86R10863 KFF-F
By: Miller H.B. No. 3695
A BILL TO BE ENTITLED
AN ACT
relating to providing access to local health departments and
certain health service regional offices under the Medicaid managed
care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.001, Government Code, is amended by
adding Subdivisions (3-a) and (3-b) to read as follows:
(3-a) "Health service regional office" means an office
located in a public health region and administered by a regional
director under Section 121.007, Health and Safety Code.
(3-b) "Local health department" means a local health
department established under Subchapter D, Chapter 121, Health and
Safety Code.
SECTION 2. Section 533.006(a), Government Code, is amended
to read as follows:
(a) The commission shall require that each managed care
organization that contracts with the commission to provide health
care services to recipients in a region:
(1) seek participation in the organization's provider
network from:
(A) each health care provider in the region who
has traditionally provided care to recipients;
(B) each hospital in the region that has been
designated as a disproportionate share hospital under Medicaid;
[and]
(C) each specialized pediatric laboratory in the
region, including those laboratories located in children's
hospitals; and
(D) each local health department in the region
and each health service regional office acting in the capacity of a
local health department in the region; and
(2) include in its provider network for not less than
three years:
(A) each health care provider in the region who:
(i) previously provided care to Medicaid
and charity care recipients at a significant level as prescribed by
the commission;
(ii) agrees to accept the prevailing
provider contract rate of the managed care organization; and
(iii) has the credentials required by the
managed care organization, provided that lack of board
certification or accreditation by The Joint Commission may not be
the sole ground for exclusion from the provider network;
(B) each accredited primary care residency
program in the region; [and]
(C) each disproportionate share hospital
designated by the commission as a statewide significant traditional
provider; and
(D) each local health department in the region
and each health service regional office acting in the capacity of a
local health department in the region.
SECTION 3. Section 533.0061(a), Government Code, is amended
to read as follows:
(a) The commission shall establish minimum provider access
standards for the provider network of a managed care organization
that contracts with the commission to provide health care services
to recipients. The access standards must ensure that a managed
care organization provides recipients sufficient access to:
(1) preventive care;
(2) primary care;
(3) specialty care;
(4) after-hours urgent care;
(5) chronic care;
(6) long-term services and supports;
(7) nursing services;
(8) therapy services, including services provided in a
clinical setting or in a home or community-based setting; [and]
(9) services provided by each local health department
in the region and each health service regional office acting in the
capacity of a local health department in the region; and
(10) any other services identified by the commission.
SECTION 4. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this Act, require
that the managed care organization comply with Section 533.006,
Government Code, as amended by this Act.
(b) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations under
Chapter 533, Government Code, before the effective date of this Act
to require those managed care organizations to comply with Section
533.006, Government Code, as amended by this Act. To the extent of
a conflict between that section and a provision of a contract with a
managed care organization entered into before the effective date of
this Act, the contract provision prevails.
SECTION 5. 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 6. This Act takes effect September 1, 2019.