Regular

Texas Senate Bill SB1927 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1		By: Kolkhorst S.B. No. 1927
2		-	(Raymond)
3	2
4	3
5	4		A BILL TO BE ENTITLED
6	5		AN ACT
7	6		relating to requiring the Health and Human Services Commission to
8	7		evaluate and implement changes to the Medicaid and child health
9	8		plan programs to make the programs more cost-effective, increase
10	9		competition among providers, and improve health outcomes for
11	10		recipients.
12	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	12		SECTION 1. Subchapter B, Chapter 531, Government Code, is
14	13		amended by adding Section 531.02142 to read as follows:
15	14		Sec. 531.02142. PUBLIC ACCESS TO CERTAIN MEDICAID DATA.
16	15		(a) To the extent permitted by federal law, the commission shall
17	16		make available to the public on its Internet website in an
18	17		easy-to-read format data relating to the quality of health care
19	18		received by recipients and the health outcomes of recipients under
20	19		Medicaid. Data made available to the public under this section must
21	20		be made available in a manner that does not identify or allow for
22	21		the identification of individual recipients.
23	22		(b) In performing its duties under this section, the
24	23		commission may collaborate with an institution of higher education
25	24		or another state agency with experience in analyzing and producing
26	25		public use data.
27	26		SECTION 2. Section 531.1131, Government Code, is amended by
28	27		amending Subsections (a), (b), and (c) and adding Subsections
29	28		(c-1), (c-2), and (c-3) to read as follows:
30	29		(a) If a managed care organization [organization's special
31	30		investigative unit under Section 531.113(a)(1)] or an [the] entity
32	31		with which the managed care organization contracts under Section
33	32		531.113(a)(2) discovers fraud or abuse in Medicaid or the child
34	33		health plan program, the organization [unit] or entity shall:
35	34		(1) immediately submit written notice to [and
36	35		contemporaneously notify] the commission's office of inspector
37	36		general and the office of the attorney general in the form and
38	37		manner prescribed by the office of inspector general and containing
39	38		a detailed description of the fraud or abuse and each payment made
40	39		to a provider as a result of the fraud or abuse;
41	40		(2) subject to Subsection (b), begin payment recovery
42	41		efforts; and
43	42		(3) ensure that any payment recovery efforts in which
44	43		the organization engages are in accordance with applicable rules
45	44		adopted by the executive commissioner.
46	45		(b) If the amount sought to be recovered under Subsection
47	46		(a)(2) exceeds $100,000, the managed care organization
48	47		[organization's special investigative unit] or the contracted
49	48		entity described by Subsection (a) may not engage in payment
50	49		recovery efforts if, not later than the 10th business day after the
51	50		date the organization [unit] or entity notified the commission's
52	51		office of inspector general and the office of the attorney general
53	52		under Subsection (a)(1), the organization [unit] or entity receives
54	53		a notice from either office indicating that the organization [unit]
55	54		or entity is not authorized to proceed with recovery efforts.
56	55		(c) A managed care organization may retain one-half of any
57	56		money recovered under Subsection (a)(2) by the organization
58	57		[organization's special investigative unit] or the contracted
59	58		entity described by Subsection (a). The managed care organization
60	59		shall remit the remaining amount of money recovered under
61	60		Subsection (a)(2) to the commission's office of inspector general
62	61		for deposit to the credit of the general revenue fund.
63	62		(c-1) If the commission's office of inspector general
64	63		notifies a managed care organization under Subsection (b), proceeds
65	64		with recovery efforts, and recovers all or part of the payments the
66	65		organization identified as required by Subsection (a)(1), the
67	66		organization is entitled to one-half of the amount recovered for
68	67		each payment the organization identified after any applicable
69	68		federal share is deducted. The organization may not receive more
70	69		than one-half of the total amount of money recovered after any
71	70		applicable federal share is deducted.
72	71		(c-2) Notwithstanding any provision of this section, if the
73	72		commission's office of inspector general discovers fraud, waste, or
74	73		abuse in Medicaid or the child health plan program in the
75	74		performance of its duties, the office may recover payments made to a
76	75		provider as a result of the fraud, waste, or abuse as otherwise
77	76		provided by this subchapter. All payments recovered by the office
78	77		under this subsection shall be deposited to the credit of the
79	78		general revenue fund.
80	79		(c-3) The commission's office of inspector general shall
81	80		coordinate with appropriate managed care organizations to ensure
82	81		that the office and an organization or an entity with which an
83	82		organization contracts under Section 531.113(a)(2) do not both
84	83		begin payment recovery efforts under this section for the same case
85	84		of fraud, waste, or abuse.
86	85		SECTION 3. Subchapter A, Chapter 533, Government Code, is
87	86		amended by adding Sections 533.023 and 533.024 to read as follows:
88	87		Sec. 533.023. OPTIONS FOR ESTABLISHING COMPETITIVE
89	88		PROCUREMENT PROCESS. Not later than December 1, 2018, the
90	89		commission shall develop and analyze options, including the
91	90		potential costs of and cost savings that may be achieved by the
92	91		options, for establishing a range of rates within which a managed
93	92		care organization must bid during a competitive procurement process
94	93		to contract with the commission to arrange for or provide a managed
95	94		care plan. This section expires September 1, 2019.
96	95		Sec. 533.024. ASSESSMENT OF STATEWIDE MANAGED CARE PLANS.
97	96		(a) Not later than December 1, 2018, the commission shall assess
98	97		the feasibility and cost-effectiveness of contracting with managed
99	98		care organizations to arrange for or provide managed care plans to
100	99		recipients throughout the state instead of on a regional basis. In
101	100		conducting the assessment, the commission shall consider:
102	101		(1) regional variations in the cost of and access to
103	102		health care services;
104	103		(2) recipient access to and choice of providers;
105	104		(3) the potential impact on providers, including
106	105		safety net providers; and
107	106		(4) public input.
