Texas 2021 - 87th Regular

Texas Senate Bill SB1648 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 1648
	1	+	By: Perry S.B. No. 1648
	2	+	(Krause)
2	3
3	4
	5	+	A BILL TO BE ENTITLED
4	6		AN ACT
5		-	relating to the provision of benefits ~~under the~~ Medicaid ~~program,~~
6		-	~~including to~~ recipients with complex medical needs.
	7	+	relating to the provision of benefits to certain Medicaid
	8	+	recipients with complex medical needs.
7	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8		-	SECTION 1. Subchapter B, Chapter 531, Government Code, is
9		-	amended by adding Section 531.024165 to read as follows:
10		-	Sec. 531.024165. MEDICAL REVIEW OF MEDICAID SERVICE DENIALS
11		-	FOR FOSTER CARE YOUTH. (a) Using existing resources, the
12		-	commission shall coordinate with the Department of Family and
13		-	Protective Services to develop and implement a process to review a
14		-	denial of services under the Medicaid managed care program on the
15		-	basis of medical necessity for foster care youth.
16		-	(b) Not later than December 31, 2022, the commission and the
17		-	Department of Family and Protective Services shall submit a report
18		-	to the legislature that includes a summary of the process developed
19		-	and implemented under Subsection (a).
20		-	(c) This section expires September 1, 2023.
21		-	SECTION 2. Section 531.024172(d), Government Code, is
22		-	amended to read as follows:
23		-	(d) In implementing the electronic visit verification
24		-	system:
25		-	(1) subject to Subsection (e), the executive
26		-	commissioner shall adopt compliance standards for health care
27		-	providers; and
28		-	(2) the commission shall ensure that:
29		-	(A) the information required to be reported by
30		-	health care providers is standardized across managed care
31		-	organizations that contract with the commission to provide health
32		-	care services to Medicaid recipients and across commission
33		-	programs;
34		-	(B) processes required by managed care
35		-	organizations to retrospectively correct data are standardized and
36		-	publicly accessible to health care providers; [and]
37		-	(C) standardized processes are established for
38		-	addressing the failure of a managed care organization to provide a
39		-	timely authorization for delivering services necessary to ensure
40		-	continuity of care; and
41		-	(D) a health care provider is allowed to enter a
42		-	variable schedule into the electronic visit verification system.
43		-	SECTION 3. Subchapter B, Chapter 531, Government Code, is
44		-	amended by adding Sections 531.0501, 531.0512, and 531.0605 to read
45		-	as follows:
46		-	Sec. 531.0501. MEDICAID WAIVER PROGRAMS: INTEREST LIST
47		-	MANAGEMENT. (a) The commission, in consultation with the
48		-	Intellectual and Developmental Disability System Redesign Advisory
49		-	Committee established under Section 534.053 and the STAR Kids
50		-	Managed Care Advisory Committee, shall study the feasibility of
51		-	creating an online portal for individuals to request to be placed
52		-	and check the individual's placement on a Medicaid waiver program
53		-	interest list. As part of the study, the commission shall determine
54		-	the most appropriate and cost-effective automated method for
55		-	determining the level of need of an individual seeking services
56		-	through a Medicaid waiver program.
57		-	(b) Not later than January 1, 2023, the commission shall
58		-	prepare and submit a report to the governor, the lieutenant
59		-	governor, the speaker of the house of representatives, and the
60		-	standing legislative committees with primary jurisdiction over
61		-	health and human services that summarizes the commission's findings
62		-	and conclusions from the study.
63		-	(c) Subsections (a) and (b) and this subsection expire
64		-	September 1, 2023.
65		-	(d) The commission shall develop a protocol in the office of
66		-	the ombudsman to improve the capture and updating of contact
67		-	information for an individual who contacts the office of the
68		-	ombudsman regarding Medicaid waiver programs or services.
69		-	Sec. 531.0512. NOTIFICATION REGARDING CONSUMER DIRECTION
70		-	MODEL. The commission shall:
71		-	(1) develop a procedure to:
72		-	(A) verify that a Medicaid recipient or the
73		-	recipient's parent or legal guardian is informed regarding the
74		-	consumer direction model and provided the option to choose to
75		-	receive care under that model; and
76		-	(B) if the individual declines to receive care
77		-	under the consumer direction model, document the declination; and
78		-	(2) ensure that each Medicaid managed care
79		-	organization implements the procedure.
80		-	Sec. 531.0605. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
81		-	PROGRAM. (a) The commission shall collaborate with the STAR Kids
82		-	Managed Care Advisory Committee, Medicaid recipients, family
83		-	members of children with complex medical conditions, children's
84		-	health care advocates, Medicaid managed care organizations, and
85		-	other stakeholders to develop and implement a pilot program that is
86		-	substantially similar to the program described by Section 3,
87		-	Medicaid Services Investment and Accountability Act of 2019 (Pub.
88		-	L. No. 116-16), to provide coordinated care through a health home
89		-	to children with complex medical conditions.
90		-	(b) The commission shall seek guidance from the Centers for
91		-	Medicare and Medicaid Services and the United States Department of
92		-	Health and Human Services regarding the design of the program and,
93		-	based on the guidance, may actively seek and apply for federal
94		-	funding to implement the program.
95		-	(c) Not later than December 31, 2024, the commission shall
96		-	prepare and submit a report to the legislature that includes:
97		-	(1) a summary of the commission's implementation of
98		-	the pilot program; and
99		-	(2) if the pilot program has been operating for a
100		-	period sufficient to obtain necessary data, a summary of the
101		-	commission's evaluation of the effect of the pilot program on the
102		-	coordination of care for children with complex medical conditions
103		-	and a recommendation as to whether the pilot program should be
104		-	continued, expanded, or terminated.
