Texas 2019 - 86th Regular

Texas Senate Bill SB791 Compare Versions

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

Old	New	Differences
1	1	86R5368 MM-F
2	2	By: Buckingham S.B. No. 791
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the accreditation of and a recipient's enrollment in a
8	8	Medicaid managed care plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter A, Chapter 533, Government Code, is
11	11	amended by adding Section 533.0031 to read as follows:
12	12	Sec. 533.0031. MEDICAID MANAGED CARE PLAN ACCREDITATION.
13	13	Notwithstanding Section 533.004 or any other law requiring the
14	14	commission to contract with a managed care organization to provide
15	15	health care services to recipients, the commission may contract
16	16	with a managed care organization to provide those services only if
17	17	the managed care plan offered by the organization is accredited by a
18	18	nationally recognized accrediting entity.
19	19	SECTION 2. Section 533.0075, Government Code, is amended to
20	20	read as follows:
21	21	Sec. 533.0075. RECIPIENT ENROLLMENT. (a) The commission
22	22	shall:
23	23	(1) encourage recipients to choose appropriate
24	24	managed care plans and primary health care providers by:
25	25	(A) providing initial information to recipients
26	26	and providers in a region about the need for recipients to choose
27	27	plans and providers not later than the 90th day before the date on
28	28	which a managed care organization plans to begin to provide health
29	29	care services to recipients in that region through managed care;
30	30	(B) providing follow-up information before
31	31	assignment of plans and providers and after assignment, if
32	32	necessary, to recipients who delay in choosing plans and providers
33	33	after receiving the initial information under Paragraph (A); and
34	34	(C) allowing plans and providers to provide
35	35	information to recipients or engage in marketing activities under
36	36	marketing guidelines established by the commission under Section
37	37	533.008 after the commission approves the information or
38	38	activities;
39	39	(2) consider the following factors in assigning
40	40	managed care plans and primary health care providers to recipients
41	41	who fail to choose plans and providers:
42	42	(A) the importance of maintaining existing
43	43	provider-patient and physician-patient relationships, including
44	44	relationships with specialists, public health clinics, and
45	45	community health centers;
46	46	(B) to the extent possible, the need to assign
47	47	family members to the same providers and plans; and
48	48	(C) geographic convenience of plans and
49	49	providers for recipients;
50	50	(3) retain responsibility for enrollment and
51	51	disenrollment of recipients in managed care plans, except that the
52	52	commission may delegate the responsibility to an independent
53	53	contractor who receives no form of payment from, and has no
54	54	financial ties to, any managed care organization;
55	55	(4) develop and implement an expedited process for
56	56	determining eligibility for and enrolling pregnant women and
57	57	newborn infants in managed care plans; and
58	58	(5) ensure immediate access to prenatal services and
59	59	newborn care for pregnant women and newborn infants enrolled in
60	60	managed care plans, including ensuring that a pregnant woman may
61	61	obtain an appointment with an obstetrical care provider for an
62	62	initial maternity evaluation not later than the 30th day after the
63	63	date the woman applies for Medicaid.
64	64	(b) The commission shall, notwithstanding any other law,
65	65	implement an automatic enrollment process under which an applicant
66	66	determined eligible to receive Medicaid benefits through managed
67	67	care is automatically enrolled, at the time the applicant is
68	68	determined eligible for those benefits, in a Medicaid managed care
69	69	plan chosen by the applicant or, if the applicant fails to choose a
70	70	plan, by the commission.
71	71	SECTION 3. Section 533.0076(c), Government Code, is amended
72	72	to read as follows:
73	73	(c) The commission shall allow a recipient who is enrolled
74	74	in a managed care plan under this chapter to disenroll from that
75	75	plan and enroll in another managed care plan[:
76	76	[(1)] at any time for cause in accordance with federal
77	77	law[; and
78	78	[(2) once for any reason after the periods described
79	79	by Subsections (a) and (b)].
80	80	SECTION 4. Section 533.0025(h), Government Code, is
81	81	repealed.
82	82	SECTION 5. Section 533.0031, Government Code, as added by
83	83	this Act, applies to a contract entered into or renewed on or after
84	84	the effective date of this Act. A contract entered into or renewed
85	85	before that date is governed by the law in effect immediately before
86	86	the effective date of this Act, and that law is continued in effect
87	87	for that purpose.
88	88	SECTION 6. If before implementing any provision of this Act
89	89	a state agency determines that a waiver or authorization from a
90	90	federal agency is necessary for implementation of that provision,
91	91	the agency affected by the provision shall request the waiver or
92	92	authorization and may delay implementing that provision until the
93	93	waiver or authorization is granted.
94	94	SECTION 7. This Act takes effect September 1, 2019.