86R1342 KFF-D
By: Krause H.B. No. 2539
A BILL TO BE ENTITLED
AN ACT
relating to improving the provision of Medicaid benefits to certain
children, including children receiving benefits under the STAR Kids
managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.0213(d), Government Code, is amended
to read as follows:
(d) As a part of the support and information services
required by this section, the commission shall:
(1) operate a statewide toll-free assistance
telephone number that includes relay services for persons with
speech or hearing disabilities and assistance for persons who speak
Spanish;
(2) intervene promptly with the state Medicaid office,
managed care organizations and providers, and any other appropriate
entity on behalf of a person who has an urgent need for medical
services;
(3) assist a person who is experiencing barriers in
the Medicaid application and enrollment process and refer the
person for further assistance if appropriate;
(4) educate persons so that they:
(A) understand the concept of managed care;
(B) understand their rights under Medicaid,
including grievance and appeal procedures; and
(C) are able to advocate for themselves;
(5) collect and maintain statistical information on a
regional basis regarding calls received by the assistance lines and
publish quarterly reports that:
(A) list the number of calls received by region;
(B) identify trends in delivery and access
problems;
(C) identify recurring barriers in the Medicaid
system; and
(D) indicate other problems identified with
Medicaid managed care;
(6) assist the state Medicaid office and managed care
organizations and providers in identifying and correcting
problems, including site visits to affected regions if necessary;
(7) meet the needs of all current and future Medicaid
managed care recipients, including children receiving dental
benefits and other recipients receiving benefits, under the:
(A) STAR Medicaid managed care program;
(B) STAR+PLUS [STAR + PLUS] Medicaid managed care
program, including the Texas Dual Eligibles Integrated Care
Demonstration Project provided under that program;
(C) STAR Kids managed care program established
under Section 533.071 [533.00253]; and
(D) STAR Health program;
(8) incorporate support services for children
enrolled in the child health plan established under Chapter 62,
Health and Safety Code; and
(9) ensure that staff providing support and
information services receives sufficient training, including
training in the Medicare program for the purpose of assisting
recipients who are dually eligible for Medicare and Medicaid, and
has sufficient authority to resolve barriers experienced by
recipients to health care and long-term services and supports.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.02132, 531.0601, and 531.0602 to
read as follows:
Sec. 531.02132. EDUCATION PROGRAM FOR MEDICALLY DEPENDENT
CHILDREN (MDCP) WAIVER PROGRAM. The commission shall develop an
education program for the families of and care coordinators for
children eligible for or receiving benefits under the medically
dependent children (MDCP) waiver program that:
(1) educates the families and care coordinators about:
(A) the option to receive benefits under a
traditional fee-for-service model under Section 32.042421, Human
Resources Code, or through the STAR Kids managed care program under
Section 533.071; and
(B) the evaluation and assessment process for
determining eligibility for and receiving benefits under the
medically dependent children (MDCP) waiver program; and
(2) provides information to families on the appeals
process, including how to prepare for an appeal.
Sec. 531.0601. LONG-TERM CARE SERVICES WAIVER PROGRAM
INTEREST LISTS. (a) This section applies only to a child who
becomes ineligible for services under the medically dependent
children (MDCP) waiver program because the child no longer meets:
(1) the level of care criteria for medical necessity
for nursing facility care; or
(2) the age requirement for the program.
(b) A parent or guardian of a child who is notified by the
commission that the child is no longer eligible for the medically
dependent children (MDCP) waiver program may request that the
commission:
(1) return the child to the interest list for the
program unless the child is ineligible due to the child's age; or
(2) place the child on the interest list for another
Section 1915(c) waiver program.
(c) At the time a child's parent or guardian makes a request
under Subsection (b), the commission shall:
(1) for a child who becomes ineligible for the reason
described by Subsection (a)(1), place the child:
(A) on the interest list for the medically
dependent children (MDCP) waiver program in the first position on
the list; or
(B) except as provided by Subdivision (3), on the
interest list for another Section 1915(c) waiver program in a
position relative to other persons on the list that is based on the
date the child was initially placed on the interest list for the
medically dependent children (MDCP) waiver program;
(2) except as provided by Subdivision (3) and subject
to Section 533.071(e) and Section 32.042421(b), Human Resources
Code, for a child who becomes ineligible for the reason described by
Subsection (a)(2), place the child on the interest list for another
Section 1915(c) waiver program in a position relative to other
persons on the list that is based on the date the child was
initially placed on the interest list for the medically dependent
children (MDCP) waiver program; or
(3) for a child who becomes ineligible for a reason
described by Subsection (a) and who is already on an interest list
for another Section 1915(c) waiver program, move the child to a
position on the interest list relative to other persons on the list
that is based on the date the child was initially placed on the
interest list for the medically dependent children (MDCP) waiver
program, if that date is earlier than the date the child was
initially placed on the interest list for the other waiver program.
