Texas 2019 - 86th Regular

Texas House Bill HB3695 Compare Versions

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

Old	New	Differences
1	1	86R10863 KFF-F
2	2	By: Miller H.B. No. 3695
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to providing access to local health departments and
8	8	certain health service regional offices under the Medicaid managed
9	9	care program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 533.001, Government Code, is amended by
12	12	adding Subdivisions (3-a) and (3-b) to read as follows:
13	13	(3-a) "Health service regional office" means an office
14	14	located in a public health region and administered by a regional
15	15	director under Section 121.007, Health and Safety Code.
16	16	(3-b) "Local health department" means a local health
17	17	department established under Subchapter D, Chapter 121, Health and
18	18	Safety Code.
19	19	SECTION 2. Section 533.006(a), Government Code, is amended
20	20	to read as follows:
21	21	(a) The commission shall require that each managed care
22	22	organization that contracts with the commission to provide health
23	23	care services to recipients in a region:
24	24	(1) seek participation in the organization's provider
25	25	network from:
26	26	(A) each health care provider in the region who
27	27	has traditionally provided care to recipients;
28	28	(B) each hospital in the region that has been
29	29	designated as a disproportionate share hospital under Medicaid;
30	30	[and]
31	31	(C) each specialized pediatric laboratory in the
32	32	region, including those laboratories located in children's
33	33	hospitals; and
34	34	(D) each local health department in the region
35	35	and each health service regional office acting in the capacity of a
36	36	local health department in the region; and
37	37	(2) include in its provider network for not less than
38	38	three years:
39	39	(A) each health care provider in the region who:
40	40	(i) previously provided care to Medicaid
41	41	and charity care recipients at a significant level as prescribed by
42	42	the commission;
43	43	(ii) agrees to accept the prevailing
44	44	provider contract rate of the managed care organization; and
45	45	(iii) has the credentials required by the
46	46	managed care organization, provided that lack of board
47	47	certification or accreditation by The Joint Commission may not be
48	48	the sole ground for exclusion from the provider network;
49	49	(B) each accredited primary care residency
50	50	program in the region; [and]
51	51	(C) each disproportionate share hospital
52	52	designated by the commission as a statewide significant traditional
53	53	provider; and
54	54	(D) each local health department in the region
55	55	and each health service regional office acting in the capacity of a
56	56	local health department in the region.
57	57	SECTION 3. Section 533.0061(a), Government Code, is amended
58	58	to read as follows:
59	59	(a) The commission shall establish minimum provider access
60	60	standards for the provider network of a managed care organization
61	61	that contracts with the commission to provide health care services
62	62	to recipients. The access standards must ensure that a managed
63	63	care organization provides recipients sufficient access to:
64	64	(1) preventive care;
65	65	(2) primary care;
66	66	(3) specialty care;
67	67	(4) after-hours urgent care;
68	68	(5) chronic care;
69	69	(6) long-term services and supports;
70	70	(7) nursing services;
71	71	(8) therapy services, including services provided in a
72	72	clinical setting or in a home or community-based setting; [and]
73	73	(9) services provided by each local health department
74	74	in the region and each health service regional office acting in the
75	75	capacity of a local health department in the region; and
76	76	(10) any other services identified by the commission.
77	77	SECTION 4. (a) The Health and Human Services Commission
78	78	shall, in a contract between the commission and a managed care
79	79	organization under Chapter 533, Government Code, that is entered
80	80	into or renewed on or after the effective date of this Act, require
81	81	that the managed care organization comply with Section 533.006,
82	82	Government Code, as amended by this Act.
83	83	(b) The Health and Human Services Commission shall seek to
84	84	amend contracts entered into with managed care organizations under
85	85	Chapter 533, Government Code, before the effective date of this Act
86	86	to require those managed care organizations to comply with Section
87	87	533.006, Government Code, as amended by this Act. To the extent of
88	88	a conflict between that section and a provision of a contract with a
89	89	managed care organization entered into before the effective date of
90	90	this Act, the contract provision prevails.
91	91	SECTION 5. If before implementing any provision of this Act
92	92	a state agency determines that a waiver or authorization from a
93	93	federal agency is necessary for implementation of that provision,
94	94	the agency affected by the provision shall request the waiver or
95	95	authorization and may delay implementing that provision until the
96	96	waiver or authorization is granted.
97	97	SECTION 6. This Act takes effect September 1, 2019.