| 1 | 1 | | By: Perry S.R. No. 846 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | SENATE RESOLUTION |
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| 5 | 5 | | BE IT RESOLVED by the Senate of the State of Texas, 86th |
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| 6 | 6 | | Legislature, 2019, That Senate Rule 12.03 be suspended in part as |
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| 7 | 7 | | provided by Senate Rule 12.08 to enable the conference committee |
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| 8 | 8 | | appointed to resolve the differences on Senate Bill 1207 (the |
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| 9 | 9 | | operation and administration of Medicaid, including the Medicaid |
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| 10 | 10 | | managed care program and the medically dependent children (MDCP) |
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| 11 | 11 | | waiver program) to consider and take action on the following |
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| 12 | 12 | | matters: |
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| 13 | 13 | | (1) Senate Rule 12.03(4) is suspended to permit the |
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| 14 | 14 | | committee to add text on a matter not included in either the house |
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| 15 | 15 | | or senate version of the bill by adding the following SECTION to |
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| 16 | 16 | | the bill: |
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| 17 | 17 | | SECTION 2. Section 531.024, Government Code, is amended |
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| 18 | 18 | | by amending Subsection (b) and adding Subsection (c) to read as |
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| 19 | 19 | | follows: |
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| 20 | 20 | | (b) The rules promulgated under Subsection (a)(7) must |
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| 21 | 21 | | provide due process to an applicant for Medicaid services and to |
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| 22 | 22 | | a Medicaid recipient who seeks a Medicaid service, including a |
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| 23 | 23 | | service that requires prior authorization. The rules must |
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| 24 | 24 | | provide the protections for applicants and recipients required |
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| 25 | 25 | | by 42 C.F.R. Part 431, Subpart E, including requiring that: |
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| 26 | 26 | | (1) the written notice to an individual of the |
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| 27 | 27 | | individual's right to a hearing must: |
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| 28 | 28 | | (A) contain an explanation of the |
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| 29 | 29 | | circumstances under which Medicaid is continued if a hearing is |
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| 30 | 30 | | requested; and |
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| 31 | 31 | | (B) be delivered by mail, and postmarked |
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| 32 | 32 | | [mailed] at least 10 business days, before the date the |
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| 33 | 33 | | individual's Medicaid eligibility or service is scheduled to be |
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| 34 | 34 | | terminated, suspended, or reduced, except as provided by 42 |
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| 35 | 35 | | C.F.R. Section 431.213 or 431.214; and |
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| 36 | 36 | | (2) if a hearing is requested before the date a |
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| 37 | 37 | | Medicaid recipient's service, including a service that requires |
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| 38 | 38 | | prior authorization, is scheduled to be terminated, suspended, |
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| 39 | 39 | | or reduced, the agency may not take that proposed action before a |
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| 40 | 40 | | decision is rendered after the hearing unless: |
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| 41 | 41 | | (A) it is determined at the hearing that the |
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| 42 | 42 | | sole issue is one of federal or state law or policy; and |
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| 43 | 43 | | (B) the agency promptly informs the recipient |
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| 44 | 44 | | in writing that services are to be terminated, suspended, or |
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| 45 | 45 | | reduced pending the hearing decision. |
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| 46 | 46 | | (c) The commission shall develop a process to address a |
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| 47 | 47 | | situation in which: |
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| 48 | 48 | | (1) an individual does not receive adequate notice |
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| 49 | 49 | | as required by Subsection (b)(1); or |
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| 50 | 50 | | (2) the notice required by Subsection (b)(1) is |
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| 51 | 51 | | delivered without a postmark. |
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| 52 | 52 | | Explanation: This addition is necessary to change the |
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| 53 | 53 | | requirements for notice of a right to a hearing for an applicant |
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| 54 | 54 | | for Medicaid services and a Medicaid recipient. |
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| 55 | 55 | | (2) Senate Rule 12.03(4) is suspended to permit the |
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| 56 | 56 | | committee to add text on a matter not included in either the house |
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| 57 | 57 | | or senate version of the bill by adding the following text to |
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| 58 | 58 | | SECTION 3 of the bill: |
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| 59 | 59 | | (a) To the extent of any conflict, Section 531.024162, |
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| 60 | 60 | | Government Code, as added by this section, prevails over any |
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| 61 | 61 | | provision of another Act of the 86th Legislature, Regular |
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| 62 | 62 | | Session, 2019, relating to notice requirements regarding |
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| 63 | 63 | | Medicaid coverage or prior authorization denials or incomplete |
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| 64 | 64 | | requests, that becomes law. |
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| 65 | 65 | | Explanation: This addition is necessary to provide that |
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| 66 | 66 | | the amendment adding Section 531.024162, Government Code, |
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| 67 | 67 | | prevails over other similar amendments made by the 86th |
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| 68 | 68 | | Legislature. |
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