108	107		(b) This section expires September 1, 2019.
109	108		SECTION 4. (a) Using existing resources, the Health and
110	109		Human Services Commission shall:
111	110		(1) identify and evaluate barriers preventing
112	111		Medicaid recipients enrolled in the STAR + PLUS Medicaid managed
113	112		care program or a home and community-based services waiver program
114	113		from choosing the consumer directed services option and develop
115	114		recommendations for increasing the percentage of Medicaid
116	115		recipients enrolled in those programs who choose the consumer
117	116		directed services option; and
118	117		(2) study the feasibility of establishing a community
119	118		attendant registry to assist Medicaid recipients enrolled in the
120	119		community attendant services program in locating providers.
121	120		(b) Not later than December 1, 2018, the Health and Human
122	121		Services Commission shall submit a report containing the
123	122		commission's findings and recommendations under Subsection (a) of
124	123		this section to the governor, the legislature, and the Legislative
125	124		Budget Board. The report required by this subsection may be
126	125		combined with any other report required by this Act or other law.
127	126		SECTION 5. (a) The Health and Human Services Commission
128	127		shall conduct a study to evaluate the 30-day limitation on
129	128		reimbursement for inpatient hospital care provided to Medicaid
130	129		recipients enrolled in the STAR + PLUS Medicaid managed care
131	130		program under 1 T.A.C. Section 354.1072(a)(1) and other applicable
132	131		law. In evaluating the limitation and to the extent data is
133	132		available on the subject, the commission shall consider:
134	133		(1) the number of Medicaid recipients affected by the
135	134		limitation and their clinical outcomes;
136	135		(2) the types of providers providing health care
137	136		services to Medicaid recipients who have been denied Medicaid
138	137		coverage because of the limitation;
139	138		(3) the impact of the limitation on the providers
140	139		described in Subdivision (2) of this subsection;
141	140		(4) the appropriateness of hospitals using money
142	141		received under the uncompensated care payment program established
143	142		under the Texas Health Care Transformation and Quality Improvement
144	143		Program waiver issued under Section 1115 of the federal Social
145	144		Security Act (42 U.S.C. Section 1315) to pay for health care
146	145		services provided to Medicaid recipients who have been denied
147	146		Medicaid coverage because of the limitation; and
148	147		(5) the impact of the limitation on reducing
149	148		unnecessary Medicaid inpatient hospital days and any cost savings
150	149		achieved by the limitation under Medicaid.
151	150		(b) Not later than December 1, 2018, the Health and Human
152	151		Services Commission shall submit a report containing the results of
153	152		the study conducted under Subsection (a) of this section to the
154	153		governor, the legislature, and the Legislative Budget Board. The
155	154		report required under this subsection may be combined with any
156	155		other report required by this Act or other law.
157	156		SECTION 6. (a) The Health and Human Services Commission
158	157		shall conduct a study of the provision of dental services to adults
159	158		with disabilities under the Medicaid program, including:
160	159		(1) the types of dental services provided, including
161	160		preventive dental care, emergency dental services, and
162	161		periodontal, restorative, and prosthodontic services;
163	162		(2) limits or caps on the types and costs of dental
164	163		services provided;
165	164		(3) unique considerations in providing dental care to
166	165		adults with disabilities, including additional services necessary
167	166		for adults with particular disabilities; and
168	167		(4) the availability and accessibility of dentists who
169	168		provide dental care to adults with disabilities, including the
170	169		availability of dentists who provide additional services necessary
171	170		for adults with particular disabilities.
172	171		(b) In conducting the study under Subsection (a) of this
173	172		section, the Health and Human Services Commission shall:
174	173		(1) identify the number of adults with disabilities
175	174		whose Medicaid benefits include limited or no dental services and
176	175		who, as a result, have sought medically necessary dental services
177	176		during an emergency room visit;
178	177		(2) if feasible, estimate the number of adults with
179	178		disabilities who are receiving services under the Medicaid program
180	179		and who have access to alternative sources of dental care,
181	180		including pro bono dental services, faith-based dental services
182	181		providers, and other public health care providers; and
183	182		(3) collect data on the receipt of dental services
184	183		during emergency room visits by adults with disabilities who are
185	184		receiving services under the Medicaid program, including the
186	185		reasons for seeking dental services during an emergency room visit
187	186		and the costs of providing the dental services during an emergency
188	187		room visit, as compared to the cost of providing the dental services
189	188		in the community.
190	189		(c) Not later than December 1, 2018, the Health and Human
191	190		Services Commission shall submit a report containing the results of
192	191		the study conducted under Subsection (a) of this section and the
193	192		commission's recommendations for improving access to dental
194	193		services in the community for and reducing the provision of dental
195	194		services during emergency room visits to adults with disabilities
196	195		receiving services under the Medicaid program to the governor, the
197	196		legislature, and the Legislative Budget Board. The report required
198	197		by this subsection may be combined with any other report required by
199	198		this Act or other law.
200	199		SECTION 7. Section 531.1131, Government Code, as amended by
201	200		this Act, applies only to an amount of money recovered on or after
202	201		the effective date of this Act. An amount of money recovered before
203	202		the effective date of this Act is governed by the law in effect
204	203		immediately before that date, and that law is continued in effect
205	204		for that purpose.
206	205		SECTION 8. If before implementing any provision of this Act
207	206		a state agency determines that a waiver or authorization from a
208	207		federal agency is necessary for implementation of that provision,
209	208		the agency affected by the provision shall request the waiver or
210	209		authorization and may delay implementing that provision until the
211	210		waiver or authorization is granted.
212	211		SECTION 9. This Act takes effect September 1, 2017.