(d) At the time the commission provides notice to a parent
or guardian that a child is no longer eligible for the medically
dependent children (MDCP) waiver program, the commission shall
inform the parent or guardian in writing about the options under
this section for placing the child on an interest list.
Sec. 531.0602. MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
PROGRAM REASSESSMENTS. To the extent allowed by federal law, the
commission shall require that a child participating in the
medically dependent children (MDCP) waiver program be reassessed to
determine whether the child meets the level of care criteria for
medical necessity for nursing facility care only if the child has a
significant change in function that may affect the medical
necessity for that level of care instead of requiring that the
reassessment be made annually.
SECTION 3. Section 533.0025(b), Government Code, is amended
to read as follows:
(b) Except as otherwise provided by this section and Section
32.042421, Human Resources Code, and notwithstanding any other law,
the commission shall provide Medicaid acute care services through
the most cost-effective model of Medicaid capitated managed care as
determined by the commission. The commission shall require
mandatory participation in a Medicaid capitated managed care
program for all persons eligible for Medicaid acute care benefits,
but may implement alternative models or arrangements, including a
traditional fee-for-service arrangement, if the commission
determines the alternative would be more cost-effective or
efficient.
SECTION 4. Section 533.0063(c), Government Code, is amended
to read as follows:
(c) A managed care organization participating in the
STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
[Medicaid] managed care program established under Section 533.071
[533.00253] shall, for a recipient in that program, issue a
provider network directory for the program in paper form unless the
recipient opts out of receiving the directory in paper form.
SECTION 5. Chapter 533, Government Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. STAR KIDS MANAGED CARE PROGRAM
Sec. 533.072. MEDICALLY DEPENDENT CHILD OPT-IN
ALTERNATIVE. (a) The commission shall provide a process by which
the parent or guardian of a child receiving benefits under the
medically dependent children (MDCP) waiver program may opt the
medically dependent child out of receiving benefits through the
traditional fee-for-service delivery model under Section
32.042421, Human Resources Code, and into receiving benefits
through the STAR Kids managed care program operated under Section
533.071. The commission shall ensure that any transition in the
delivery of benefits to a child under this section is completed in a
manner that protects continuity of care.
(b) Notwithstanding any other law, the commission shall
ensure that:
(1) the parent or guardian of a child who opts the
child into receiving benefits through the STAR Kids managed care
program under this section is allowed to choose the managed care
plan offered under the STAR Kids managed care program into which the
child is enrolled, regardless of the health care service region in
which the child resides; and
(2) a child receiving benefits through the STAR Kids
managed care program under this section is not required to obtain
prior authorization or a referral for the provision of specialty
care.
Sec. 533.073. MANAGED CARE ORGANIZATION STANDARDIZED
POLICIES AND PROCEDURES. Notwithstanding any other law, including
Section 533.005, the commission shall adopt standardized policies
and procedures applicable to each managed care organization that
contracts with the commission to provide health care services to
recipients under the STAR Kids managed care program to ensure the
provision of benefits is substantially similar across all of those
managed care organizations. The commission shall adopt policies
and procedures under this section that require managed care
organizations, under the terms of the organizations' contracts, to
implement and adhere to:
(1) a standard prior authorization protocol,
including minimum time frames for approving prior authorization
requests;
(2) standardized claims payment and appeal processes;
(3) a standard approval process for the provision of
nonemergency transportation services;
(4) similar requirements for accessing therapy
services;
(5) a pharmacy benefit plan that complies strictly
with Sections 533.005(a)(23)(A), (B), and (C) and does not impose
additional requirements or restrictions on its enrolled
recipients; and
(6) a robust online recipient and provider portal that
is designed to support transparency, accountability, and the
coordination of services by providing the recipients and providers,
as appropriate, access to evaluations and assessments, including
any screening and assessment instruments, individual service
plans, prior authorization requests, explanations of benefits, and
referrals.
