Texas 2019 - 86th Regular

Texas House Bill HB2539 Compare Versions

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

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1	1	86R1342 KFF-D
2	2	By: Krause H.B. No. 2539
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to improving the provision of Medicaid benefits to certain
8	8	children, including children receiving benefits under the STAR Kids
9	9	managed care program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 531.0213(d), Government Code, is amended
12	12	to read as follows:
13	13	(d) As a part of the support and information services
14	14	required by this section, the commission shall:
15	15	(1) operate a statewide toll-free assistance
16	16	telephone number that includes relay services for persons with
17	17	speech or hearing disabilities and assistance for persons who speak
18	18	Spanish;
19	19	(2) intervene promptly with the state Medicaid office,
20	20	managed care organizations and providers, and any other appropriate
21	21	entity on behalf of a person who has an urgent need for medical
22	22	services;
23	23	(3) assist a person who is experiencing barriers in
24	24	the Medicaid application and enrollment process and refer the
25	25	person for further assistance if appropriate;
26	26	(4) educate persons so that they:
27	27	(A) understand the concept of managed care;
28	28	(B) understand their rights under Medicaid,
29	29	including grievance and appeal procedures; and
30	30	(C) are able to advocate for themselves;
31	31	(5) collect and maintain statistical information on a
32	32	regional basis regarding calls received by the assistance lines and
33	33	publish quarterly reports that:
34	34	(A) list the number of calls received by region;
35	35	(B) identify trends in delivery and access
36	36	problems;
37	37	(C) identify recurring barriers in the Medicaid
38	38	system; and
39	39	(D) indicate other problems identified with
40	40	Medicaid managed care;
41	41	(6) assist the state Medicaid office and managed care
42	42	organizations and providers in identifying and correcting
43	43	problems, including site visits to affected regions if necessary;
44	44	(7) meet the needs of all current and future Medicaid
45	45	managed care recipients, including children receiving dental
46	46	benefits and other recipients receiving benefits, under the:
47	47	(A) STAR Medicaid managed care program;
48	48	(B) STAR+PLUS [STAR + PLUS] Medicaid managed care
49	49	program, including the Texas Dual Eligibles Integrated Care
50	50	Demonstration Project provided under that program;
51	51	(C) STAR Kids managed care program established
52	52	under Section 533.071 [533.00253]; and
53	53	(D) STAR Health program;
54	54	(8) incorporate support services for children
55	55	enrolled in the child health plan established under Chapter 62,
56	56	Health and Safety Code; and
57	57	(9) ensure that staff providing support and
58	58	information services receives sufficient training, including
59	59	training in the Medicare program for the purpose of assisting
60	60	recipients who are dually eligible for Medicare and Medicaid, and
61	61	has sufficient authority to resolve barriers experienced by
62	62	recipients to health care and long-term services and supports.
63	63	SECTION 2. Subchapter B, Chapter 531, Government Code, is
64	64	amended by adding Sections 531.02132, 531.0601, and 531.0602 to
65	65	read as follows:
66	66	Sec. 531.02132. EDUCATION PROGRAM FOR MEDICALLY DEPENDENT
67	67	CHILDREN (MDCP) WAIVER PROGRAM. The commission shall develop an
68	68	education program for the families of and care coordinators for
69	69	children eligible for or receiving benefits under the medically
70	70	dependent children (MDCP) waiver program that:
71	71	(1) educates the families and care coordinators about:
72	72	(A) the option to receive benefits under a
73	73	traditional fee-for-service model under Section 32.042421, Human
74	74	Resources Code, or through the STAR Kids managed care program under
75	75	Section 533.071; and
76	76	(B) the evaluation and assessment process for
77	77	determining eligibility for and receiving benefits under the
78	78	medically dependent children (MDCP) waiver program; and
79	79	(2) provides information to families on the appeals
80	80	process, including how to prepare for an appeal.
81	81	Sec. 531.0601. LONG-TERM CARE SERVICES WAIVER PROGRAM
82	82	INTEREST LISTS. (a) This section applies only to a child who
83	83	becomes ineligible for services under the medically dependent
84	84	children (MDCP) waiver program because the child no longer meets:
85	85	(1) the level of care criteria for medical necessity
86	86	for nursing facility care; or
87	87	(2) the age requirement for the program.
