| 1 | 1 | | 86R13480 KLA-D |
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| 2 | 2 | | By: Muñoz, Jr. H.B. No. 2354 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to establishing caseload standards for certain care |
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| 8 | 8 | | coordinators under the Medicaid managed care program. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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| 11 | 11 | | amended by adding Section 533.00292 to read as follows: |
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| 12 | 12 | | Sec. 533.00292. CARE COORDINATOR CASELOAD STANDARDS. (a) |
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| 13 | 13 | | In this section: |
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| 14 | 14 | | (1) "Care coordination" means assisting recipients to |
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| 15 | 15 | | develop a plan of care, including a service plan, that meets the |
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| 16 | 16 | | recipient's needs and coordinating the provision of Medicaid |
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| 17 | 17 | | benefits in a manner that is consistent with the plan of care. The |
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| 18 | 18 | | term is synonymous with "case management," "service coordination," |
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| 19 | 19 | | and "service management." |
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| 20 | 20 | | (2) "Care coordinator" means a person, including a |
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| 21 | 21 | | case manager, engaged by a managed care organization to provide |
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| 22 | 22 | | care coordination benefits. |
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| 23 | 23 | | (b) The executive commissioner by rule shall establish |
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| 24 | 24 | | caseload standards for care coordinators providing care |
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| 25 | 25 | | coordination under the STAR+PLUS home and community-based services |
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| 26 | 26 | | supports (HCBS) program. |
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| 27 | 27 | | (c) The executive commissioner by rule may, if the executive |
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| 28 | 28 | | commissioner determines it appropriate, establish caseload |
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| 29 | 29 | | standards for care coordinators providing care coordination under |
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| 30 | 30 | | Medicaid programs other than the STAR+PLUS home and community-based |
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| 31 | 31 | | services supports (HCBS) program. |
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| 32 | 32 | | (d) In determining whether to establish caseload standards |
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| 33 | 33 | | for a Medicaid program under Subsection (c), the executive |
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| 34 | 34 | | commissioner shall consider whether implementing the standards |
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| 35 | 35 | | would improve: |
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| 36 | 36 | | (1) contract compliance by managed care organizations |
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| 37 | 37 | | that contract with the commission under this chapter to provide |
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| 38 | 38 | | health care services to recipients; |
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| 39 | 39 | | (2) the quality and consistency of care coordination |
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| 40 | 40 | | provided under the program; and |
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| 41 | 41 | | (3) transparency regarding the availability of care |
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| 42 | 42 | | coordination benefits to recipients and interested stakeholders. |
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| 43 | 43 | | SECTION 2. If before implementing any provision of this Act |
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| 44 | 44 | | a state agency determines that a waiver or authorization from a |
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| 45 | 45 | | federal agency is necessary for implementation of that provision, |
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| 46 | 46 | | the agency affected by the provision shall request the waiver or |
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| 47 | 47 | | authorization and may delay implementing that provision until the |
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| 48 | 48 | | waiver or authorization is granted. |
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| 49 | 49 | | SECTION 3. This Act takes effect immediately if it receives |
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| 50 | 50 | | a vote of two-thirds of all the members elected to each house, as |
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| 51 | 51 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 52 | 52 | | Act does not receive the vote necessary for immediate effect, this |
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| 53 | 53 | | Act takes effect September 1, 2019. |
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