Sec. 533.074. STANDARDS FOR DETERMINING MEDICAL NECESSITY.
The commission shall establish standards that govern the processes,
criteria, and guidelines under which managed care organizations
determine the medical necessity of a health care service provided
through the STAR Kids managed care program. In establishing
standards under this section, the commission shall ensure that the
treating provider or other neutral third party makes the
determination of medical necessity rather than a care coordinator
or other professional employed by the managed care organization.
Sec. 533.075. PROVIDER NETWORK REQUIREMENTS.
Notwithstanding any other law, the commission shall require a
managed care organization that contracts with the commission to
provide health care services to recipients under the STAR Kids
managed care program to:
(1) include significant traditional providers in the
organization's provider network for the duration of the
organization's contract with the commission; and
(2) include at least two providers of a particular
health care service in order to satisfy network adequacy
requirements.
Sec. 533.076. PROVIDER MONITORING PROGRAM. (a)
Notwithstanding Section 533.005(a)(22), the commission, in
consultation with the STAR Kids Managed Care Advisory Committee
established under Section 533.00254 or a successor committee, the
advisory committee established under Section 534.183, and other
organizations with relevant expertise the commission determines
appropriate, shall ensure a contract between the commission and a
managed care organization to provide health care services to
children receiving benefits under the medically dependent children
(MDCP) waiver program through the STAR Kids managed care program in
accordance with Sections 531.071(e) and 533.072 contains a
requirement that the managed care organization develop a monitoring
program that uses individual and consumer-based quality metrics
designed specifically with the needs of the recipient population in
mind for purposes of measuring the quality of health care services
provided by the organization's provider network.
(b) Based on metrics designed under Subsection (a), each
managed care organization that contracts with the commission as
described by that subsection shall perform evaluations and audits
of the organization's provider network.
Sec. 533.077. PROVIDER PROTECTIONS. (a) Notwithstanding
any other law, the commission shall require a managed care
organization that contracts with the commission to provide health
care services to recipients under the STAR Kids managed care
program to:
(1) obtain the express approval of a recipient's
parent or guardian before selecting a provider for the recipient or
changing that provider; and
(2) reimburse a provider for a service at a rate that
is at least 75 percent of the reimbursement rate paid for the same
service under the traditional fee-for-service delivery model
implemented under Section 32.042421, Human Resources Code.
(b) The commission shall establish a complaints process for
providers contracting with managed care organizations that
contract with the commission to provide health care services to
recipients under the STAR Kids managed care program under which the
providers are:
(1) confident their complaints will be appropriately
considered and resolved and will not be referred back to the managed
care organization; and
(2) protected from retaliatory action by the managed
care organization.
Sec. 533.078. REGIONAL REVIEW PANELS. (a) The commission
shall establish regional review panels to review denials based on
medical necessity issued by managed care organizations that
contract with the commission to provide health care services under
the STAR Kids managed care program. The panels must be composed of
at least six but not more than eight members and must include:
(1) the parent or guardian of a child with an
intellectual or developmental disability who has complex medical
needs;
(2) an advocate for children with an intellectual or
developmental disability;
(3) a representative of primary care physicians
participating in the STAR Medicaid managed care program or the STAR
Kids managed care program; and
(4) a representative of health care providers, other
than primary care physicians, participating in the STAR Medicaid
managed care program or the STAR Kids managed care program.
(b) The executive commissioner or the executive
commissioner's designee shall appoint a presiding member of each
regional review panel established under this section.
(c) Each regional review panel shall meet at least quarterly
at the call of the presiding officer.
(d) Each member of a regional review panel serves without
compensation.
(e) A regional review panel established under this section
shall:
(1) review denials described by Subsection (a) for
which there are requests for the commission to conduct a fair
hearing before the commission conducts its fair hearing;
(2) make a determination regarding whether to uphold
or overturn the denial; and
(3) notify all parties and the commission of the
regional review panel's determination under Subdivision (2).
(f) If a regional review panel upholds a denial, the
recipient or provider, as applicable, may further pursue a fair
hearing with the commission. If a regional review panel overturns a
denial, the managed care organization is bound by the determination
but may appeal the determination to the commission.
(g) The commission is not bound by a determination of a
regional review panel under this section.
(h) The executive commissioner shall adopt rules necessary
to implement this section.
