S.B. No. 1648
AN ACT
relating to the provision of benefits under the Medicaid program,
including to recipients with complex medical needs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.024165 to read as follows:
Sec. 531.024165. MEDICAL REVIEW OF MEDICAID SERVICE DENIALS
FOR FOSTER CARE YOUTH. (a) Using existing resources, the
commission shall coordinate with the Department of Family and
Protective Services to develop and implement a process to review a
denial of services under the Medicaid managed care program on the
basis of medical necessity for foster care youth.
(b) Not later than December 31, 2022, the commission and the
Department of Family and Protective Services shall submit a report
to the legislature that includes a summary of the process developed
and implemented under Subsection (a).
(c) This section expires September 1, 2023.
SECTION 2. Section 531.024172(d), Government Code, is
amended to read as follows:
(d) In implementing the electronic visit verification
system:
(1) subject to Subsection (e), the executive
commissioner shall adopt compliance standards for health care
providers; and
(2) the commission shall ensure that:
(A) the information required to be reported by
health care providers is standardized across managed care
organizations that contract with the commission to provide health
care services to Medicaid recipients and across commission
programs;
(B) processes required by managed care
organizations to retrospectively correct data are standardized and
publicly accessible to health care providers; [and]
(C) standardized processes are established for
addressing the failure of a managed care organization to provide a
timely authorization for delivering services necessary to ensure
continuity of care; and
(D) a health care provider is allowed to enter a
variable schedule into the electronic visit verification system.
SECTION 3. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.0501, 531.0512, and 531.0605 to read
as follows:
Sec. 531.0501. MEDICAID WAIVER PROGRAMS: INTEREST LIST
MANAGEMENT. (a) The commission, in consultation with the
Intellectual and Developmental Disability System Redesign Advisory
Committee established under Section 534.053 and the STAR Kids
Managed Care Advisory Committee, shall study the feasibility of
creating an online portal for individuals to request to be placed
and check the individual's placement on a Medicaid waiver program
interest list. As part of the study, the commission shall determine
the most appropriate and cost-effective automated method for
determining the level of need of an individual seeking services
through a Medicaid waiver program.
(b) Not later than January 1, 2023, the commission shall
prepare and submit a report to the governor, the lieutenant
governor, the speaker of the house of representatives, and the
standing legislative committees with primary jurisdiction over
health and human services that summarizes the commission's findings
and conclusions from the study.
(c) Subsections (a) and (b) and this subsection expire
September 1, 2023.
(d) The commission shall develop a protocol in the office of
the ombudsman to improve the capture and updating of contact
information for an individual who contacts the office of the
ombudsman regarding Medicaid waiver programs or services.
Sec. 531.0512. NOTIFICATION REGARDING CONSUMER DIRECTION
MODEL. The commission shall:
(1) develop a procedure to:
(A) verify that a Medicaid recipient or the
recipient's parent or legal guardian is informed regarding the
consumer direction model and provided the option to choose to
receive care under that model; and
(B) if the individual declines to receive care
under the consumer direction model, document the declination; and
(2) ensure that each Medicaid managed care
organization implements the procedure.
Sec. 531.0605. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
PROGRAM. (a) The commission shall collaborate with the STAR Kids
Managed Care Advisory Committee, Medicaid recipients, family
members of children with complex medical conditions, children's
health care advocates, Medicaid managed care organizations, and
other stakeholders to develop and implement a pilot program that is
substantially similar to the program described by Section 3,
Medicaid Services Investment and Accountability Act of 2019 (Pub.
L. No. 116-16), to provide coordinated care through a health home
to children with complex medical conditions.
(b) The commission shall seek guidance from the Centers for
Medicare and Medicaid Services and the United States Department of
Health and Human Services regarding the design of the program and,
based on the guidance, may actively seek and apply for federal
funding to implement the program.
(c) Not later than December 31, 2024, the commission shall
prepare and submit a report to the legislature that includes:
(1) a summary of the commission's implementation of
the pilot program; and
(2) if the pilot program has been operating for a
period sufficient to obtain necessary data, a summary of the
commission's evaluation of the effect of the pilot program on the
coordination of care for children with complex medical conditions
and a recommendation as to whether the pilot program should be
continued, expanded, or terminated.
(d) The pilot program terminates and this section expires
September 1, 2025.
SECTION 4. 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 5. 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 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 develop a simple, timely, and
efficient process to and shall make a good-faith effort to,
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 6. Section 32.054, Human Resources Code, is amended
by adding Subsection (f) to read as follows:
(f) To prevent serious medical conditions and reduce
emergency room visits necessitated by complications resulting from
a lack of access to dental care, the commission shall provide
medical assistance reimbursement for preventive dental services,
including reimbursement for one preventive dental care visit per
year, for an adult recipient with a disability who is enrolled in
the STAR+PLUS Medicaid managed care program. This subsection does
not apply to an adult recipient who is enrolled in the STAR+PLUS
home and community-based services (HCBS) waiver program. This
subsection may not be construed to reduce dental services available
to persons with disabilities that are otherwise reimbursable under
the medical assistance program.
SECTION 7. Section 531.0601(f), Government Code, is
repealed.
SECTION 8. 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 9. 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 10. This Act takes effect September 1, 2021.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1648 passed the Senate on
May 12, 2021, by the following vote: Yeas 30, Nays 0;
May 27, 2021, Senate refused to concur in House amendments and
requested appointment of Conference Committee; May 28, 2021, House
granted request of the Senate; May 30, 2021, Senate adopted
Conference Committee Report by the following vote: Yeas 31,
Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1648 passed the House, with
amendments, on May 24, 2021, by the following vote: Yeas 141,
Nays 1, one present not voting; May 28, 2021, House granted request
of the Senate for appointment of Conference Committee;
May 30, 2021, House adopted Conference Committee Report by the
following vote: Yeas 137, Nays 0, two present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor