S.B. No. 2138
AN ACT
relating to the administration and operation of Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.021135 to read as follows:
Sec. 531.021135. COMMISSION'S AUTHORITY TO RETAIN CERTAIN
MONEY TO ADMINISTER CERTAIN MEDICAID PROGRAMS; REPORT REQUIRED.
(a) In this section, "directed payment program" means a delivery
system and provider patient initiative implemented by this state
under 42 C.F.R. Section 438.6(c).
(b) This section applies only to money the commission
receives from a source other than the general revenue fund to
operate a waiver program established under Section 1115 of the
federal Social Security Act (42 U.S.C. Section 1315) or a directed
payment program or successor program as determined by the
commission.
(c) Subject to Subsection (e), the commission may retain
from money to which this section applies an amount equal to the
estimated costs necessary to administer the program for which the
money is received, but not to exceed $8 million for a state fiscal
year.
(d) The commission shall spend money retained under this
section to assist in paying the costs necessary to administer the
program for which the money is received, except that the commission
may not use the money to pay any type of administrative cost that,
before June 1, 2019, was funded with general revenue.
(e) If the commission determines that the commission needs
additional money to administer a program described by Subsection
(b), the commission may retain an additional amount with the
approval of the governor and the Legislative Budget Board, but not
to exceed a total retained amount equal to 0.25 percent of the total
amount estimated to be received for the program.
(f) The commission shall submit an annual report to the
governor and the Legislative Budget Board that:
(1) details the amount of money retained and spent by
the commission under this section during the preceding state fiscal
year, including a separate detail of any increase in the amount of
money retained for a program under Subsection (e);
(2) contains a transparent description of how the
commission used the money described by Subdivision (1); and
(3) assesses the extent to which the money retained by
the commission under this section covered the estimated costs to
administer the applicable program and states whether, based on that
assessment, the commission adjusted or considered adjustments to
the amount retained.
(g) The executive commissioner shall adopt rules necessary
to implement this section.
SECTION 2. Section 531.1023, Government Code, is amended to
read as follows:
Sec. 531.1023. COMPLIANCE WITH FEDERAL CODING GUIDELINES.
(a) The commission's office of inspector general, including
office staff and any third party with which the office contracts to
perform coding services, and the commission's medical and
utilization review appeals unit shall comply with federal coding
guidelines, including guidelines for diagnosis-related group (DRG)
validation and related audits.
(b) In this section, "federal coding guidelines" means the
code sets and guidelines adopted by the United States Department of
Health and Human Services in accordance with the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d
et seq.).
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0031 to read as follows:
Sec. 533.0031. MEDICAID MANAGED CARE PLAN ACCREDITATION.
(a) A managed care plan offered by a Medicaid managed care
organization must be accredited by a nationally recognized
accreditation organization. The commission may choose whether to
require all managed care plans offered by Medicaid managed care
organizations to be accredited by the same organization or to allow
for accreditation by different organizations.
(b) The commission may use the data, scoring, and other
information provided to or received from an accreditation
organization in the commission's contract oversight processes.
SECTION 4. The Health and Human Services Commission shall
require that a managed care plan offered by a Medicaid managed care
organization with which the commission enters into or renews a
contract under Chapter 533, Government Code, on or after the
effective date of this Act complies with Section 533.0031,
Government Code, as added by this Act, not later than September 1,
2022.
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 immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2019.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 2138 passed the Senate on
April 29, 2019, by the following vote: Yeas 30, Nays 1;
May 23, 2019, Senate refused to concur in House amendments and
requested appointment of Conference Committee; May 23, 2019, House
granted request of the Senate; May 26, 2019, Senate adopted
Conference Committee Report by the following vote: Yeas 31,
Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 2138 passed the House, with
amendments, on May 22, 2019, by the following vote: Yeas 131,
Nays 13, two present not voting; May 23, 2019, House granted
request of the Senate for appointment of Conference Committee;
May 26, 2019, House adopted Conference Committee Report by the
following vote: Yeas 125, Nays 21, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor