By: Phelan, et al. H.B. No. 1576
(Senate Sponsor - Buckingham, et al.)
(In the Senate - Received from the House April 26, 2019;
April 29, 2019, read first time and referred to Committee on Health &
Human Services; May 19, 2019, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 9, Nays 0;
May 19, 2019, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR H.B. No. 1576 By: Buckingham
A BILL TO BE ENTITLED
AN ACT
relating to the delivery of certain transportation services under
Medicaid and certain other health and human services programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.001, Government Code, is amended by
adding Subdivision (4-c) to read as follows:
(4-c) "Medicaid managed care organization" means a
managed care organization as defined by Section 533.001 that
contracts with the commission under Chapter 533 to provide health
care services to Medicaid recipients.
SECTION 2. The heading to Section 531.02414, Government
Code, is amended to read as follows:
Sec. 531.02414. NONEMERGENCY TRANSPORTATION SERVICES UNDER
[ADMINISTRATION AND OPERATION OF] MEDICAL TRANSPORTATION PROGRAM.
SECTION 3. Section 531.02414(a), Government Code, is
amended by amending Subdivision (1) and adding Subdivisions (1-a)
and (3) to read as follows:
(1) "Medical transportation program" means the
program that provides nonemergency transportation services [to and
from covered health care services, based on medical necessity,] to
recipients under Medicaid, subject to Subsection (a-1), the
children with special health care needs program, and the
transportation for indigent cancer patients program, who have no
other means of transportation.
(1-a) "Nonemergency transportation service" means
nonemergency medical transportation services authorized under:
(A) for a Medicaid recipient, the state Medicaid
plan; and
(B) for a recipient under another program
described by Subdivision (1), that program.
(3) "Transportation network company" has the meaning
assigned by Section 2402.001, Occupations Code.
SECTION 4. Section 531.02414, Government Code, is amended
by adding Subsections (a-1), (i), (j), (k), (l), and (m) and
amending Subsections (b), (e), and (f) to read as follows:
(a-1) This section does not apply to the provision of
nonemergency transportation services on or after September 1, 2020,
to a Medicaid recipient who is enrolled in a managed care plan
offered by a Medicaid managed care organization.
(b) Notwithstanding any other law, the commission shall
directly supervise the administration and operation of the medical
transportation program under this section.
(e) The executive commissioner shall adopt rules to ensure
the safe and efficient provision of nonemergency transportation
services under this section [the medical transportation program by
regional contracted brokers and subcontractors of regional
contracted brokers]. The rules must include:
(1) minimum standards regarding the physical
condition and maintenance of motor vehicles used to provide the
services, including standards regarding the accessibility of motor
vehicles by persons with disabilities;
(2) a requirement that a regional contracted broker
verify that each motor vehicle operator providing the services or
seeking to provide the services has a valid driver's license;
(3) a requirement that a regional contracted broker
check the driving record information maintained by the Department
of Public Safety under Subchapter C, Chapter 521, Transportation
Code, of each motor vehicle operator providing the services or
seeking to provide the services;
(4) a requirement that a regional contracted broker
check the public criminal record information maintained by the
Department of Public Safety and made available to the public
through the department's Internet website of each motor vehicle
operator providing the services or seeking to provide the services;
and
(5) training requirements for motor vehicle operators
providing the services through a regional contracted broker,
including training on the following topics:
(A) passenger safety;
(B) passenger assistance;
(C) assistive devices, including wheelchair
lifts, tie-down equipment, and child safety seats;
(D) sensitivity and diversity;
(E) customer service;
(F) defensive driving techniques; and
(G) prohibited behavior by motor vehicle
operators.
(f) Except as provided by Subsection (j), the [The]
commission shall require compliance with the rules adopted under
Subsection (e) in any contract entered into with a regional
contracted broker to provide nonemergency transportation services
under the medical transportation program.
(i) Emergency medical services personnel and emergency
medical services vehicles, as those terms are defined by Section
773.003, Health and Safety Code, may not provide nonemergency
transportation services under the medical transportation program.
(j) A regional contracted broker may subcontract with a
transportation network company to provide services under this
section. A rule or other requirement adopted by the executive
commissioner under Subsection (e) does not apply to the
subcontracted transportation network company or a motor vehicle
operator who is part of the company's network. The commission or
the regional contracted broker may not require a motor vehicle
operator who is part of the subcontracted transportation network
company's network to enroll as a Medicaid provider to provide
services under this section.
(k) The commission or a regional contracted broker that
subcontracts with a transportation network company under
Subsection (j) may require the transportation network company or a
motor vehicle operator who provides services under this section to
be periodically screened against the list of excluded individuals
and entities maintained by the Office of Inspector General of the
United States Department of Health and Human Services.
