86R9846 KFF-D
By: Perry S.B. No. 1094
A BILL TO BE ENTITLED
AN ACT
relating to the delivery of Medicaid benefits to certain medically
dependent children with private health benefits coverage.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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 2. Sections 533.00253(b) and (d), Government Code,
are amended to read as follows:
(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.
(d) The commission shall provide Medicaid benefits through
the STAR Kids managed care program operated [established] under
this section to children who are receiving benefits under the
medically dependent children (MDCP) waiver program, except that the
parent or guardian of a medically dependent child may opt the child
out of receiving benefits through the STAR Kids managed care
program and instead have the child receive benefits in accordance
with Section 32.042421, Human Resources Code. 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.
SECTION 3. 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 4. 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
MEDICALLY DEPENDENT CHILDREN WITH PRIVATE HEALTH BENEFITS
COVERAGE. (a) The commission shall establish a program to provide
medical assistance benefits under a fee-for-service delivery model
to a recipient who:
(1) has private health benefits coverage, including a
recipient participating in the health insurance premium payment
program under Section 32.0422; and
(2) is a child receiving benefits under the medically
dependent children (MDCP) waiver program.
(b) In establishing a program under this section, the
commission shall ensure that the medical assistance program is the
secondary payor for covered benefits after application of the
private health benefits coverage.
(c) The executive commissioner shall adopt rules necessary
to implement this section.
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.