Texas 2021 - 87th Regular

Texas House Bill HB3944 Compare Versions

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

Old	New	Differences
1	1	87R7411 KFF-F
2	2	By: Klick H.B. No. 3944
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the provision of initial health risk assessments for
8	8	Medicaid recipients.
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 533.002501 to read as follows:
12	12	Sec. 533.002501. INITIAL HEALTH RISK ASSESSMENTS OF CERTAIN
13	13	RECIPIENTS. (a) In this section, "assessing third-party entity"
14	14	means the third-party entity with which the commission is required
15	15	to contract under Subsection (c) to conduct health risk assessments
16	16	of recipients under this section.
17	17	(b) The commission shall, in accordance with this section,
18	18	conduct an initial health risk assessment of each recipient who is
19	19	to be enrolled in a managed care plan offered by a Medicaid managed
20	20	care organization.
21	21	(c) The commission shall contract with an independent,
22	22	third-party entity to provide the health risk assessment required
23	23	by this section. A third-party entity is eligible to contract with
24	24	the commission under this subsection only if:
25	25	(1) the entity is qualified under Sections 1902(d) and
26	26	1903(a)(3)(C) of the federal Social Security Act (42 U.S.C.
27	27	Sections 1396a(d) and 1396b(a)(3)(C)) to provide the service;
28	28	(2) the entity is independent of each:
29	29	(A) Medicaid managed care organization; and
30	30	(B) health care provider participating in a
31	31	managed care model or arrangement implemented under this chapter;
32	32	and
33	33	(3) a person who is an owner, employee, or consultant
34	34	of or who has another contract arrangement with the entity:
35	35	(A) does not have a direct or indirect financial
36	36	interest in a managed care organization or health care provider
37	37	described by Subdivision (2); and
38	38	(B) has not been excluded from participating in a
39	39	program established under Title XVIII or XIX of the federal Social
40	40	Security Act, debarred by a federal agency, or subject to a civil
41	41	money penalty under the federal Social Security Act.
42	42	(d) The health risk assessment required by this section
43	43	must:
44	44	(1) be completed by the assessing third-party entity
45	45	as soon as practicable and, if possible, before the recipient is
46	46	enrolled in a managed care plan; and
47	47	(2) subject to Subsection (e), be administered using a
48	48	standardized risk assessment instrument.
49	49	(e) For a recipient who is to be enrolled in the STAR+PLUS
50	50	Medicaid managed care program or the STAR Kids managed care
51	51	program, the assessing third-party entity shall complete a
52	52	functional needs assessment that uses a nationally recognized,
53	53	evidence-based instrument to conduct the assessment.
54	54	Notwithstanding any other law, the functional needs assessment
55	55	conducted under this section must be used:
56	56	(1) as the basis for determining the recipient's
57	57	eligibility for waiver services; and
58	58	(2) in the development of the recipient's individual
59	59	service plan.
60	60	(f) The assessing third-party entity shall retain the
61	61	results of the health risk assessments conducted under this section
62	62	and report the results of the assessments to the commission and the
63	63	appropriate managed care organization. If a recipient enrolls in
64	64	another managed care plan offered by another Medicaid managed care
65	65	organization, the managed care organization in which the recipient
66	66	is enrolled shall notify the commission and the commission shall
67	67	ensure that a copy of the recipient's health risk assessment is
68	68	provided to the managed care organization by the third-party entity
69	69	that assessed the recipient.
70	70	SECTION 2. (a) Not later than September 1, 2022, the Health
71	71	and Human Services Commission shall:
72	72	(1) contract with a third-party entity as required by
73	73	Section 533.002501(c), Government Code, as added by this Act; and
74	74	(2) subject to Subsection (b) of this section,
75	75	develop, in conjunction with each Medicaid managed care
76	76	organization with which the commission contracts to provide health
77	77	care services to Medicaid recipients under Chapter 533, Government
78	78	Code, a plan for phasing in the transition of responsibility for the
79	79	provision of health risk assessments of Medicaid recipients who are
80	80	to be enrolled in the Medicaid managed care plan from the managed
81	81	care organizations offering the managed care plans in which those
82	82	recipients are enrolled to the third-party entity with which the
83	83	commission contracts under Section 533.002501(c), Government Code,
84	84	as added by this Act.
85	85	(b) The plan for phasing in the transition of the provision
86	86	of health risk assessments required by Subsection (a) of this
87	87	section must begin with the transition of recipients who are to be
88	88	enrolled in the STAR Kids managed care program.
89	89	(c) Section 533.002501, Government Code, as added by this
90	90	Act, applies only to a Medicaid recipient who is initially enrolled
91	91	in a managed care plan offered by a Medicaid managed care
92	92	organization that contracts with the Health and Human Services
93	93	Commission under Chapter 533, Government Code, on or after the date
94	94	specified in the plan for phasing in the transition of the provision
95	95	of health risk assessments required by Subsection (a) of this
96	96	section.
97	97	SECTION 3. If before implementing any provision of this Act
98	98	a state agency determines that a waiver or authorization from a
99	99	federal agency is necessary for implementation of that provision,
100	100	the agency affected by the provision shall request the waiver or
101	101	authorization and may delay implementing that provision until the
102	102	waiver or authorization is granted.
103	103	SECTION 4. This Act takes effect September 1, 2021.