(l) Notwithstanding any other law, a motor vehicle operator
who is part of the network of a transportation network company that
subcontracts with a regional contracted broker under Subsection (j)
and who satisfies the driver requirements in Section 2402.107,
Occupations Code, is qualified to provide services under this
section. The commission and the regional contracted broker may not
impose any additional requirements on a motor vehicle operator who
satisfies the driver requirements in Section 2402.107, Occupations
Code, to provide services under this section.
(m) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 5. The heading to Section 533.00257, Government
Code, is amended to read as follows:
Sec. 533.00257. DELIVERY OF MEDICAL TRANSPORTATION PROGRAM
SERVICES THROUGH MANAGED TRANSPORTATION ORGANIZATION.
SECTION 6. Section 533.00257(a), Government Code, is
amended by adding Subdivision (2-a) to read as follows:
(2-a) "Transportation network company" has the
meaning assigned by Section 2402.001, Occupations Code.
SECTION 7. Section 533.00257, Government Code, is amended
by amending Subsections (b), (d), and (g) and adding Subsections
(k), (l), (m), and (n) to read as follows:
(b) The [Subject to Subsection (i), the] commission may
[shall] provide medical transportation program services on a
regional basis through a managed transportation delivery model
using managed transportation organizations and providers, as
appropriate, that:
(1) operate under a capitated rate system;
(2) assume financial responsibility under a full-risk
model;
(3) operate a call center;
(4) use fixed routes when available and appropriate;
and
(5) agree to provide data to the commission if the
commission determines that the data is required to receive federal
matching funds.
(d) Except as provided by Subsections (k) and (m), a [A]
managed transportation organization that participates in the
medical transportation program must attempt to contract with
medical transportation providers that:
(1) are considered significant traditional providers,
as defined by rule by the executive commissioner;
(2) meet the minimum quality and efficiency measures
required under Subsection (g) and other requirements that may be
imposed by the managed transportation organization; and
(3) agree to accept the prevailing contract rate of
the managed transportation organization.
(g) Except as provided by Subsections (k) and (m), the [The]
commission shall require that managed transportation organizations
and providers participating in the medical transportation program
meet minimum quality and efficiency measures as determined by the
commission.
(k) A managed transportation organization may subcontract
with a transportation network company to provide services under
this section. A rule or other requirement adopted by the executive
commissioner under this section or Section 531.02414 does not apply
to the subcontracted transportation network company or a motor
vehicle operator who is part of the company's network. The
commission or the managed transportation organization may not
require a motor vehicle operator who is part of the subcontracted
transportation network company's network to enroll as a Medicaid
provider to provide services under this section.
(l) The commission or a managed transportation organization
that subcontracts with a transportation network company under
Subsection (k) may require the transportation network company or a
motor vehicle operator who provides services under this section to
be periodically screened against the list of excluded individuals
and entities maintained by the Office of Inspector General of the
United States Department of Health and Human Services.
(m) Notwithstanding any other law, a motor vehicle operator
who is part of the network of a transportation network company that
subcontracts with a managed transportation organization under
Subsection (k) and who satisfies the driver requirements in Section
2402.107, Occupations Code, is qualified to provide services under
this section. The commission and the managed transportation
organization may not impose any additional requirements on a motor
vehicle operator who satisfies the driver requirements in Section
2402.107, Occupations Code, to provide services under this section.
(n) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 8. Subchapter A, Chapter 533, Government Code, is
amended by adding Sections 533.002571, 533.00258, and 533.002581 to
read as follows:
Sec. 533.002571. DELIVERY OF NONEMERGENCY TRANSPORTATION
SERVICES TO CERTAIN MEDICAID RECIPIENTS THROUGH MEDICAID MANAGED
CARE ORGANIZATION. (a) In this section:
(1) "Nonemergency transportation service" has the
meaning assigned by Section 531.02414.
(2) "Nonmedical transportation service" and
"transportation network company" have the meanings assigned by
Section 533.00258.
(b) The commission shall require each Medicaid managed care
organization to arrange and provide nonemergency transportation
services to a recipient enrolled in a managed care plan offered by
the organization using the most cost-effective and cost-efficient
method of delivery, including by delivering nonmedical
transportation services through a transportation network company
or other transportation vendor as provided by Section 533.002581,
if available and medically appropriate. The commission shall
supervise the provision of the services.
(c) Subject to Subsection (d), the executive commissioner
shall adopt:
(1) rules applicable to the provision of nonemergency
medical transportation services by a Medicaid managed care
organization that impose the same standards and requirements as
those adopted under Section 531.02414(e); and
(2) other rules as necessary to ensure the safe and
efficient provision of nonemergency transportation services by a
Medicaid managed care organization under this section.