88	88	(b) A parent or guardian of a child who is notified by the
89	89	commission that the child is no longer eligible for the medically
90	90	dependent children (MDCP) waiver program may request that the
91	91	commission:
92	92	(1) return the child to the interest list for the
93	93	program unless the child is ineligible due to the child's age; or
94	94	(2) place the child on the interest list for another
95	95	Section 1915(c) waiver program.
96	96	(c) At the time a child's parent or guardian makes a request
97	97	under Subsection (b), the commission shall:
98	98	(1) for a child who becomes ineligible for the reason
99	99	described by Subsection (a)(1), place the child:
100	100	(A) on the interest list for the medically
101	101	dependent children (MDCP) waiver program in the first position on
102	102	the list; or
103	103	(B) except as provided by Subdivision (3), on the
104	104	interest list for another Section 1915(c) waiver program in a
105	105	position relative to other persons on the list that is based on the
106	106	date the child was initially placed on the interest list for the
107	107	medically dependent children (MDCP) waiver program;
108	108	(2) except as provided by Subdivision (3) and subject
109	109	to Section 533.071(e) and Section 32.042421(b), Human Resources
110	110	Code, for a child who becomes ineligible for the reason described by
111	111	Subsection (a)(2), place the child on the interest list for another
112	112	Section 1915(c) waiver program in a position relative to other
113	113	persons on the list that is based on the date the child was
114	114	initially placed on the interest list for the medically dependent
115	115	children (MDCP) waiver program; or
116	116	(3) for a child who becomes ineligible for a reason
117	117	described by Subsection (a) and who is already on an interest list
118	118	for another Section 1915(c) waiver program, move the child to a
119	119	position on the interest list relative to other persons on the list
120	120	that is based on the date the child was initially placed on the
121	121	interest list for the medically dependent children (MDCP) waiver
122	122	program, if that date is earlier than the date the child was
123	123	initially placed on the interest list for the other waiver program.
124	124	(d) At the time the commission provides notice to a parent
125	125	or guardian that a child is no longer eligible for the medically
126	126	dependent children (MDCP) waiver program, the commission shall
127	127	inform the parent or guardian in writing about the options under
128	128	this section for placing the child on an interest list.
129	129	Sec. 531.0602. MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
130	130	PROGRAM REASSESSMENTS. To the extent allowed by federal law, the
131	131	commission shall require that a child participating in the
132	132	medically dependent children (MDCP) waiver program be reassessed to
133	133	determine whether the child meets the level of care criteria for
134	134	medical necessity for nursing facility care only if the child has a
135	135	significant change in function that may affect the medical
136	136	necessity for that level of care instead of requiring that the
137	137	reassessment be made annually.
138	138	SECTION 3. Section 533.0025(b), Government Code, is amended
139	139	to read as follows:
140	140	(b) Except as otherwise provided by this section and Section
141	141	32.042421, Human Resources Code, and notwithstanding any other law,
142	142	the commission shall provide Medicaid acute care services through
143	143	the most cost-effective model of Medicaid capitated managed care as
144	144	determined by the commission. The commission shall require
145	145	mandatory participation in a Medicaid capitated managed care
146	146	program for all persons eligible for Medicaid acute care benefits,
147	147	but may implement alternative models or arrangements, including a
148	148	traditional fee-for-service arrangement, if the commission
149	149	determines the alternative would be more cost-effective or
150	150	efficient.
151	151	SECTION 4. Section 533.0063(c), Government Code, is amended
152	152	to read as follows:
153	153	(c) A managed care organization participating in the
154	154	STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
155	155	[Medicaid] managed care program established under Section 533.071
156	156	[533.00253] shall, for a recipient in that program, issue a
157	157	provider network directory for the program in paper form unless the
158	158	recipient opts out of receiving the directory in paper form.
