TX
Texas Senate Bill SB2021

Texas 2019 - 86th Regular

Texas Senate Bill SB2021 Compare Versions

OldNewDifferences
1-86R32414 KFF-F
21 By: Miles S.B. No. 2021
3- (Miller, Thompson of Harris)
4- Substitute the following for S.B. No. 2021: No.
52
63
74 A BILL TO BE ENTITLED
85 AN ACT
96 relating to providing access to local health departments and
10- certain health service regional offices under Medicaid.
7+ certain health service regional offices under the Medicaid managed
8+ care program.
119 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12- SECTION 1. Section 32.003, Human Resources Code, is amended
13- by adding Subdivisions (2) and (3) to read as follows:
14- (2) "Health service regional office" means an office
10+ SECTION 1. Section 533.001, Government Code, is amended by
11+ adding Subdivisions (3-a) and (3-b) to read as follows:
12+ (3-a) "Health service regional office" means an office
1513 located in a public health region and administered by a regional
1614 director under Section 121.007, Health and Safety Code.
17- (3) "Local health department" means a local health
15+ (3-b) "Local health department" means a local health
1816 department established under Subchapter D, Chapter 121, Health and
1917 Safety Code.
20- SECTION 2. Section 32.024, Human Resources Code, is amended
21- by adding Subsection (ll) to read as follows:
22- (ll) The executive commissioner shall establish a separate
23- provider type for local health departments, including health
24- service regional offices acting in the capacity of local health
25- departments, for purposes of enrollment as a provider for and
26- reimbursement under the medical assistance program.
27- SECTION 3. Section 32.101(2), Human Resources Code, is
28- amended to read as follows:
29- (2) "Health care provider" means a person, other than
30- a physician, who:
31- (A) is licensed or otherwise authorized to
32- provide a health care service in this state, including:
33- (i) a pharmacist, dentist, optometrist,
34- mental health counselor, social worker, advanced practice nurse,
35- physician assistant, or durable medical equipment supplier; [or]
36- (ii) a pharmacy, hospital, or other
37- institution or organization; or
38- (iii) a local health department or a health
39- service regional office acting in the capacity of a local health
40- department in a public health region;
41- (B) is wholly owned or controlled by:
42- (i) a health care provider or a group of
43- health care providers described by Paragraph (A); or
44- (ii) one or more hospitals and physicians,
45- including a physician-hospital organization;
46- (C) is a professional association of physicians
47- organized under the Texas Professional Association Law, as
48- described by Section 1.008, Business Organizations Code;
49- (D) is an approved nonprofit health corporation
50- certified under Chapter 162, Occupations Code;
51- (E) is a medical and dental unit, as defined by
52- Section 61.003, Education Code, a medical school, as defined by
53- Section 61.501, Education Code, or a health science center
54- described by Subchapter K, Chapter 74, Education Code, that employs
55- or contracts with physicians to teach or provide medical services,
56- or employs physicians and contracts with physicians in a practice
57- plan; or
58- (F) is another person wholly owned by physicians.
18+ SECTION 2. Section 533.006(a), Government Code, is amended
19+ to read as follows:
20+ (a) The commission shall require that each managed care
21+ organization that contracts with the commission to provide health
22+ care services to recipients in a region:
23+ (1) seek participation in the organization's provider
24+ network from:
25+ (A) each health care provider in the region who
26+ has traditionally provided care to recipients;
27+ (B) each hospital in the region that has been
28+ designated as a disproportionate share hospital under Medicaid;
29+ [and]
30+ (C) each specialized pediatric laboratory in the
31+ region, including those laboratories located in children's
32+ hospitals; and
33+ (D) each local health department in the region
34+ and each health service regional office acting in the capacity of a
35+ local health department in the region; and
36+ (2) include in its provider network for not less than
37+ three years:
38+ (A) each health care provider in the region who:
39+ (i) previously provided care to Medicaid
40+ and charity care recipients at a significant level as prescribed by
41+ the commission;
42+ (ii) agrees to accept the prevailing
43+ provider contract rate of the managed care organization; and
44+ (iii) has the credentials required by the
45+ managed care organization, provided that lack of board
46+ certification or accreditation by The Joint Commission may not be
47+ the sole ground for exclusion from the provider network;
48+ (B) each accredited primary care residency
49+ program in the region; [and]
50+ (C) each disproportionate share hospital
51+ designated by the commission as a statewide significant traditional
52+ provider; and
53+ (D) each local health department in the region
54+ and each health service regional office acting in the capacity of a
55+ local health department in the region.
56+ SECTION 3. (a) The Health and Human Services Commission
57+ shall, in a contract between the commission and a managed care
58+ organization under Chapter 533, Government Code, that is entered
59+ into or renewed on or after the effective date of this Act, require
60+ that the managed care organization comply with Section 533.006,
61+ Government Code, as amended by this Act.
62+ (b) The Health and Human Services Commission shall seek to
63+ amend contracts entered into with managed care organizations under
64+ Chapter 533, Government Code, before the effective date of this Act
65+ to require those managed care organizations to comply with Section
66+ 533.006, Government Code, as amended by this Act. To the extent of
67+ a conflict between that section and a provision of a contract with a
68+ managed care organization entered into before the effective date of
69+ this Act, the contract provision prevails.
5970 SECTION 4. The Health and Human Services Commission is
6071 required to implement a provision of this Act only if the
6172 legislature appropriates money to the commission specifically for
6273 that purpose. If the legislature does not appropriate money
6374 specifically for that purpose, the commission may, but is not
6475 required to, implement a provision of this Act using other
6576 appropriations that are available for that purpose.
6677 SECTION 5. If before implementing any provision of this Act
6778 a state agency determines that a waiver or authorization from a
6879 federal agency is necessary for implementation of that provision,
6980 the agency affected by the provision shall request the waiver or
7081 authorization and may delay implementing that provision until the
7182 waiver or authorization is granted.
7283 SECTION 6. This Act takes effect September 1, 2020.