Texas 2021 - 87th Regular

Texas House Bill HB484 Compare Versions

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

Old	New	Differences
1	1	87R941 KFF-D
2	2	By: Shaheen H.B. No. 484
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a direct primary care model pilot program for Medicaid.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subchapter B, Chapter 531, Government Code, is
10	10	amended by adding Section 531.024151 to read as follows:
11	11	Sec. 531.024151. DIRECT PRIMARY CARE MODEL PILOT PROGRAM
12	12	FOR MEDICAID. (a) In this section:
13	13	(1) "Direct fee" means a fee charged by a physician to
14	14	a patient or a patient's designee for primary medical care services
15	15	provided by, or to be provided by, the physician to the
16	16	patient. The term includes a fee in any form, including a:
17	17	(A) retainer;
18	18	(B) membership fee;
19	19	(C) subscription fee; or
20	20	(D) fee paid under a medical service agreement.
21	21	(2) "Direct primary care," "medical service
22	22	agreement," "physician," and "primary medical care service" have
23	23	the meanings assigned by Section 162.251, Occupations Code.
24	24	(3) "Participating physician" means a physician
25	25	participating in the pilot program.
26	26	(4) "Participating recipient" means a Medicaid
27	27	recipient participating in the pilot program.
28	28	(5) "Pilot program" means the direct primary care
29	29	model pilot program established under this section.
30	30	(b) The commission shall develop a pilot program to
31	31	implement a direct primary care model in Medicaid through which a
32	32	Medicaid recipient enters into a medical service agreement with a
33	33	physician for the provision of primary medical care services in
34	34	exchange for a direct fee that is paid on a monthly basis.
35	35	(c) The commission shall implement the pilot program
36	36	statewide.
37	37	(d) Under the pilot program, a participating physician:
38	38	(1) is not required to enroll as a Medicaid provider;
39	39	and
40	40	(2) notwithstanding Subdivision (1), has the
41	41	authority of ordering, referring, and prescribing Medicaid
42	42	providers for purposes of the pilot program.
43	43	(e) To be eligible to participate in the pilot program, a
44	44	physician must be practicing under a direct primary care model that
45	45	does not accept payment or otherwise seek reimbursement for primary
46	46	medical care services from a third-party insurer or managed care
47	47	organization.
48	48	(f) A Medicaid recipient must be younger than 65 years of
49	49	age to be eligible to participate in the pilot program. The
50	50	recipient or the recipient's parent or legally authorized
51	51	representative on behalf of the recipient must enter into a medical
52	52	service agreement with a physician eligible to participate in the
53	53	pilot program. After the commission verifies that the recipient or
54	54	the recipient's parent or legally authorized representative has
55	55	entered into the agreement, the commission shall pay the lesser of:
56	56	(1) the amount of the direct fee required under the
57	57	agreement; or
58	58	(2) $40 per month for a recipient who is 18 years of
59	59	age or younger, or $70 per month for a recipient who is at least 19
60	60	years of age but younger than 65 years of age.
61	61	(g) A participating recipient shall pay the amount of the
62	62	direct fee required under the medical service agreement that
63	63	exceeds the maximum fee amount the commission pays under Subsection
64	64	(f).
65	65	(h) The commission may pay the amount of the direct fee
66	66	under a medical service agreement directly to the participating
67	67	recipient, who is then responsible for paying the participating
68	68	physician under the agreement, or may establish a system under
69	69	which the commission pays the fee directly to the physician, either
70	70	by depositing the fee into an account established for the physician
71	71	for that purpose or by another means the commission determines most
72	72	appropriate. If cost-effective, the commission may issue an
73	73	electronic benefits transfer card to a participating recipient who
74	74	shall use the card to pay the amount of the direct fee under an
75	75	agreement.
76	76	(i) A participating recipient shall immediately notify the
77	77	commission when a medical service agreement terminates.
78	78	(j) Not later than December 31, 2024, the commission shall
79	79	prepare and submit a report to the legislature that includes:
80	80	(1) a summary of the commission's evaluation of the
81	81	effect of the pilot program on the provision of primary medical care
82	82	services and Medicaid costs; and
83	83	(2) a recommendation as to whether the pilot program
84	84	should be continued or terminated.
85	85	(k) The executive commissioner shall adopt rules as
86	86	necessary to implement this section.
87	87	(l) The pilot program terminates and this section expires
88	88	September 1, 2025.
89	89	SECTION 2. If before implementing any provision of this Act
90	90	a state agency determines that a waiver or authorization from a
91	91	federal agency is necessary for implementation of that provision,
92	92	the agency affected by the provision shall request the waiver or
93	93	authorization and may delay implementing that provision until the
94	94	waiver or authorization is granted.
95	95	SECTION 3. This Act takes effect September 1, 2021.