159	159	SECTION 5. Chapter 533, Government Code, is amended by
160	160	adding Subchapter C to read as follows:
161	161	SUBCHAPTER C. STAR KIDS MANAGED CARE PROGRAM
162	162	Sec. 533.072. MEDICALLY DEPENDENT CHILD OPT-IN
163	163	ALTERNATIVE. (a) The commission shall provide a process by which
164	164	the parent or guardian of a child receiving benefits under the
165	165	medically dependent children (MDCP) waiver program may opt the
166	166	medically dependent child out of receiving benefits through the
167	167	traditional fee-for-service delivery model under Section
168	168	32.042421, Human Resources Code, and into receiving benefits
169	169	through the STAR Kids managed care program operated under Section
170	170	533.071. The commission shall ensure that any transition in the
171	171	delivery of benefits to a child under this section is completed in a
172	172	manner that protects continuity of care.
173	173	(b) Notwithstanding any other law, the commission shall
174	174	ensure that:
175	175	(1) the parent or guardian of a child who opts the
176	176	child into receiving benefits through the STAR Kids managed care
177	177	program under this section is allowed to choose the managed care
178	178	plan offered under the STAR Kids managed care program into which the
179	179	child is enrolled, regardless of the health care service region in
180	180	which the child resides; and
181	181	(2) a child receiving benefits through the STAR Kids
182	182	managed care program under this section is not required to obtain
183	183	prior authorization or a referral for the provision of specialty
184	184	care.
185	185	Sec. 533.073. MANAGED CARE ORGANIZATION STANDARDIZED
186	186	POLICIES AND PROCEDURES. Notwithstanding any other law, including
187	187	Section 533.005, the commission shall adopt standardized policies
188	188	and procedures applicable to each managed care organization that
189	189	contracts with the commission to provide health care services to
190	190	recipients under the STAR Kids managed care program to ensure the
191	191	provision of benefits is substantially similar across all of those
192	192	managed care organizations. The commission shall adopt policies
193	193	and procedures under this section that require managed care
194	194	organizations, under the terms of the organizations' contracts, to
195	195	implement and adhere to:
196	196	(1) a standard prior authorization protocol,
197	197	including minimum time frames for approving prior authorization
198	198	requests;
199	199	(2) standardized claims payment and appeal processes;
200	200	(3) a standard approval process for the provision of
201	201	nonemergency transportation services;
202	202	(4) similar requirements for accessing therapy
203	203	services;
204	204	(5) a pharmacy benefit plan that complies strictly
205	205	with Sections 533.005(a)(23)(A), (B), and (C) and does not impose
206	206	additional requirements or restrictions on its enrolled
207	207	recipients; and
208	208	(6) a robust online recipient and provider portal that
209	209	is designed to support transparency, accountability, and the
210	210	coordination of services by providing the recipients and providers,
211	211	as appropriate, access to evaluations and assessments, including
212	212	any screening and assessment instruments, individual service
213	213	plans, prior authorization requests, explanations of benefits, and
214	214	referrals.
215	215	Sec. 533.074. STANDARDS FOR DETERMINING MEDICAL NECESSITY.
216	216	The commission shall establish standards that govern the processes,
217	217	criteria, and guidelines under which managed care organizations
218	218	determine the medical necessity of a health care service provided
219	219	through the STAR Kids managed care program. In establishing
220	220	standards under this section, the commission shall ensure that the
221	221	treating provider or other neutral third party makes the
222	222	determination of medical necessity rather than a care coordinator
223	223	or other professional employed by the managed care organization.
224	224	Sec. 533.075. PROVIDER NETWORK REQUIREMENTS.
225	225	Notwithstanding any other law, the commission shall require a
226	226	managed care organization that contracts with the commission to
227	227	provide health care services to recipients under the STAR Kids
228	228	managed care program to:
229	229	(1) include significant traditional providers in the
230	230	organization's provider network for the duration of the
231	231	organization's contract with the commission; and
232	232	(2) include at least two providers of a particular
233	233	health care service in order to satisfy network adequacy
234	234	requirements.
