87R7411 KFF-F
By: Klick H.B. No. 3944
A BILL TO BE ENTITLED
AN ACT
relating to the provision of initial health risk assessments for
Medicaid recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.002501 to read as follows:
Sec. 533.002501. INITIAL HEALTH RISK ASSESSMENTS OF CERTAIN
RECIPIENTS. (a) In this section, "assessing third-party entity"
means the third-party entity with which the commission is required
to contract under Subsection (c) to conduct health risk assessments
of recipients under this section.
(b) The commission shall, in accordance with this section,
conduct an initial health risk assessment of each recipient who is
to be enrolled in a managed care plan offered by a Medicaid managed
care organization.
(c) The commission shall contract with an independent,
third-party entity to provide the health risk assessment required
by this section. A third-party entity is eligible to contract with
the commission under this subsection only if:
(1) the entity is qualified under Sections 1902(d) and
1903(a)(3)(C) of the federal Social Security Act (42 U.S.C.
Sections 1396a(d) and 1396b(a)(3)(C)) to provide the service;
(2) the entity is independent of each:
(A) Medicaid managed care organization; and
(B) health care provider participating in a
managed care model or arrangement implemented under this chapter;
and
(3) a person who is an owner, employee, or consultant
of or who has another contract arrangement with the entity:
(A) does not have a direct or indirect financial
interest in a managed care organization or health care provider
described by Subdivision (2); and
(B) has not been excluded from participating in a
program established under Title XVIII or XIX of the federal Social
Security Act, debarred by a federal agency, or subject to a civil
money penalty under the federal Social Security Act.
(d) The health risk assessment required by this section
must:
(1) be completed by the assessing third-party entity
as soon as practicable and, if possible, before the recipient is
enrolled in a managed care plan; and
(2) subject to Subsection (e), be administered using a
standardized risk assessment instrument.
(e) For a recipient who is to be enrolled in the STAR+PLUS
Medicaid managed care program or the STAR Kids managed care
program, the assessing third-party entity shall complete a
functional needs assessment that uses a nationally recognized,
evidence-based instrument to conduct the assessment.
Notwithstanding any other law, the functional needs assessment
conducted under this section must be used:
(1) as the basis for determining the recipient's
eligibility for waiver services; and
(2) in the development of the recipient's individual
service plan.
(f) The assessing third-party entity shall retain the
results of the health risk assessments conducted under this section
and report the results of the assessments to the commission and the
appropriate managed care organization. If a recipient enrolls in
another managed care plan offered by another Medicaid managed care
organization, the managed care organization in which the recipient
is enrolled shall notify the commission and the commission shall
ensure that a copy of the recipient's health risk assessment is
provided to the managed care organization by the third-party entity
that assessed the recipient.
SECTION 2. (a) Not later than September 1, 2022, the Health
and Human Services Commission shall:
(1) contract with a third-party entity as required by
Section 533.002501(c), Government Code, as added by this Act; and
(2) subject to Subsection (b) of this section,
develop, in conjunction with each Medicaid managed care
organization with which the commission contracts to provide health
care services to Medicaid recipients under Chapter 533, Government
Code, a plan for phasing in the transition of responsibility for the
provision of health risk assessments of Medicaid recipients who are
to be enrolled in the Medicaid managed care plan from the managed
care organizations offering the managed care plans in which those
recipients are enrolled to the third-party entity with which the
commission contracts under Section 533.002501(c), Government Code,
as added by this Act.
(b) The plan for phasing in the transition of the provision
of health risk assessments required by Subsection (a) of this
section must begin with the transition of recipients who are to be
enrolled in the STAR Kids managed care program.
(c) Section 533.002501, Government Code, as added by this
Act, applies only to a Medicaid recipient who is initially enrolled
in a managed care plan offered by a Medicaid managed care
organization that contracts with the Health and Human Services
Commission under Chapter 533, Government Code, on or after the date
specified in the plan for phasing in the transition of the provision
of health risk assessments required by Subsection (a) of this
section.
SECTION 3. 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 4. This Act takes effect September 1, 2021.