By: Perry S.B. No. 1648
A BILL TO BE ENTITLED
AN ACT
relating to the provision of benefits to certain Medicaid
recipients with complex medical needs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Section 533.038, Government Code,
is amended to read as follows:
Sec. 533.038. COORDINATION OF BENEFITS; CONTINUITY OF
SPECIALTY CARE FOR CERTAIN RECIPIENTS.
SECTION 2. Section 533.038, Government Code, is amended by
amending Subsection (g) and adding Subsections (h) and (i) to read
as follows:
(g) The commission shall develop a clear and easy process,
to be implemented through a contract, that allows a recipient with
complex medical needs who has established a relationship with a
specialty provider to continue receiving care from that provider,
regardless of whether the recipient has primary health benefit plan
coverage in addition to Medicaid coverage.
(h) If a recipient who has complex medical needs and who
does not have primary health benefit plan coverage wants to
continue to receive care from a specialty provider that is not in
the provider network of the Medicaid managed care organization
offering the managed care plan in which the recipient is enrolled,
the managed care organization shall negotiate a single-case
agreement with the specialty provider. Until the Medicaid managed
care organization and the specialty provider enter into the
single-case agreement, the specialty provider shall be reimbursed
in accordance with the applicable reimbursement methodology
specified in commission rule, including 1 T.A.C. Section 353.4.
(i) A single-case agreement entered into under this section
is not considered accessing an out-of-network provider for the
purposes of Medicaid managed care organization network adequacy
requirements.
SECTION 3. Section 531.0601(f), Government Code, is
repealed.
SECTION 4. The Health and Human Services Commission is
required to implement a provision of this Act only if the
legislature appropriates money to the commission specifically for
that purpose. If the legislature does not appropriate money
specifically for that purpose, the commission may, but is not
required to, implement a provision of this Act using other
appropriations that are available for that purpose.
SECTION 5. 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 6. This Act takes effect September 1, 2021.