235	235	Sec. 533.076. PROVIDER MONITORING PROGRAM. (a)
236	236	Notwithstanding Section 533.005(a)(22), the commission, in
237	237	consultation with the STAR Kids Managed Care Advisory Committee
238	238	established under Section 533.00254 or a successor committee, the
239	239	advisory committee established under Section 534.183, and other
240	240	organizations with relevant expertise the commission determines
241	241	appropriate, shall ensure a contract between the commission and a
242	242	managed care organization to provide health care services to
243	243	children receiving benefits under the medically dependent children
244	244	(MDCP) waiver program through the STAR Kids managed care program in
245	245	accordance with Sections 531.071(e) and 533.072 contains a
246	246	requirement that the managed care organization develop a monitoring
247	247	program that uses individual and consumer-based quality metrics
248	248	designed specifically with the needs of the recipient population in
249	249	mind for purposes of measuring the quality of health care services
250	250	provided by the organization's provider network.
251	251	(b) Based on metrics designed under Subsection (a), each
252	252	managed care organization that contracts with the commission as
253	253	described by that subsection shall perform evaluations and audits
254	254	of the organization's provider network.
255	255	Sec. 533.077. PROVIDER PROTECTIONS. (a) Notwithstanding
256	256	any other law, the commission shall require a managed care
257	257	organization that contracts with the commission to provide health
258	258	care services to recipients under the STAR Kids managed care
259	259	program to:
260	260	(1) obtain the express approval of a recipient's
261	261	parent or guardian before selecting a provider for the recipient or
262	262	changing that provider; and
263	263	(2) reimburse a provider for a service at a rate that
264	264	is at least 75 percent of the reimbursement rate paid for the same
265	265	service under the traditional fee-for-service delivery model
266	266	implemented under Section 32.042421, Human Resources Code.
267	267	(b) The commission shall establish a complaints process for
268	268	providers contracting with managed care organizations that
269	269	contract with the commission to provide health care services to
270	270	recipients under the STAR Kids managed care program under which the
271	271	providers are:
272	272	(1) confident their complaints will be appropriately
273	273	considered and resolved and will not be referred back to the managed
274	274	care organization; and
275	275	(2) protected from retaliatory action by the managed
276	276	care organization.
277	277	Sec. 533.078. REGIONAL REVIEW PANELS. (a) The commission
278	278	shall establish regional review panels to review denials based on
279	279	medical necessity issued by managed care organizations that
280	280	contract with the commission to provide health care services under
281	281	the STAR Kids managed care program. The panels must be composed of
282	282	at least six but not more than eight members and must include:
283	283	(1) the parent or guardian of a child with an
284	284	intellectual or developmental disability who has complex medical
285	285	needs;
286	286	(2) an advocate for children with an intellectual or
287	287	developmental disability;
288	288	(3) a representative of primary care physicians
289	289	participating in the STAR Medicaid managed care program or the STAR
290	290	Kids managed care program; and
291	291	(4) a representative of health care providers, other
292	292	than primary care physicians, participating in the STAR Medicaid
293	293	managed care program or the STAR Kids managed care program.
294	294	(b) The executive commissioner or the executive
295	295	commissioner's designee shall appoint a presiding member of each
296	296	regional review panel established under this section.
297	297	(c) Each regional review panel shall meet at least quarterly
298	298	at the call of the presiding officer.
299	299	(d) Each member of a regional review panel serves without
300	300	compensation.
301	301	(e) A regional review panel established under this section
302	302	shall:
303	303	(1) review denials described by Subsection (a) for
304	304	which there are requests for the commission to conduct a fair
305	305	hearing before the commission conducts its fair hearing;
306	306	(2) make a determination regarding whether to uphold
307	307	or overturn the denial; and
308	308	(3) notify all parties and the commission of the
309	309	regional review panel's determination under Subdivision (2).
310	310	(f) If a regional review panel upholds a denial, the
311	311	recipient or provider, as applicable, may further pursue a fair
312	312	hearing with the commission. If a regional review panel overturns a
313	313	denial, the managed care organization is bound by the determination
314	314	but may appeal the determination to the commission.
315	315	(g) The commission is not bound by a determination of a
316	316	regional review panel under this section.
317	317	(h) The executive commissioner shall adopt rules necessary
318	318	to implement this section.
