By: Kolkhorst, Gutierrez S.B. No. 1149
Zaffirini
A BILL TO BE ENTITLED
AN ACT
relating to the transition of case management for children and
pregnant women program services and Healthy Texas Women program
services to a managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.002555 to read as follows:
Sec. 533.002555. TRANSITION OF CASE MANAGEMENT FOR CHILDREN
AND PREGNANT WOMEN PROGRAM RECIPIENTS TO MANAGED CARE PROGRAM. (a)
In this section, "children and pregnant women program" means the
benefits program provided under Medicaid and administered by the
Department of State Health Services that provides case management
services to children who have a health condition or health risk and
pregnant women who have a high-risk condition.
(b) The commission shall transition to a Medicaid managed
care model for case management services provided to recipients
under the children and pregnant women program. In transitioning
services under this section, the commission shall ensure a
recipient is provided case management services through the managed
care plan in which the recipient is enrolled.
(c) In implementing this section, the commission shall
ensure:
(1) a seamless transition in case management for
recipients receiving benefits under the children and pregnant women
program; and
(2) case management services provided under the
program are not interrupted.
SECTION 2. Subchapter F, Chapter 32, Health and Safety
Code, is amended by amending Section 32.152 and adding Sections
32.156 and 32.157 to read as follows:
Sec. 32.152. [ASSESSING] PROVISION OF HEALTHY TEXAS WOMEN
PROGRAM SERVICES THROUGH MANAGED CARE. [(a)] The commission shall
contract [assess:
[(1) the feasibility and cost-effectiveness of
contracting] with Medicaid managed care organizations to provide
Healthy Texas Women program services [through managed care in one
or more health care service regions in this state if the Healthy
Texas Women Section 1115 Demonstration Waiver is approved; and
[(2) the potential impact of that delivery model on
women receiving services under the program].
[(b) This section expires September 1, 2021.]
Sec. 32.156. INFORMATION ABOUT AVAILABILITY OF SUBSIDIZED
HEALTH INSURANCE COVERAGE. (a) The commission and each managed
care organization participating in the Healthy Texas Women program
shall provide a written notice containing information about
eligibility requirements for and enrollment in a health benefit
plan for which an enrollee receives a premium subsidy under the
Patient Protection and Affordable Care Act (Pub. L. No. 111-148),
based on family income, to a woman who:
(1) is enrolled in the Healthy Texas Women program;
and
(2) has a household income that is more than 100
percent but not more than 200 percent of the federal poverty level.
(b) The commission, in consultation with the Texas
Department of Insurance, shall develop the form and content of the
notice required under this section. The notice must include:
(1) the latest information written in clear and easily
understood language on available options for obtaining a subsidized
health benefit plan described by Subsection (a); and
(2) resources for receiving assistance applying for
and enrolling in that health benefit plan.
Sec. 32.157. ASSESSING AUTOMATIC ENROLLMENT OF CERTAIN
WOMEN IN MANAGED CARE. (a) Not later than January 1, 2023, the
commission shall assess the feasibility, cost-effectiveness, and
benefits of automatically enrolling in managed care the women who
become pregnant while receiving services through the Healthy Texas
Women program. The assessment must examine whether automatically
enrolling those women leads to the delivery of prenatal care and
services earlier in the women's pregnancies.
(b) This section expires September 1, 2023.
SECTION 3. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules necessary to implement the
changes in law made by this Act.
SECTION 4. 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 5. The Health and Human Services Commission is
required to implement a provision of this Act only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the Health and Human Services Commission may, but is not
required to, implement a provision of this Act using other
appropriations available for that purpose.
SECTION 6. This Act takes effect September 1, 2021.