SECTION 6. Section 533.00253, Government Code, is
transferred to Subchapter C, Chapter 533, Government Code, as added
by this Act, redesignated as Section 533.071, Government Code, and
amended to read as follows:
Sec. 533.071 [533.00253]. STAR KIDS [MEDICAID] MANAGED
CARE PROGRAM. (a) In this section:
(1) "Advisory committee" means the STAR Kids Managed
Care Advisory Committee established under Section 533.00254 or a
successor committee.
(2) "Health home" means a primary care provider
practice, or, if appropriate, a specialty care provider practice,
incorporating several features, including comprehensive care
coordination, family-centered care, and data management, that are
focused on improving outcome-based quality of care and increasing
patient and provider satisfaction under Medicaid.
(3) "Potentially preventable event" has the meaning
assigned by Section 536.001.
(b) Except as provided by Section 32.042421, Human
Resources Code, and subject [Subject] to Section 533.0025, the
commission shall operate[, in consultation with the Children's
Policy Council established under Section 22.035, Human Resources
Code, establish] a mandatory STAR Kids capitated managed care
program tailored to provide Medicaid benefits to children with
disabilities. The managed care program [developed] under this
section must:
(1) provide Medicaid benefits that are customized to
meet the health care needs of recipients under the program through a
defined system of care;
(2) better coordinate care of recipients under the
program;
(3) improve the health outcomes of recipients;
(4) improve recipients' access to health care
services;
(5) achieve cost containment and cost efficiency;
(6) reduce the administrative complexity of
delivering Medicaid benefits;
(7) reduce the incidence of unnecessary
institutionalizations and potentially preventable events by
ensuring the availability of appropriate services and care
management;
(8) require a health home; and
(9) coordinate and collaborate with long-term care
service providers and long-term care management providers, if
recipients are receiving long-term services and supports outside of
the managed care organization.
(c) The commission may require that care management
services made available as provided by Subsection (b)(7):
(1) incorporate best practices, as determined by the
commission;
(2) integrate with a nurse advice line to ensure
appropriate redirection rates;
(3) use an identification and stratification
methodology that identifies recipients who have the greatest need
for services;
(4) provide a care needs assessment for a recipient
that is comprehensive, holistic, consumer-directed,
evidence-based, and takes into consideration social and medical
issues, for purposes of prioritizing the recipient's needs that
threaten independent living;
(5) are delivered through multidisciplinary care
teams located in different geographic areas of this state that use
in-person contact with recipients and their caregivers;
(6) identify immediate interventions for transition
of care;
(7) include monitoring and reporting outcomes that, at
a minimum, include:
(A) recipient quality of life;
(B) recipient satisfaction; and
(C) other financial and clinical metrics
determined appropriate by the commission; and
(8) use innovations in the provision of services.
(d) The commission shall provide Medicaid benefits through
the STAR Kids managed care program operated [established] under
this section to a child [children] who is [are] receiving benefits
under the medically dependent children (MDCP) waiver program if the
parent or guardian of the medically dependent child opts the child
into receiving benefits through the STAR Kids managed care program
in accordance with Section 533.072. The commission shall ensure
that the STAR Kids managed care program provides all of the benefits
provided under the medically dependent children (MDCP) waiver
program to the extent necessary to implement this subsection.
(e) The commission shall ensure that there is a plan for
transitioning the provision of Medicaid benefits to recipients 21
years of age or older from under the STAR Kids managed care program
to under:
(1) the STAR+PLUS [STAR + PLUS] Medicaid managed care
program; or
(2) if the child is receiving benefits under the
medically dependent children (MDCP) waiver program and the
commission determines it is more appropriate, another Medicaid
waiver program, as defined by Section 534.001.
(f) The commission shall ensure that the plan described by
Subsection (e):
(1) protects the recipient's continuity of care;
(2) if applicable and to the maximum extent possible,
avoids placing a recipient on an interest list for a Medicaid waiver
program, as defined by Section 534.001; and
(3) provides for[. The plan must ensure that]
coordination between the STAR Kids managed care program and the
STAR+PLUS Medicaid managed care program or other Medicaid waiver
program beginning [programs begins] when a recipient reaches 18
years of age.
SECTION 7. Section 533.00254(f), Government Code, is
amended to read as follows:
(f) On the first anniversary of the date the commission
completes implementation of the STAR Kids [Medicaid] managed care
program under Section 533.071 [533.00253]:
(1) the advisory committee is abolished; and
(2) this section expires.