319	319	SECTION 6. Section 533.00253, Government Code, is
320	320	transferred to Subchapter C, Chapter 533, Government Code, as added
321	321	by this Act, redesignated as Section 533.071, Government Code, and
322	322	amended to read as follows:
323	323	Sec. 533.071 [533.00253]. STAR KIDS [MEDICAID] MANAGED
324	324	CARE PROGRAM. (a) In this section:
325	325	(1) "Advisory committee" means the STAR Kids Managed
326	326	Care Advisory Committee established under Section 533.00254 or a
327	327	successor committee.
328	328	(2) "Health home" means a primary care provider
329	329	practice, or, if appropriate, a specialty care provider practice,
330	330	incorporating several features, including comprehensive care
331	331	coordination, family-centered care, and data management, that are
332	332	focused on improving outcome-based quality of care and increasing
333	333	patient and provider satisfaction under Medicaid.
334	334	(3) "Potentially preventable event" has the meaning
335	335	assigned by Section 536.001.
336	336	(b) Except as provided by Section 32.042421, Human
337	337	Resources Code, and subject [Subject] to Section 533.0025, the
338	338	commission shall operate[, in consultation with the Children's
339	339	Policy Council established under Section 22.035, Human Resources
340	340	Code, establish] a mandatory STAR Kids capitated managed care
341	341	program tailored to provide Medicaid benefits to children with
342	342	disabilities. The managed care program [developed] under this
343	343	section must:
344	344	(1) provide Medicaid benefits that are customized to
345	345	meet the health care needs of recipients under the program through a
346	346	defined system of care;
347	347	(2) better coordinate care of recipients under the
348	348	program;
349	349	(3) improve the health outcomes of recipients;
350	350	(4) improve recipients' access to health care
351	351	services;
352	352	(5) achieve cost containment and cost efficiency;
353	353	(6) reduce the administrative complexity of
354	354	delivering Medicaid benefits;
355	355	(7) reduce the incidence of unnecessary
356	356	institutionalizations and potentially preventable events by
357	357	ensuring the availability of appropriate services and care
358	358	management;
359	359	(8) require a health home; and
360	360	(9) coordinate and collaborate with long-term care
361	361	service providers and long-term care management providers, if
362	362	recipients are receiving long-term services and supports outside of
363	363	the managed care organization.
364	364	(c) The commission may require that care management
365	365	services made available as provided by Subsection (b)(7):
366	366	(1) incorporate best practices, as determined by the
367	367	commission;
368	368	(2) integrate with a nurse advice line to ensure
369	369	appropriate redirection rates;
370	370	(3) use an identification and stratification
371	371	methodology that identifies recipients who have the greatest need
372	372	for services;
373	373	(4) provide a care needs assessment for a recipient
374	374	that is comprehensive, holistic, consumer-directed,
375	375	evidence-based, and takes into consideration social and medical
376	376	issues, for purposes of prioritizing the recipient's needs that
377	377	threaten independent living;
378	378	(5) are delivered through multidisciplinary care
379	379	teams located in different geographic areas of this state that use
380	380	in-person contact with recipients and their caregivers;
381	381	(6) identify immediate interventions for transition
382	382	of care;
383	383	(7) include monitoring and reporting outcomes that, at
384	384	a minimum, include:
385	385	(A) recipient quality of life;
386	386	(B) recipient satisfaction; and
387	387	(C) other financial and clinical metrics
388	388	determined appropriate by the commission; and
389	389	(8) use innovations in the provision of services.
390	390	(d) The commission shall provide Medicaid benefits through
391	391	the STAR Kids managed care program operated [established] under
392	392	this section to a child [children] who is [are] receiving benefits
393	393	under the medically dependent children (MDCP) waiver program if the
394	394	parent or guardian of the medically dependent child opts the child
395	395	into receiving benefits through the STAR Kids managed care program
396	396	in accordance with Section 533.072. The commission shall ensure
397	397	that the STAR Kids managed care program provides all of the benefits
398	398	provided under the medically dependent children (MDCP) waiver
399	399	program to the extent necessary to implement this subsection.