105		-	(d) The pilot program terminates and this section expires
106		-	September 1, 2025.
107		-	SECTION 4. The heading to Section 533.038, Government Code,
	10	+	SECTION 1. The heading to Section 533.038, Government Code,
108	11		is amended to read as follows:
109	12		Sec. 533.038. COORDINATION OF BENEFITS; CONTINUITY OF
110	13		SPECIALTY CARE FOR CERTAIN RECIPIENTS.
111		-	SECTION 5. Section 533.038, Government Code, is amended by
	14	+	SECTION 2. Section 533.038, Government Code, is amended by
112	15		amending Subsection (g) and adding Subsections (h) and (i) to read
113	16		as follows:
114	17		(g) The commission shall develop a clear and easy process,
115	18		to be implemented through a contract, that allows a recipient with
116	19		complex medical needs who has established a relationship with a
117	20		specialty provider to continue receiving care from that provider,
118	21		regardless of whether the recipient has primary health benefit plan
119	22		coverage in addition to Medicaid coverage.
120		-	(h) If a recipient who has complex medical needs wants to
	23	+	(h) If a recipient who has complex medical needs and who
	24	+	does not have primary health benefit plan coverage wants to
121	25		continue to receive care from a specialty provider that is not in
122	26		the provider network of the Medicaid managed care organization
123	27		offering the managed care plan in which the recipient is enrolled,
124		-	the managed care organization shall develop a simple, timely, and
125		-	efficient process to and shall make a good-faith effort to,
126		-	negotiate a single-case agreement with the specialty provider.
127		-	Until the Medicaid managed care organization and the specialty
128		-	provider enter into the single-case agreement, the specialty
129		-	provider shall be reimbursed in accordance with the applicable
130		-	reimbursement methodology specified in commission rule, including
131		-	1 T.A.C. Section 353.4.
	28	+	the managed care organization shall negotiate a single-case
	29	+	agreement with the specialty provider. Until the Medicaid managed
	30	+	care organization and the specialty provider enter into the
	31	+	single-case agreement, the specialty provider shall be reimbursed
	32	+	in accordance with the applicable reimbursement methodology
	33	+	specified in commission rule, including 1 T.A.C. Section 353.4.
132	34		(i) A single-case agreement entered into under this section
133	35		is not considered accessing an out-of-network provider for the
134	36		purposes of Medicaid managed care organization network adequacy
135	37		requirements.
136		-	SECTION 6. Section 32.054, Human Resources Code, is amended
137		-	by adding Subsection (f) to read as follows:
138		-	(f) To prevent serious medical conditions and reduce
139		-	emergency room visits necessitated by complications resulting from
140		-	a lack of access to dental care, the commission shall provide
141		-	medical assistance reimbursement for preventive dental services,
142		-	including reimbursement for one preventive dental care visit per
143		-	year, for an adult recipient with a disability who is enrolled in
144		-	the STAR+PLUS Medicaid managed care program. This subsection does
145		-	not apply to an adult recipient who is enrolled in the STAR+PLUS
146		-	home and community-based services (HCBS) waiver program. This
147		-	subsection may not be construed to reduce dental services available
148		-	to persons with disabilities that are otherwise reimbursable under
149		-	the medical assistance program.
150		-	SECTION 7. Section 531.0601(f), Government Code, is
	38	+	SECTION 3. Section 531.0601(f), Government Code, is
151	39		repealed.
152		-	SECTION 8. The Health and Human Services Commission is
	40	+	SECTION 4. The Health and Human Services Commission is
153	41		required to implement a provision of this Act only if the
154	42		legislature appropriates money to the commission specifically for
155	43		that purpose. If the legislature does not appropriate money
156	44		specifically for that purpose, the commission may, but is not
157	45		required to, implement a provision of this Act using other
158	46		appropriations that are available for that purpose.
159		-	SECTION 9. If before implementing any provision of this Act
	47	+	SECTION 5. If before implementing any provision of this Act
160	48		a state agency determines that a waiver or authorization from a
161	49		federal agency is necessary for implementation of that provision,
162	50		the agency affected by the provision shall request the waiver or
163	51		authorization and may delay implementing that provision until the
164	52		waiver or authorization is granted.
165		-	SECTION 10. This Act takes effect September 1, 2021.
166		-	______________________________ ______________________________
167		-	President of the Senate Speaker of the House
168		-	I hereby certify that S.B. No. 1648 passed the Senate on
169		-	May 12, 2021, by the following vote: Yeas 30, Nays 0;
170		-	May 27, 2021, Senate refused to concur in House amendments and
171		-	requested appointment of Conference Committee; May 28, 2021, House
172		-	granted request of the Senate; May 30, 2021, Senate adopted
173		-	Conference Committee Report by the following vote: Yeas 31,
174		-	Nays 0.
175		-	______________________________
176		-	Secretary of the Senate
177		-	I hereby certify that S.B. No. 1648 passed the House, with
178		-	amendments, on May 24, 2021, by the following vote: Yeas 141,
179		-	Nays 1, one present not voting; May 28, 2021, House granted request
180		-	of the Senate for appointment of Conference Committee;
181		-	May 30, 2021, House adopted Conference Committee Report by the
182		-	following vote: Yeas 137, Nays 0, two present not voting.
183		-	______________________________
184		-	Chief Clerk of the House
185		-	Approved:
186		-	______________________________
187		-	Date
188		-	______________________________
189		-	Governor
	53	+	SECTION 6. This Act takes effect September 1, 2021.