SECTION 8. Section 533.0063(c), Government Code, is amended
to read as follows:
(c) A managed care organization participating in the
STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
[Medicaid] managed care program operated [established] under
Section 533.071 [533.00253] shall, for a recipient in that program,
issue a provider network directory for the program in paper form
unless the recipient opts out of receiving the directory in paper
form.
SECTION 9. Chapter 534, Government Code, is amended by
adding Subchapter D-1 to read as follows:
SUBCHAPTER D-1. ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
Sec. 534.181. DEFINITIONS. In this subchapter:
(1) "Health care service region" has the meaning
assigned by Section 533.001.
(2) "Pilot program" means the pilot program
implemented under this subchapter.
Sec. 534.182. ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
IMPLEMENTATION. (a) The commission shall develop and implement a
pilot program to test alternative methods for delivering Medicaid
benefits to children with an intellectual or developmental
disability, including children receiving benefits under the
medically dependent children (MDCP) waiver program, who are
otherwise receiving some or all of those benefits through the STAR
Medicaid managed care program or the STAR Kids managed care
program. The commission shall design the pilot program in a manner
that allows the commission to determine whether the alternative
delivery methods:
(1) achieve cost savings and efficiencies in the
delivery of Medicaid acute care services and long-term services and
supports; and
(2) improve the quality of and access to the services
described by Subdivision (1).
(b) The pilot program must:
(1) be conducted in each health care service region of
this state, begin not later than September 1, 2020, and operate for
at least 24 months;
(2) include a total of at least 2,000 Medicaid
recipients receiving benefits under the STAR Medicaid managed care
program, and a total of at least 2,000 Medicaid recipients
receiving benefits under the STAR Kids managed care program; and
(3) be designed in a manner that ensures continuity of
care and the receipt of Medicaid acute care services and long-term
services and supports for program participants.
(c) Recipient participation in the pilot program must be
voluntary.
Sec. 534.183. ADVISORY COMMITTEE. (a) In developing the
pilot program, the executive commissioner shall seek input from
stakeholders by establishing an advisory committee to make
recommendations to the commission on pilot program goals, outcome
measures, and evaluation processes.
(b) The advisory committee must be composed of at least
eight members who have expertise in and knowledge of the care needs
of potential pilot program participants, including:
(1) a representative of the commission;
(2) the parent or guardian of a child with an
intellectual or developmental disability who has complex medical
needs;
(3) an advocate for children with an intellectual or
developmental disability;
(4) a representative of primary care physicians
participating in the STAR Medicaid managed care program or the STAR
Kids managed care program; and
(5) a representative of health care providers, other
than primary care physicians, participating in the STAR Medicaid
managed care program or the STAR Kids managed care program.
(c) The executive commissioner shall appoint a member of the
advisory committee as the presiding officer.
(d) The advisory committee shall meet at least quarterly at
the call of the presiding officer.
(e) A member of the advisory committee serves without
compensation.
(f) The advisory committee is subject to the requirements of
Chapter 551.
Sec. 534.184. REPORTING REQUIREMENT. (a) The commission
shall conduct an initial evaluation of the pilot program and submit
a written report on that evaluation not later than September 1,
2021, to:
(1) the legislature, including the standing
committees of the house of representatives and senate having
primary jurisdiction over Medicaid;
(2) the advisory committee established under Section
534.183; and
(3) the STAR Kids Managed Care Advisory Committee
established under Section 533.00254 or a successor committee.
(b) The commission shall conduct a final evaluation of the
pilot program and submit a written report on that evaluation to the
entities described under Subsection (a) not later than September 1,
2022.
(c) Each evaluation required under this section must
include:
(1) an evaluation of the success of the pilot program
in achieving the program's goals; and
(2) recommendations for legislation that identify any
statutory requirements that are impairing the success of the
program or that may impair permanent implementation of a program
delivery model.
Sec. 534.185. MORATORIUM ON IMPLEMENTATION OF CERTAIN LAW.
Notwithstanding any other law, including Subchapter E, the
commission may not expand on or after December 1, 2019, the delivery
of Medicaid acute care services or long-term services and supports
to children with an intellectual or developmental disability under
the STAR Medicaid managed care program or the STAR Kids managed care
program until the commission submits to the legislature the report
on the final evaluation required under Section 534.184.
Sec. 534.186. EXPIRATION. This subchapter expires
September 1, 2022.
SECTION 10. Section 32.0212, Human Resources Code, is
amended to read as follows:
Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE. Except as
provided by Section 32.042421 and notwithstanding
[Notwithstanding] any other law [and subject to Section 533.0025,
Government Code], the commission shall provide medical assistance
for acute care services through the Medicaid managed care system in
accordance with [implemented under] Chapter 533, Government Code,
or another Medicaid capitated managed care program.
SECTION 11. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.042421 to read as follows:
Sec. 32.042421. DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN
RECIPIENTS UNDER THE MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
PROGRAM. (a) The commission shall establish a program to provide
medical assistance benefits under a traditional fee-for-service
delivery model to a recipient who is a child receiving benefits
under the medically dependent children (MDCP) waiver program,
including a recipient who is a participant in the health insurance
premium payment program under Section 32.0422.
(b) To the same extent required under Section 533.071(e),
Government Code, the commission shall ensure that there is a plan
for transitioning the provision of Medicaid benefits to recipients
21 years of age or older from the fee-for-service delivery model
provided under this section to the STAR+PLUS Medicaid managed care
program or, if appropriate, a Medicaid waiver program, as defined
by Section 534.001, Government Code, that protects continuity of
care. The plan must ensure that the coordination begins when the
recipient reaches 18 years of age.
(c) The executive commissioner shall adopt rules necessary
to implement this section.
SECTION 12. As soon as practicable after the effective date
of this Act, the Health and Human Services Commission shall conduct
a study to identify incentives the commission could implement to
increase the number of physicians and other health care providers
contracting with managed care organizations to provide services to
children with complex medical needs who are recipients under
Medicaid. Not later than December 1, 2021, the commission shall
submit a report of its findings under the study to the standing
committees of the house of representatives and senate having
primary jurisdiction over the Medicaid program.
SECTION 13. (a) As soon as possible after the effective
date of this Act, the Health and Human Services Commission shall
identify each child who became ineligible for services under the
medically dependent children (MDCP) waiver program on or after June
1, 2016, and before the effective date of this Act.
(b) Section 531.0601, Government Code, as added by this Act,
applies to:
(1) a child who becomes ineligible for the medically
dependent children (MDCP) waiver program on or after the effective
date of this Act; and
(2) a child identified under Subsection (a) of this
section.
SECTION 14. Section 531.0602, Government Code, as added by
this Act, applies only to a reassessment of a child's eligibility
for the medically dependent children (MDCP) waiver program made on
or after the effective date of this Act.
SECTION 15. Not later than December 1, 2019, the executive
commissioner of the Health and Human Services Commission shall
establish the advisory committee required by Section 534.183,
Government Code, as added by this Act.
SECTION 16. (a) Not later than September 1, 2020, and
subject to Subsections (b) and (c) of this section, the Health and
Human Services Commission shall:
(1) adopt the standardized policies and procedures
required by Section 533.073, Government Code, as added by this Act,
for managed care organizations participating in the STAR Kids
managed care program;
(2) establish the standards for determining medical
necessity required by Section 533.074, Government Code, as added by
this Act, and applicable to managed care organizations
participating in the STAR Kids managed care program;
(3) implement the provider protections required under
Section 533.077, Government Code, as added by this Act; and
(4) establish the regional review panels required by
Section 533.078, Government Code, as added by this Act.
(b) The Health and Human Services Commission shall ensure
that a contract between the commission and a managed care
organization to provide Medicaid benefits to recipients under the
STAR Kids managed care program operated under Section 533.071,
Government Code, as transferred, redesignated, and amended by this
Act, that is entered into or renewed on or after the effective date
of this Act complies with the provisions of Subchapter C, Chapter
533, Government Code, as added by this Act.
(c) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations to
provide Medicaid benefits to recipients under the STAR Kids managed
care program operated under Section 533.071, Government Code, as
transferred, redesignated, and amended by this Act, before the
effective date of this Act to ensure those contracts comply with the
provisions of Subchapter C, Chapter 533, Government Code, as added
by this Act. To the extent of a conflict between a provision of that
subchapter and a term of a contract with a managed care organization
entered into before the effective date of this Act, the contract
provision prevails.
SECTION 17. 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 18. This Act takes effect September 1, 2019.