400	400	(e) The commission shall ensure that there is a plan for
401	401	transitioning the provision of Medicaid benefits to recipients 21
402	402	years of age or older from under the STAR Kids managed care program
403	403	to under:
404	404	(1) the STAR+PLUS [STAR + PLUS] Medicaid managed care
405	405	program; or
406	406	(2) if the child is receiving benefits under the
407	407	medically dependent children (MDCP) waiver program and the
408	408	commission determines it is more appropriate, another Medicaid
409	409	waiver program, as defined by Section 534.001.
410	410	(f) The commission shall ensure that the plan described by
411	411	Subsection (e):
412	412	(1) protects the recipient's continuity of care;
413	413	(2) if applicable and to the maximum extent possible,
414	414	avoids placing a recipient on an interest list for a Medicaid waiver
415	415	program, as defined by Section 534.001; and
416	416	(3) provides for[. The plan must ensure that]
417	417	coordination between the STAR Kids managed care program and the
418	418	STAR+PLUS Medicaid managed care program or other Medicaid waiver
419	419	program beginning [programs begins] when a recipient reaches 18
420	420	years of age.
421	421	SECTION 7. Section 533.00254(f), Government Code, is
422	422	amended to read as follows:
423	423	(f) On the first anniversary of the date the commission
424	424	completes implementation of the STAR Kids [Medicaid] managed care
425	425	program under Section 533.071 [533.00253]:
426	426	(1) the advisory committee is abolished; and
427	427	(2) this section expires.
428	428	SECTION 8. Section 533.0063(c), Government Code, is amended
429	429	to read as follows:
430	430	(c) A managed care organization participating in the
431	431	STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
432	432	[Medicaid] managed care program operated [established] under
433	433	Section 533.071 [533.00253] shall, for a recipient in that program,
434	434	issue a provider network directory for the program in paper form
435	435	unless the recipient opts out of receiving the directory in paper
436	436	form.
437	437	SECTION 9. Chapter 534, Government Code, is amended by
438	438	adding Subchapter D-1 to read as follows:
439	439	SUBCHAPTER D-1. ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
440	440	Sec. 534.181. DEFINITIONS. In this subchapter:
441	441	(1) "Health care service region" has the meaning
442	442	assigned by Section 533.001.
443	443	(2) "Pilot program" means the pilot program
444	444	implemented under this subchapter.
445	445	Sec. 534.182. ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
446	446	IMPLEMENTATION. (a) The commission shall develop and implement a
447	447	pilot program to test alternative methods for delivering Medicaid
448	448	benefits to children with an intellectual or developmental
449	449	disability, including children receiving benefits under the
450	450	medically dependent children (MDCP) waiver program, who are
451	451	otherwise receiving some or all of those benefits through the STAR
452	452	Medicaid managed care program or the STAR Kids managed care
453	453	program. The commission shall design the pilot program in a manner
454	454	that allows the commission to determine whether the alternative
455	455	delivery methods:
456	456	(1) achieve cost savings and efficiencies in the
457	457	delivery of Medicaid acute care services and long-term services and
458	458	supports; and
459	459	(2) improve the quality of and access to the services
460	460	described by Subdivision (1).
461	461	(b) The pilot program must:
462	462	(1) be conducted in each health care service region of
463	463	this state, begin not later than September 1, 2020, and operate for
464	464	at least 24 months;
465	465	(2) include a total of at least 2,000 Medicaid
466	466	recipients receiving benefits under the STAR Medicaid managed care
467	467	program, and a total of at least 2,000 Medicaid recipients
468	468	receiving benefits under the STAR Kids managed care program; and
469	469	(3) be designed in a manner that ensures continuity of
470	470	care and the receipt of Medicaid acute care services and long-term
471	471	services and supports for program participants.
472	472	(c) Recipient participation in the pilot program must be
473	473	voluntary.
474	474	Sec. 534.183. ADVISORY COMMITTEE. (a) In developing the
475	475	pilot program, the executive commissioner shall seek input from
476	476	stakeholders by establishing an advisory committee to make
477	477	recommendations to the commission on pilot program goals, outcome
478	478	measures, and evaluation processes.
