Texas 2019 - 86th Regular

Texas Senate Bill SB1094 Compare Versions

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

Old	New	Differences
1	1	86R9846 KFF-D
2	2	By: Perry S.B. No. 1094
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the delivery of Medicaid benefits to certain medically
8	8	dependent children with private health benefits coverage.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 533.0025(b), Government Code, is amended
11	11	to read as follows:
12	12	(b) Except as otherwise provided by this section and Section
13	13	32.042421, Human Resources Code, and notwithstanding any other law,
14	14	the commission shall provide Medicaid acute care services through
15	15	the most cost-effective model of Medicaid capitated managed care as
16	16	determined by the commission. The commission shall require
17	17	mandatory participation in a Medicaid capitated managed care
18	18	program for all persons eligible for Medicaid acute care benefits,
19	19	but may implement alternative models or arrangements, including a
20	20	traditional fee-for-service arrangement, if the commission
21	21	determines the alternative would be more cost-effective or
22	22	efficient.
23	23	SECTION 2. Sections 533.00253(b) and (d), Government Code,
24	24	are amended to read as follows:
25	25	(b) Except as provided by Section 32.042421, Human
26	26	Resources Code, and subject [Subject] to Section 533.0025, the
27	27	commission shall operate [, in consultation with the Children's
28	28	Policy Council established under Section 22.035, Human Resources
29	29	Code, establish] a mandatory STAR Kids capitated managed care
30	30	program tailored to provide Medicaid benefits to children with
31	31	disabilities. The managed care program [developed] under this
32	32	section must:
33	33	(1) provide Medicaid benefits that are customized to
34	34	meet the health care needs of recipients under the program through a
35	35	defined system of care;
36	36	(2) better coordinate care of recipients under the
37	37	program;
38	38	(3) improve the health outcomes of recipients;
39	39	(4) improve recipients' access to health care
40	40	services;
41	41	(5) achieve cost containment and cost efficiency;
42	42	(6) reduce the administrative complexity of
43	43	delivering Medicaid benefits;
44	44	(7) reduce the incidence of unnecessary
45	45	institutionalizations and potentially preventable events by
46	46	ensuring the availability of appropriate services and care
47	47	management;
48	48	(8) require a health home; and
49	49	(9) coordinate and collaborate with long-term care
50	50	service providers and long-term care management providers, if
51	51	recipients are receiving long-term services and supports outside of
52	52	the managed care organization.
53	53	(d) The commission shall provide Medicaid benefits through
54	54	the STAR Kids managed care program operated [established] under
55	55	this section to children who are receiving benefits under the
56	56	medically dependent children (MDCP) waiver program, except that the
57	57	parent or guardian of a medically dependent child may opt the child
58	58	out of receiving benefits through the STAR Kids managed care
59	59	program and instead have the child receive benefits in accordance
60	60	with Section 32.042421, Human Resources Code. The commission shall
61	61	ensure that the STAR Kids managed care program provides all of the
62	62	benefits provided under the medically dependent children (MDCP)
63	63	waiver program to the extent necessary to implement this
64	64	subsection.
65	65	SECTION 3. Section 32.0212, Human Resources Code, is
66	66	amended to read as follows:
67	67	Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE. Except as
68	68	provided by Section 32.042421 and notwithstanding
69	69	[Notwithstanding] any other law [and subject to Section 533.0025,
70	70	Government Code], the commission shall provide medical assistance
71	71	for acute care services through the Medicaid managed care system in
72	72	accordance with [implemented under] Chapter 533, Government Code,
73	73	or another Medicaid capitated managed care program.
74	74	SECTION 4. Subchapter B, Chapter 32, Human Resources Code,
75	75	is amended by adding Section 32.042421 to read as follows:
76	76	Sec. 32.042421. DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN
77	77	MEDICALLY DEPENDENT CHILDREN WITH PRIVATE HEALTH BENEFITS
78	78	COVERAGE. (a) The commission shall establish a program to provide
79	79	medical assistance benefits under a fee-for-service delivery model
80	80	to a recipient who:
81	81	(1) has private health benefits coverage, including a
82	82	recipient participating in the health insurance premium payment
83	83	program under Section 32.0422; and
84	84	(2) is a child receiving benefits under the medically
85	85	dependent children (MDCP) waiver program.
86	86	(b) In establishing a program under this section, the
87	87	commission shall ensure that the medical assistance program is the
88	88	secondary payor for covered benefits after application of the
89	89	private health benefits coverage.
90	90	(c) The executive commissioner shall adopt rules necessary
91	91	to implement this section.
92	92	SECTION 5. If before implementing any provision of this Act
93	93	a state agency determines that a waiver or authorization from a
94	94	federal agency is necessary for implementation of that provision,
95	95	the agency affected by the provision shall request the waiver or
96	96	authorization and may delay implementing that provision until the
97	97	waiver or authorization is granted.
98	98	SECTION 6. This Act takes effect September 1, 2019.