By: Kolkhorst S.B. No. 1927
(Raymond)
A BILL TO BE ENTITLED
AN ACT
relating to requiring the Health and Human Services Commission to
evaluate and implement changes to the Medicaid and child health
plan programs to make the programs more cost-effective, increase
competition among providers, and improve health outcomes for
recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02142 to read as follows:
Sec. 531.02142. PUBLIC ACCESS TO CERTAIN MEDICAID DATA.
(a) To the extent permitted by federal law, the commission shall
make available to the public on its Internet website in an
easy-to-read format data relating to the quality of health care
received by recipients and the health outcomes of recipients under
Medicaid. Data made available to the public under this section must
be made available in a manner that does not identify or allow for
the identification of individual recipients.
(b) In performing its duties under this section, the
commission may collaborate with an institution of higher education
or another state agency with experience in analyzing and producing
public use data.
SECTION 2. Section 531.1131, Government Code, is amended by
amending Subsections (a), (b), and (c) and adding Subsections
(c-1), (c-2), and (c-3) to read as follows:
(a) If a managed care organization [organization's special
investigative unit under Section 531.113(a)(1)] or an [the] entity
with which the managed care organization contracts under Section
531.113(a)(2) discovers fraud or abuse in Medicaid or the child
health plan program, the organization [unit] or entity shall:
(1) immediately submit written notice to [and
contemporaneously notify] the commission's office of inspector
general and the office of the attorney general in the form and
manner prescribed by the office of inspector general and containing
a detailed description of the fraud or abuse and each payment made
to a provider as a result of the fraud or abuse;
(2) subject to Subsection (b), begin payment recovery
efforts; and
(3) ensure that any payment recovery efforts in which
the organization engages are in accordance with applicable rules
adopted by the executive commissioner.
(b) If the amount sought to be recovered under Subsection
(a)(2) exceeds $100,000, the managed care organization
[organization's special investigative unit] or the contracted
entity described by Subsection (a) may not engage in payment
recovery efforts if, not later than the 10th business day after the
date the organization [unit] or entity notified the commission's
office of inspector general and the office of the attorney general
under Subsection (a)(1), the organization [unit] or entity receives
a notice from either office indicating that the organization [unit]
or entity is not authorized to proceed with recovery efforts.
(c) A managed care organization may retain one-half of any
money recovered under Subsection (a)(2) by the organization
[organization's special investigative unit] or the contracted
entity described by Subsection (a). The managed care organization
shall remit the remaining amount of money recovered under
Subsection (a)(2) to the commission's office of inspector general
for deposit to the credit of the general revenue fund.
(c-1) If the commission's office of inspector general
notifies a managed care organization under Subsection (b), proceeds
with recovery efforts, and recovers all or part of the payments the
organization identified as required by Subsection (a)(1), the
organization is entitled to one-half of the amount recovered for
each payment the organization identified after any applicable
federal share is deducted. The organization may not receive more
than one-half of the total amount of money recovered after any
applicable federal share is deducted.
(c-2) Notwithstanding any provision of this section, if the
commission's office of inspector general discovers fraud, waste, or
abuse in Medicaid or the child health plan program in the
performance of its duties, the office may recover payments made to a
provider as a result of the fraud, waste, or abuse as otherwise
provided by this subchapter. All payments recovered by the office
under this subsection shall be deposited to the credit of the
general revenue fund.
(c-3) The commission's office of inspector general shall
coordinate with appropriate managed care organizations to ensure
that the office and an organization or an entity with which an
organization contracts under Section 531.113(a)(2) do not both
begin payment recovery efforts under this section for the same case
of fraud, waste, or abuse.
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Sections 533.023 and 533.024 to read as follows:
Sec. 533.023. OPTIONS FOR ESTABLISHING COMPETITIVE
PROCUREMENT PROCESS. Not later than December 1, 2018, the
commission shall develop and analyze options, including the
potential costs of and cost savings that may be achieved by the
options, for establishing a range of rates within which a managed
care organization must bid during a competitive procurement process
to contract with the commission to arrange for or provide a managed
care plan. This section expires September 1, 2019.
Sec. 533.024. ASSESSMENT OF STATEWIDE MANAGED CARE PLANS.
(a) Not later than December 1, 2018, the commission shall assess
the feasibility and cost-effectiveness of contracting with managed
care organizations to arrange for or provide managed care plans to
recipients throughout the state instead of on a regional basis. In
conducting the assessment, the commission shall consider:
(1) regional variations in the cost of and access to
health care services;
(2) recipient access to and choice of providers;
(3) the potential impact on providers, including
safety net providers; and
(4) public input.
(b) This section expires September 1, 2019.
SECTION 4. (a) Using existing resources, the Health and
Human Services Commission shall:
(1) identify and evaluate barriers preventing
Medicaid recipients enrolled in the STAR + PLUS Medicaid managed
care program or a home and community-based services waiver program
from choosing the consumer directed services option and develop
recommendations for increasing the percentage of Medicaid
recipients enrolled in those programs who choose the consumer
directed services option; and
(2) study the feasibility of establishing a community
attendant registry to assist Medicaid recipients enrolled in the
community attendant services program in locating providers.
(b) Not later than December 1, 2018, the Health and Human
Services Commission shall submit a report containing the
commission's findings and recommendations under Subsection (a) of
this section to the governor, the legislature, and the Legislative
Budget Board. The report required by this subsection may be
combined with any other report required by this Act or other law.
SECTION 5. (a) The Health and Human Services Commission
shall conduct a study to evaluate the 30-day limitation on
reimbursement for inpatient hospital care provided to Medicaid
recipients enrolled in the STAR + PLUS Medicaid managed care
program under 1 T.A.C. Section 354.1072(a)(1) and other applicable
law. In evaluating the limitation and to the extent data is
available on the subject, the commission shall consider:
(1) the number of Medicaid recipients affected by the
limitation and their clinical outcomes;
(2) the types of providers providing health care
services to Medicaid recipients who have been denied Medicaid
coverage because of the limitation;
(3) the impact of the limitation on the providers
described in Subdivision (2) of this subsection;
(4) the appropriateness of hospitals using money
received under the uncompensated care payment program established
under the Texas Health Care Transformation and Quality Improvement
Program waiver issued under Section 1115 of the federal Social
Security Act (42 U.S.C. Section 1315) to pay for health care
services provided to Medicaid recipients who have been denied
Medicaid coverage because of the limitation; and
(5) the impact of the limitation on reducing
unnecessary Medicaid inpatient hospital days and any cost savings
achieved by the limitation under Medicaid.
(b) Not later than December 1, 2018, the Health and Human
Services Commission shall submit a report containing the results of
the study conducted under Subsection (a) of this section to the
governor, the legislature, and the Legislative Budget Board. The
report required under this subsection may be combined with any
other report required by this Act or other law.
SECTION 6. (a) The Health and Human Services Commission
shall conduct a study of the provision of dental services to adults
with disabilities under the Medicaid program, including:
(1) the types of dental services provided, including
preventive dental care, emergency dental services, and
periodontal, restorative, and prosthodontic services;
(2) limits or caps on the types and costs of dental
services provided;
(3) unique considerations in providing dental care to
adults with disabilities, including additional services necessary
for adults with particular disabilities; and
(4) the availability and accessibility of dentists who
provide dental care to adults with disabilities, including the
availability of dentists who provide additional services necessary
for adults with particular disabilities.
(b) In conducting the study under Subsection (a) of this
section, the Health and Human Services Commission shall:
(1) identify the number of adults with disabilities
whose Medicaid benefits include limited or no dental services and
who, as a result, have sought medically necessary dental services
during an emergency room visit;
(2) if feasible, estimate the number of adults with
disabilities who are receiving services under the Medicaid program
and who have access to alternative sources of dental care,
including pro bono dental services, faith-based dental services
providers, and other public health care providers; and
(3) collect data on the receipt of dental services
during emergency room visits by adults with disabilities who are
receiving services under the Medicaid program, including the
reasons for seeking dental services during an emergency room visit
and the costs of providing the dental services during an emergency
room visit, as compared to the cost of providing the dental services
in the community.
(c) Not later than December 1, 2018, the Health and Human
Services Commission shall submit a report containing the results of
the study conducted under Subsection (a) of this section and the
commission's recommendations for improving access to dental
services in the community for and reducing the provision of dental
services during emergency room visits to adults with disabilities
receiving services under the Medicaid program to the governor, the
legislature, and the Legislative Budget Board. The report required
by this subsection may be combined with any other report required by
this Act or other law.
SECTION 7. Section 531.1131, Government Code, as amended by
this Act, applies only to an amount of money recovered on or after
the effective date of this Act. An amount of money recovered before
the effective date of this Act is governed by the law in effect
immediately before that date, and that law is continued in effect
for that purpose.
SECTION 8. 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 9. This Act takes effect September 1, 2017.