479	479	(b) The advisory committee must be composed of at least
480	480	eight members who have expertise in and knowledge of the care needs
481	481	of potential pilot program participants, including:
482	482	(1) a representative of the commission;
483	483	(2) the parent or guardian of a child with an
484	484	intellectual or developmental disability who has complex medical
485	485	needs;
486	486	(3) an advocate for children with an intellectual or
487	487	developmental disability;
488	488	(4) a representative of primary care physicians
489	489	participating in the STAR Medicaid managed care program or the STAR
490	490	Kids managed care program; and
491	491	(5) a representative of health care providers, other
492	492	than primary care physicians, participating in the STAR Medicaid
493	493	managed care program or the STAR Kids managed care program.
494	494	(c) The executive commissioner shall appoint a member of the
495	495	advisory committee as the presiding officer.
496	496	(d) The advisory committee shall meet at least quarterly at
497	497	the call of the presiding officer.
498	498	(e) A member of the advisory committee serves without
499	499	compensation.
500	500	(f) The advisory committee is subject to the requirements of
501	501	Chapter 551.
502	502	Sec. 534.184. REPORTING REQUIREMENT. (a) The commission
503	503	shall conduct an initial evaluation of the pilot program and submit
504	504	a written report on that evaluation not later than September 1,
505	505	2021, to:
506	506	(1) the legislature, including the standing
507	507	committees of the house of representatives and senate having
508	508	primary jurisdiction over Medicaid;
509	509	(2) the advisory committee established under Section
510	510	534.183; and
511	511	(3) the STAR Kids Managed Care Advisory Committee
512	512	established under Section 533.00254 or a successor committee.
513	513	(b) The commission shall conduct a final evaluation of the
514	514	pilot program and submit a written report on that evaluation to the
515	515	entities described under Subsection (a) not later than September 1,
516	516	2022.
517	517	(c) Each evaluation required under this section must
518	518	include:
519	519	(1) an evaluation of the success of the pilot program
520	520	in achieving the program's goals; and
521	521	(2) recommendations for legislation that identify any
522	522	statutory requirements that are impairing the success of the
523	523	program or that may impair permanent implementation of a program
524	524	delivery model.
525	525	Sec. 534.185. MORATORIUM ON IMPLEMENTATION OF CERTAIN LAW.
526	526	Notwithstanding any other law, including Subchapter E, the
527	527	commission may not expand on or after December 1, 2019, the delivery
528	528	of Medicaid acute care services or long-term services and supports
529	529	to children with an intellectual or developmental disability under
530	530	the STAR Medicaid managed care program or the STAR Kids managed care
531	531	program until the commission submits to the legislature the report
532	532	on the final evaluation required under Section 534.184.
533	533	Sec. 534.186. EXPIRATION. This subchapter expires
534	534	September 1, 2022.
535	535	SECTION 10. Section 32.0212, Human Resources Code, is
536	536	amended to read as follows:
537	537	Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE. Except as
538	538	provided by Section 32.042421 and notwithstanding
539	539	[Notwithstanding] any other law [and subject to Section 533.0025,
540	540	Government Code], the commission shall provide medical assistance
541	541	for acute care services through the Medicaid managed care system in
542	542	accordance with [implemented under] Chapter 533, Government Code,
543	543	or another Medicaid capitated managed care program.
544	544	SECTION 11. Subchapter B, Chapter 32, Human Resources Code,
545	545	is amended by adding Section 32.042421 to read as follows:
546	546	Sec. 32.042421. DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN
547	547	RECIPIENTS UNDER THE MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
548	548	PROGRAM. (a) The commission shall establish a program to provide
549	549	medical assistance benefits under a traditional fee-for-service
550	550	delivery model to a recipient who is a child receiving benefits
551	551	under the medically dependent children (MDCP) waiver program,
552	552	including a recipient who is a participant in the health insurance
553	553	premium payment program under Section 32.0422.
554	554	(b) To the same extent required under Section 533.071(e),
555	555	Government Code, the commission shall ensure that there is a plan
556	556	for transitioning the provision of Medicaid benefits to recipients
557	557	21 years of age or older from the fee-for-service delivery model
558	558	provided under this section to the STAR+PLUS Medicaid managed care
559	559	program or, if appropriate, a Medicaid waiver program, as defined
560	560	by Section 534.001, Government Code, that protects continuity of
561	561	care. The plan must ensure that the coordination begins when the
562	562	recipient reaches 18 years of age.