(d) A Medicaid managed care organization may subcontract
with a transportation network company to provide nonemergency
transportation services under this section. A rule or other
requirement adopted by the executive commissioner under Subsection
(c) or Section 531.02414 does not apply to the subcontracted
transportation network company or a motor vehicle operator who is
part of the company's network. The commission or the Medicaid
managed care organization may not require a motor vehicle operator
who is part of the subcontracted transportation network company's
network to enroll as a Medicaid provider to provide services under
this section.
(e) The commission or a Medicaid managed care organization
that subcontracts with a transportation network company under
Subsection (d) may require the transportation network company or a
motor vehicle operator who provides services under this section to
be periodically screened against the list of excluded individuals
and entities maintained by the Office of Inspector General of the
United States Department of Health and Human Services.
(f) Notwithstanding any other law, a motor vehicle operator
who is part of the network of a transportation network company that
subcontracts with a Medicaid managed care organization under
Subsection (d) and who satisfies the driver requirements in Section
2402.107, Occupations Code, is qualified to provide services under
this section. The commission and the Medicaid managed care
organization may not impose any additional requirements on a motor
vehicle operator who satisfies the driver requirements in Section
2402.107, Occupations Code, to provide services under this section.
(g) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
(h) The commission may temporarily waive the applicability
of Subsection (b) to a Medicaid managed care organization as
necessary based on the results of a review conducted under Section
533.007 and until enrollment of recipients in a managed care plan
offered by the organization is permitted under that section.
(i) The commission shall extend a contract for the provision
of nonemergency transportation services under Section 533.00257 or
other law as necessary until the requirements of this section are
implemented with respect to each Medicaid managed care
organization. This subsection expires September 1, 2023.
Sec. 533.00258. NONMEDICAL TRANSPORTATION SERVICES UNDER
MEDICAID MANAGED CARE PROGRAM. (a) In this section:
(1) "Nonmedical transportation service" means:
(A) curb-to-curb transportation to or from a
medically necessary, nonemergency covered health care service in a
standard passenger vehicle that is scheduled not more than 48 hours
before the transportation occurs, that is provided to a recipient
enrolled in a managed care plan offered by a Medicaid managed care
organization, and that the organization determines meets the level
of care that is medically appropriate for the recipient, including
transportation related to:
(i) discharge of a recipient from a health
care facility;
(ii) receipt of urgent care; and
(iii) obtaining pharmacy services and
prescription drugs; and
(B) any other transportation to or from a
medically necessary, nonemergency covered health care service the
commission considers appropriate to be provided by a transportation
vendor, as determined by commission rule or policy.
(2) "Transportation network company" has the meaning
assigned by Section 2402.001, Occupations Code.
(3) "Transportation vendor" means an entity,
including a transportation network company, that contracts with a
Medicaid managed care organization to provide nonmedical
transportation services.
(b) The executive commissioner shall adopt rules regarding
the manner in which nonmedical transportation services may be
arranged and provided.
(c) The rules must require a Medicaid managed care
organization to create a process to:
(1) verify that a passenger is eligible to receive
nonmedical transportation services;
(2) ensure that nonmedical transportation services
are provided only to and from covered health care services in areas
in which a transportation network company operates; and
(3) ensure the timely delivery of nonmedical
transportation services to a recipient, including by setting
reasonable service response goals.
(d) Before September 1, 2020, and subject to Section
533.002581(h), a rule adopted in accordance with Subsection (c)(3)
may not impose a penalty on a Medicaid managed care organization
that contracts with a transportation vendor under this section if
the vendor is unable to provide nonmedical transportation services
to a recipient after the Medicaid managed care organization has
made a specific request for those services.
(e) The rules must require a transportation vendor to,
before permitting a motor vehicle operator to provide nonmedical
transportation services:
(1) confirm that the operator:
(A) is at least 18 years of age;
(B) maintains a valid driver's license issued by
this state, another state, or the District of Columbia; and
(C) possesses proof of registration and
automobile financial responsibility for each motor vehicle to be
used to provide nonmedical transportation services;
(2) conduct, or cause to be conducted, a local, state,
and national criminal background check for the operator that
includes the use of:
(A) a commercial multistate and
multijurisdiction criminal records locator or other similar
commercial nationwide database; and
(B) the national sex offender public website
maintained by the United States Department of Justice or a
successor agency;
(3) confirm that any vehicle to be used to provide
nonmedical transportation services:
(A) meets the applicable requirements of Chapter
548, Transportation Code; and
(B) except as provided by Subsection (j), has at
least four doors; and
(4) obtain and review the operator's driving record.
