86R5368 MM-F
By: Buckingham S.B. No. 791
A BILL TO BE ENTITLED
AN ACT
relating to the accreditation of and a recipient's enrollment in a
Medicaid managed care plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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.
Notwithstanding Section 533.004 or any other law requiring the
commission to contract with a managed care organization to provide
health care services to recipients, the commission may contract
with a managed care organization to provide those services only if
the managed care plan offered by the organization is accredited by a
nationally recognized accrediting entity.
SECTION 2. Section 533.0075, Government Code, is amended to
read as follows:
Sec. 533.0075. RECIPIENT ENROLLMENT. (a) The commission
shall:
(1) encourage recipients to choose appropriate
managed care plans and primary health care providers by:
(A) providing initial information to recipients
and providers in a region about the need for recipients to choose
plans and providers not later than the 90th day before the date on
which a managed care organization plans to begin to provide health
care services to recipients in that region through managed care;
(B) providing follow-up information before
assignment of plans and providers and after assignment, if
necessary, to recipients who delay in choosing plans and providers
after receiving the initial information under Paragraph (A); and
(C) allowing plans and providers to provide
information to recipients or engage in marketing activities under
marketing guidelines established by the commission under Section
533.008 after the commission approves the information or
activities;
(2) consider the following factors in assigning
managed care plans and primary health care providers to recipients
who fail to choose plans and providers:
(A) the importance of maintaining existing
provider-patient and physician-patient relationships, including
relationships with specialists, public health clinics, and
community health centers;
(B) to the extent possible, the need to assign
family members to the same providers and plans; and
(C) geographic convenience of plans and
providers for recipients;
(3) retain responsibility for enrollment and
disenrollment of recipients in managed care plans, except that the
commission may delegate the responsibility to an independent
contractor who receives no form of payment from, and has no
financial ties to, any managed care organization;
(4) develop and implement an expedited process for
determining eligibility for and enrolling pregnant women and
newborn infants in managed care plans; and
(5) ensure immediate access to prenatal services and
newborn care for pregnant women and newborn infants enrolled in
managed care plans, including ensuring that a pregnant woman may
obtain an appointment with an obstetrical care provider for an
initial maternity evaluation not later than the 30th day after the
date the woman applies for Medicaid.
(b) The commission shall, notwithstanding any other law,
implement an automatic enrollment process under which an applicant
determined eligible to receive Medicaid benefits through managed
care is automatically enrolled, at the time the applicant is
determined eligible for those benefits, in a Medicaid managed care
plan chosen by the applicant or, if the applicant fails to choose a
plan, by the commission.
SECTION 3. Section 533.0076(c), Government Code, is amended
to read as follows:
(c) The commission shall allow a recipient who is enrolled
in a managed care plan under this chapter to disenroll from that
plan and enroll in another managed care plan[:
[(1)] at any time for cause in accordance with federal
law[; and
[(2) once for any reason after the periods described
by Subsections (a) and (b)].
SECTION 4. Section 533.0025(h), Government Code, is
repealed.
SECTION 5. Section 533.0031, Government Code, as added by
this Act, applies to a contract entered into or renewed on or after
the effective date of this Act. A contract entered into or renewed
before that date is governed by the law in effect immediately before
the effective date of this Act, and that law is continued in effect
for that purpose.
SECTION 6. 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 7. This Act takes effect September 1, 2019.