563	563	(c) The executive commissioner shall adopt rules necessary
564	564	to implement this section.
565	565	SECTION 12. As soon as practicable after the effective date
566	566	of this Act, the Health and Human Services Commission shall conduct
567	567	a study to identify incentives the commission could implement to
568	568	increase the number of physicians and other health care providers
569	569	contracting with managed care organizations to provide services to
570	570	children with complex medical needs who are recipients under
571	571	Medicaid. Not later than December 1, 2021, the commission shall
572	572	submit a report of its findings under the study to the standing
573	573	committees of the house of representatives and senate having
574	574	primary jurisdiction over the Medicaid program.
575	575	SECTION 13. (a) As soon as possible after the effective
576	576	date of this Act, the Health and Human Services Commission shall
577	577	identify each child who became ineligible for services under the
578	578	medically dependent children (MDCP) waiver program on or after June
579	579	1, 2016, and before the effective date of this Act.
580	580	(b) Section 531.0601, Government Code, as added by this Act,
581	581	applies to:
582	582	(1) a child who becomes ineligible for the medically
583	583	dependent children (MDCP) waiver program on or after the effective
584	584	date of this Act; and
585	585	(2) a child identified under Subsection (a) of this
586	586	section.
587	587	SECTION 14. Section 531.0602, Government Code, as added by
588	588	this Act, applies only to a reassessment of a child's eligibility
589	589	for the medically dependent children (MDCP) waiver program made on
590	590	or after the effective date of this Act.
591	591	SECTION 15. Not later than December 1, 2019, the executive
592	592	commissioner of the Health and Human Services Commission shall
593	593	establish the advisory committee required by Section 534.183,
594	594	Government Code, as added by this Act.
595	595	SECTION 16. (a) Not later than September 1, 2020, and
596	596	subject to Subsections (b) and (c) of this section, the Health and
597	597	Human Services Commission shall:
598	598	(1) adopt the standardized policies and procedures
599	599	required by Section 533.073, Government Code, as added by this Act,
600	600	for managed care organizations participating in the STAR Kids
601	601	managed care program;
602	602	(2) establish the standards for determining medical
603	603	necessity required by Section 533.074, Government Code, as added by
604	604	this Act, and applicable to managed care organizations
605	605	participating in the STAR Kids managed care program;
606	606	(3) implement the provider protections required under
607	607	Section 533.077, Government Code, as added by this Act; and
608	608	(4) establish the regional review panels required by
609	609	Section 533.078, Government Code, as added by this Act.
610	610	(b) The Health and Human Services Commission shall ensure
611	611	that a contract between the commission and a managed care
612	612	organization to provide Medicaid benefits to recipients under the
613	613	STAR Kids managed care program operated under Section 533.071,
614	614	Government Code, as transferred, redesignated, and amended by this
615	615	Act, that is entered into or renewed on or after the effective date
616	616	of this Act complies with the provisions of Subchapter C, Chapter
617	617	533, Government Code, as added by this Act.
618	618	(c) The Health and Human Services Commission shall seek to
619	619	amend contracts entered into with managed care organizations to
620	620	provide Medicaid benefits to recipients under the STAR Kids managed
621	621	care program operated under Section 533.071, Government Code, as
622	622	transferred, redesignated, and amended by this Act, before the
623	623	effective date of this Act to ensure those contracts comply with the
624	624	provisions of Subchapter C, Chapter 533, Government Code, as added
625	625	by this Act. To the extent of a conflict between a provision of that
626	626	subchapter and a term of a contract with a managed care organization
627	627	entered into before the effective date of this Act, the contract
628	628	provision prevails.
629	629	SECTION 17. If before implementing any provision of this
630	630	Act a state agency determines that a waiver or authorization from a
631	631	federal agency is necessary for implementation of that provision,
632	632	the agency affected by the provision shall request the waiver or
633	633	authorization and may delay implementing that provision until the
634	634	waiver or authorization is granted.
635	635	SECTION 18. This Act takes effect September 1, 2019.