(f) The rules may not permit a motor vehicle operator to
provide nonmedical transportation services if the operator:
(1) has been convicted in the three-year period
preceding the issue date of the driving record obtained under
Subsection (e)(4) of:
(A) more than three offenses classified by the
Department of Public Safety as moving violations; or
(B) one or more of the following offenses:
(i) fleeing or attempting to elude a police
officer under Section 545.421, Transportation Code;
(ii) reckless driving under Section
545.401, Transportation Code;
(iii) driving without a valid driver's
license under Section 521.025, Transportation Code; or
(iv) driving with an invalid driver's
license under Section 521.457, Transportation Code;
(2) has been convicted in the preceding seven-year
period of any of the following:
(A) driving while intoxicated under Section
49.04 or 49.045, Penal Code;
(B) use of a motor vehicle to commit a felony;
(C) a felony crime involving property damage;
(D) fraud;
(E) theft;
(F) an act of violence; or
(G) an act of terrorism; or
(3) is found to be registered in the national sex
offender public website maintained by the United States Department
of Justice or a successor agency.
(g) The commission may not require:
(1) a motor vehicle operator to enroll as a Medicaid
provider to provide nonmedical transportation services; or
(2) a Medicaid managed care organization to credential
a motor vehicle operator to provide nonmedical transportation
services.
(h) The commission or a Medicaid managed care organization
that contracts with a transportation vendor may require the
transportation vendor or a motor vehicle operator who provides
services under this section to be periodically screened against the
list of excluded individuals and entities maintained by the Office
of Inspector General of the United States Department of Health and
Human Services.
(i) Notwithstanding any other law, a motor vehicle operator
who is part of a transportation network company's network and who
satisfies the driver requirements in Section 2402.107, Occupations
Code, is qualified to provide nonmedical transportation services.
The commission and a Medicaid managed care organization may not
impose any additional requirements on a motor vehicle operator who
satisfies the driver requirements in Section 2402.107, Occupations
Code, to provide nonmedical transportation services.
(j) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
Sec. 533.002581. DELIVERY OF NONMEDICAL TRANSPORTATION
SERVICES UNDER MEDICAID MANAGED CARE PROGRAM. (a) In this section,
"nonmedical transportation service" and "transportation vendor"
have the meanings assigned by Section 533.00258.
(b) The commission shall designate managed care service
areas in which to require, beginning not later than January 1, 2020,
each Medicaid managed care organization with which the commission
has a contract that is anticipated to be in effect on September 1,
2020, and that operates in a designated service area to arrange for
the provision of nonmedical transportation services to recipients
enrolled in a managed care plan offered by the organization. The
commission shall designate at least three, but not more than four,
managed care service areas for purposes of this subsection. At
least one of the designated service areas must be located in an
urban service area, and at least one must be located in a rural
service area. This subsection expires September 1, 2021.
(c) The commission shall require each Medicaid managed care
organization to arrange for the provision of nonmedical
transportation services to recipients enrolled in a managed care
plan offered by the organization.
(d) A Medicaid managed care organization may contract with a
transportation vendor or other third party to arrange for the
provision of nonmedical transportation services. If a Medicaid
managed care organization contracts with a third party that is not a
transportation vendor to arrange for the provision of nonmedical
transportation services, the third party shall contract with a
transportation vendor to deliver the nonmedical transportation
services.
(e) A Medicaid managed care organization that contracts
with a transportation vendor or other third party to arrange for the
provision of nonmedical transportation services shall ensure the
effective sharing and integration of service coordination, service
authorization, and utilization management data between the managed
care organization and the transportation vendor or third party.
(f) A Medicaid managed care organization may not require:
(1) a motor vehicle operator to enroll as a Medicaid
provider to provide nonmedical transportation services; or
(2) the credentialing of a motor vehicle operator to
provide nonmedical transportation services.
(g) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
(h) The commission may waive the applicability of
Subsection (c) to a Medicaid managed care organization for not more
than three months as necessary based on the results of a review
conducted under Section 533.007 and until enrollment of recipients
in a managed care plan offered by the organization is permitted
under that section.
SECTION 9. Section 533.00257(i), Government Code, is
repealed.
SECTION 10. Notwithstanding Sections 533.002571(b) and
533.002581(b), Government Code, as added by this Act, the Health
and Human Services Commission is not required to implement those
subsections until September 1, 2020.
SECTION 11. 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 12. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules as necessary to implement the
changes in law made by this Act.
SECTION 13. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2019.
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