Texas 2017 - 85th Regular

Texas Senate Bill SB2228 Compare Versions

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

Old	New	Differences
1	1	85R12082 KKR-F
2	2	By: Hinojosa S.B. No. 2228
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the provision of eye health care by certain
8	8	professionals and institutions as providers in the Medicaid managed
9	9	care program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 32.072(a), Human Resources Code, is
12	12	amended to read as follows:
13	13	(a) Notwithstanding any other law, a recipient of medical
14	14	assistance is entitled to:
15	15	(1) select an ophthalmologist or therapeutic
16	16	optometrist who is a medical assistance provider to provide eye
17	17	health care services, other than surgery, that are within the scope
18	18	of:
19	19	(A) services provided under the medical
20	20	assistance program; and
21	21	(B) the professional specialty practice for
22	22	which the ophthalmologist or therapeutic optometrist is licensed
23	23	[and credentialed]; and
24	24	(2) have direct access to the selected ophthalmologist
25	25	or therapeutic optometrist for the provision of the nonsurgical
26	26	services without any requirement that the patient or
27	27	ophthalmologist or therapeutic optometrist [to] obtain:
28	28	(A) a referral from a primary care physician or
29	29	other gatekeeper or health care coordinator; or
30	30	(B) any other prior authorization or
31	31	precertification.
32	32	SECTION 2. Subchapter B, Chapter 531, Government Code, is
33	33	amended by adding Section 531.021191 to read as follows:
34	34	Sec. 531.021191. MEDICAID ENROLLMENT OF CERTAIN EYE HEALTH
35	35	CARE PROVIDERS. (a) This section applies only to:
36	36	(1) an optometrist who is licensed by the Texas
37	37	Optometry Board;
38	38	(2) a therapeutic optometrist who is licensed by the
39	39	Texas Optometry Board;
40	40	(3) an ophthalmologist who is licensed by the Texas
41	41	Medical Board; and
42	42	(4) an institution of higher education that provides
43	43	an accredited program for:
44	44	(A) training as a Doctor of Optometry or an
45	45	optometrist residency; or
46	46	(B) training as an ophthalmologist or an
47	47	ophthalmologist residency.
48	48	(b) The commission may not prevent a provider to whom this
49	49	section applies from enrolling as a Medicaid provider if the
50	50	provider:
51	51	(1) either:
52	52	(A) joins an established practice of a health
53	53	care provider or provider group that has a contract with a managed
54	54	care organization to provide health care services to recipients
55	55	under Chapter 533; or
56	56	(B) is employed by or otherwise compensated for
57	57	providing training at an institution of higher education described
58	58	by Subsection (a)(4);
59	59	(2) applies to be an enrolled provider under the
60	60	Medicaid program;
61	61	(3) if applicable, complies with the requirements of
62	62	the contract between the provider or the provider's group and the
63	63	applicable managed care organization; and
64	64	(4) complies with all other applicable requirements
65	65	related to being a Medicaid provider.
66	66	(c) The commission may not prevent an institution of higher
67	67	education from enrolling as a Medicaid provider if the institution:
68	68	(1) has a contract with a managed care organization to
69	69	provide health care services to recipients under Chapter 533;
70	70	(2) applies to be an enrolled provider under the
71	71	Medicaid program;
72	72	(3) complies with the requirements of the contract
73	73	between the provider and the applicable managed care organization;
74	74	and
75	75	(4) complies with all other applicable requirements
76	76	related to being a Medicaid provider.
77	77	SECTION 3. Subchapter A, Chapter 533, Government Code, is
78	78	amended by adding Section 533.0067 to read as follows:
79	79	Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject
80	80	to Section 32.047, Human Resources Code, but notwithstanding any
81	81	other law, the commission shall require that each managed care
82	82	organization that contracts with the commission under any Medicaid
83	83	managed care model or arrangement to provide health care services
84	84	to recipients in a region include in the organization's provider
85	85	network each optometrist, therapeutic optometrist, and
86	86	ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
87	87	and an institution of higher education described by Section
88	88	531.021191(a)(4) in the region who:
89	89	(1) agrees to comply with the terms and conditions of
90	90	the organization;
91	91	(2) agrees to accept the prevailing provider contract
92	92	rate of the organization; and
93	93	(3) agrees to abide by the standards of care required
94	94	by the organization.
95	95	SECTION 4. (a) The Health and Human Services Commission
96	96	shall, in a contract between the commission and a Medicaid managed
97	97	care organization under Chapter 533, Government Code, that is
98	98	entered into or renewed on or after the effective date of this Act,
99	99	require that the managed care organization comply with Section
100	100	533.0067, Government Code, as added by this Act.
101	101	(b) The Health and Human Services Commission shall seek to
102	102	amend each contract entered into with a Medicaid managed care
103	103	organization under Chapter 533, Government Code, before the
104	104	effective date of this Act to require those managed care
105	105	organizations to comply with Section 533.0067, Government Code, as
106	106	added by this Act. To the extent of a conflict between Section
107	107	533.0067, Government Code, as added by this Act, and a provision of
108	108	a contract with a managed care organization entered into before the
109	109	effective date of this Act, the contract provision prevails.
110	110	SECTION 5. This Act may not be construed as authorizing or
111	111	requiring implementation of Medicaid managed care delivery models
112	112	in regions in this state in which those models are not used on the
113	113	effective date of this Act for the delivery of Medicaid services.
114	114	SECTION 6. If before implementing any provision of this Act
115	115	a state agency determines that a waiver or authorization from a
116	116	federal agency is necessary for implementation of that provision,
117	117	the agency affected by the provision shall request the waiver or
118	118	authorization and may delay implementing that provision until the
119	119	waiver or authorization is granted.
120	120	SECTION 7. This Act takes effect September 1, 2017.