Texas 2021 - 87th Regular

Texas House Bill HB3677 Compare Versions

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

Old	New	Differences
1	1	By: Parker H.B. No. 3677
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the coordination of Medicaid and private health
7	7	benefits for Medicaid recipients with complex medical needs.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 533.038, Government Code, is amended by
10	10	amending Subsections (a) and (g) and adding Subsection (h) to read
11	11	as follows:
12	12	(a) In this section:[,]
13	13	(1) "Durable medical equipment" means equipment,
14	14	services, and supplies, including repair and replacement parts for
15	15	the equipment, that:
16	16	(A) is primarily and customarily used to serve a
17	17	medical purpose as prescribed for medical necessity; and
18	18	(B) includes, but is not limited to, ventilators,
19	19	infusion pumps, medical devices, prostheses, complex
20	20	rehabilitation technology (CRT), and such other medical equipment,
21	21	supplies, and services as prescribed by the treating provider.
22	22	(2) "Medicaid wrap-around benefit" means a
23	23	Medicaid-covered service, including a pharmacy or medical benefit,
24	24	that is provided to a recipient with both Medicaid and primary
25	25	health benefit plan coverage when the recipient has exceeded the
26	26	primary health benefit plan coverage limit or when the service is
27	27	not covered by the primary health benefit plan issuer.
28	28	(3) The guarantee of continuity of care is applicable
29	29	to all Medicaid recipients regardless of:
30	30	(A) whether the recipient is a Medicaid
31	31	wrap-around beneficiary;
32	32	(B) primary health benefit plan coverage;
33	33	(C) date of enrollment of the recipient; or
34	34	(D) network status of the provider.
35	35	(D-1) In network specialty provider contract
36	36	cancellation does not void the guarantee of continuity of care. The
37	37	recipient retains the right to select their preferred specialty
38	38	provider should contract cancellation occur.
39	39	(4) "Specialty provider" means a person who provides
40	40	health-related goods or services to a recipient, including:
41	41	(A) a physician licensed under Subtitle B, Title
42	42	3, Occupations Code;
43	43	(B) an audiologist licensed under Chapter 401,
44	44	Occupations Code;
45	45	(C) a chiropractor licensed under Chapter 201,
46	46	Occupations Code;
47	47	(D) a dietitian licensed under Chapter 701,
48	48	Occupations Code;
49	49	(E) an optometrist licensed under Chapter 351,
50	50	Occupations Code;
51	51	(F) a podiatrist licensed under Chapter 202,
52	52	Occupations Code;
53	53	(G) a pharmacist licensed under Subtitle J, Title
54	54	3, Occupations Code;
55	55	(H) a durable medical equipment provider; and
56	56	(I) any other provider of health-related goods,
57	57	including medication, therapy, equipment, and services to a person
58	58	with complex medical needs.
59	59	(g) The commission shall develop a clear and easy process,
60	60	to be implemented through a contract, that allows a recipient with
61	61	complex medical needs who has established a relationship at any
62	62	time with a specialty provider to receive care, including
63	63	equipment, supplies, and services necessary to provide that care,
64	64	from that provider. A Medicaid managed care organization shall
65	65	provide a recipient with access to that care from that specialty
66	66	provider. A Medicaid managed care organization shall provide
67	67	reimbursement to the specialty provider as described by 1 T.A.C.
68	68	Section 353.4(e)(2) and (e)(3).
69	69	SECTION 2. If before implementing any provision of this Act
70	70	a state agency determines that a waiver or authorization from a
71	71	federal agency is necessary for implementation of that provision,
72	72	the agency affected by the provision shall request the waiver or
73	73	authorization and may delay implementing that provision until the
74	74	waiver or authorization is granted.
75	75	SECTION 3. This Act takes effect September 1, 2021.