Texas 2019 - 86th Regular

Texas House Bill HB2357 Compare Versions

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

Old	New	Differences
1	1	86R13476 KLA-D
2	2	By: Muñoz, Jr. H.B. No. 2357
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to utilization reviews and care coordination under the
8	8	Medicaid managed care program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 533.00281, Government Code, is amended
11	11	by adding Subsection (f) to read as follows:
12	12	(f) Nothing in this section precludes the commission from
13	13	conducting a utilization review for managed care organizations
14	14	participating in another Medicaid managed care program or with
15	15	respect to other service types within a Medicaid managed care
16	16	program.
17	17	SECTION 2. Subchapter A, Chapter 533, Government Code, is
18	18	amended by adding Section 533.00294 to read as follows:
19	19	Sec. 533.00294. CARE COORDINATION BENEFITS. (a) In this
20	20	section:
21	21	(1) "Care coordination" means assisting recipients to
22	22	develop a plan of care, including a service plan, that meets the
23	23	recipient's needs and coordinating the provision of Medicaid
24	24	benefits in a manner that is consistent with the plan of care. The
25	25	term is synonymous with "case management," "service coordination,"
26	26	and "service management."
27	27	(2) "Medicaid managed care organization" means a
28	28	managed care organization that contracts with the commission under
29	29	this chapter to provide health care services to recipients.
30	30	(b) The commission shall streamline and clarify the
31	31	provision of care coordination benefits across Medicaid programs
32	32	and services for recipients receiving benefits under a managed care
33	33	delivery model. In streamlining and clarifying the provision of
34	34	care coordination benefits, the commission shall, at a minimum,
35	35	include requirements in Medicaid managed care contracts that are
36	36	designed to:
37	37	(1) subject to Subsection (c), establish a process for
38	38	determining and designating a single person as the primary person
39	39	responsible for a recipient's care coordination;
40	40	(2) evaluate and eliminate duplicative services
41	41	intended to achieve recipient care coordination, including care
42	42	coordination or related benefits provided:
43	43	(A) by a Medicaid managed care organization;
44	44	(B) by a recipient's medical or health home;
45	45	(C) through a disease management program
46	46	provided by a Medicaid managed care organization;
47	47	(D) by a provider of targeted case management and
48	48	psychiatric rehabilitation services; or
49	49	(E) through a program of case management for
50	50	high-risk pregnant women and high-risk children established under
51	51	Section 22.0031, Human Resources Code;
52	52	(3) evaluate and, if the commission determines it
53	53	appropriate, modify the capitation rate paid to Medicaid managed
54	54	care organizations to account for the provision of care
55	55	coordination benefits by a person not affiliated with the
56	56	organization; and
57	57	(4) establish and use a consistent set of terms for
58	58	care coordination provided under a managed care delivery model.
59	59	(c) In establishing a process under Subsection (b)(1), the
60	60	commission shall ensure that:
61	61	(1) for a recipient who receives targeted case
62	62	management and psychiatric rehabilitation services through a local
63	63	mental health authority, the default entity to act as the primary
64	64	entity responsible for the recipient's care coordination under
65	65	Subsection (b)(1) is the local mental health authority;
66	66	(2) for a recipient who receives targeted case
67	67	management and psychiatric rehabilitation services through a
68	68	Medicaid managed care organization network provider, the default
69	69	person to act as the primary person responsible for the recipient's
70	70	care coordination under Subsection (b)(1) is the network provider;
71	71	and
72	72	(3) for recipients other than those described by
73	73	Subdivision (1) or (2), the process includes an evaluation designed
74	74	to identify the provider that would best and most cost-effectively
75	75	meet the care coordination needs of a recipient.
76	76	SECTION 3. If before implementing any provision of this Act
77	77	a state agency determines that a waiver or authorization from a
78	78	federal agency is necessary for implementation of that provision,
79	79	the agency affected by the provision shall request the waiver or
80	80	authorization and may delay implementing that provision until the
81	81	waiver or authorization is granted.
82	82	SECTION 4. This Act takes effect immediately if it receives
83	83	a vote of two-thirds of all the members elected to each house, as
84	84	provided by Section 39, Article III, Texas Constitution. If this
85	85	Act does not receive the vote necessary for immediate effect, this
86	86	Act takes effect September 1, 2019.