Texas 2023 - 88th Regular

Texas Senate Bill SB1239 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R7303 BDP-F
2	2	By: LaMantia S.B. No. 1239
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to reimbursement rates for eye health care services
8	8	providers participating in the Medicaid managed care program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 533.005, Government Code, is amended by
11	11	adding Subsection (i) to read as follows:
12	12	(i) In addition to the requirements specified by Subsection
13	13	(a), a contract described by that subsection must contain a
14	14	requirement that a managed care organization, including any
15	15	subcontracted administrator, contractor, vision plan, or other
16	16	entity the organization contracts with, owns, or otherwise engages
17	17	to provide or arrange for the provision of eye health care services
18	18	under a managed care plan, reimburse an eye health care services
19	19	provider who provides services to a recipient under the
20	20	organization's managed care plan at a rate that is at least equal to
21	21	the Medicaid fee-for-service rate for the provision of the same or
22	22	similar services.
23	23	SECTION 2. Section 533.0067, Government Code, is amended to
24	24	read as follows:
25	25	Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject
26	26	to Section 32.047, Human Resources Code, but notwithstanding any
27	27	other law, the commission shall require that each managed care
28	28	organization that contracts with the commission under any Medicaid
29	29	managed care model or arrangement to provide health care services
30	30	to recipients in a region include in the organization's provider
31	31	network each optometrist, therapeutic optometrist, and
32	32	ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
33	33	and an institution of higher education described by Section
34	34	531.021191(a)(4) in the region who:
35	35	(1) agrees to comply with the terms and conditions of
36	36	the organization;
37	37	(2) [agrees to accept the prevailing provider contract
38	38	rate of the organization;
39	39	[(3)] agrees to abide by the standards of care
40	40	required by the organization; and
41	41	(3) [(4)] is an enrolled provider under Medicaid.
42	42	SECTION 3. (a) The Health and Human Services Commission
43	43	shall, in a contract between the commission and a managed care
44	44	organization under Chapter 533, Government Code, that is entered
45	45	into or renewed on or after the effective date of this Act, require
46	46	that the managed care organization comply with Section 533.005(i),
47	47	Government Code, as added by this Act.
48	48	(b) The Health and Human Services Commission shall seek to
49	49	amend contracts entered into with managed care organizations under
50	50	Chapter 533, Government Code, before the effective date of this Act
51	51	to require those managed care organizations to comply with Section
52	52	533.005(i), Government Code, as added by this Act. To the extent of
53	53	a conflict between Section 533.005(i), Government Code, as added by
54	54	this Act, and a provision of a contract with a managed care
55	55	organization entered into before the effective date of this Act,
56	56	the contract provision prevails.
57	57	SECTION 4. If before implementing any provision of this Act
58	58	a state agency determines that a waiver or authorization from a
59	59	federal agency is necessary for implementation of that provision,
60	60	the agency affected by the provision shall request the waiver or
61	61	authorization and may delay implementing that provision until the
62	62	waiver or authorization is granted.
63	63	SECTION 5. This Act takes effect September 1, 2023.