| 1 | 1 | | 88R10634 KKR-F |
|---|
| 2 | 2 | | By: Blanco S.B. No. 1694 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to the reimbursement rate for the provision of vagus nerve |
|---|
| 8 | 8 | | stimulation therapy system devices by certain health care providers |
|---|
| 9 | 9 | | under Medicaid. |
|---|
| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 11 | 11 | | SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
|---|
| 12 | 12 | | is amended by adding Section 32.03145 to read as follows: |
|---|
| 13 | 13 | | Sec. 32.03145. REIMBURSEMENT FOR VAGUS NERVE STIMULATION |
|---|
| 14 | 14 | | THERAPY SYSTEM DEVICE PROVIDED BY CERTAIN PROVIDERS. (a) This |
|---|
| 15 | 15 | | section applies only to the following providers under the medical |
|---|
| 16 | 16 | | assistance program: |
|---|
| 17 | 17 | | (1) a hospital licensed under Chapter 241, Health and |
|---|
| 18 | 18 | | Safety Code, that provides acute care services; or |
|---|
| 19 | 19 | | (2) an ambulatory surgical center licensed under |
|---|
| 20 | 20 | | Chapter 243, Health and Safety Code. |
|---|
| 21 | 21 | | (b) The executive commissioner shall ensure that the rules |
|---|
| 22 | 22 | | governing the determination of reimbursement rates paid to a |
|---|
| 23 | 23 | | provider subject to this section for the provision of a vagus nerve |
|---|
| 24 | 24 | | stimulation therapy system device to a medical assistance recipient |
|---|
| 25 | 25 | | is: |
|---|
| 26 | 26 | | (1) at least equal to 82 percent of the device's |
|---|
| 27 | 27 | | acquisition cost; and |
|---|
| 28 | 28 | | (2) in addition to any other surgery fee charged by the |
|---|
| 29 | 29 | | provider. |
|---|
| 30 | 30 | | SECTION 2. Section 533.005, Government Code, is amended by |
|---|
| 31 | 31 | | adding Subsection (i) to read as follows: |
|---|
| 32 | 32 | | (i) In addition to the requirements specified by Subsection |
|---|
| 33 | 33 | | (a), a contract described by that subsection must contain a |
|---|
| 34 | 34 | | requirement that a managed care organization comply with Section |
|---|
| 35 | 35 | | 32.03145, Human Resources Code. |
|---|
| 36 | 36 | | SECTION 3. (a) The Health and Human Services Commission |
|---|
| 37 | 37 | | shall, in a contract between the commission and a managed care |
|---|
| 38 | 38 | | organization under Chapter 533, Government Code, that is entered |
|---|
| 39 | 39 | | into or renewed on or after the effective date of this Act, require |
|---|
| 40 | 40 | | that the managed care organization comply with Section 533.005(i), |
|---|
| 41 | 41 | | Government Code, as added by this Act. |
|---|
| 42 | 42 | | (b) The Health and Human Services Commission shall seek to |
|---|
| 43 | 43 | | amend contracts entered into with managed care organizations under |
|---|
| 44 | 44 | | Chapter 533, Government Code, before the effective date of this Act |
|---|
| 45 | 45 | | to require those managed care organizations to comply with Section |
|---|
| 46 | 46 | | 533.005(i), Government Code, as added by this Act. To the extent of |
|---|
| 47 | 47 | | a conflict between Section 533.005(i), Government Code, as added by |
|---|
| 48 | 48 | | this Act, and a provision of a contract with a managed care |
|---|
| 49 | 49 | | organization entered into before the effective date of this Act, |
|---|
| 50 | 50 | | the contract provision prevails. |
|---|
| 51 | 51 | | SECTION 4. If before implementing any provision of this Act |
|---|
| 52 | 52 | | a state agency determines that a waiver or authorization from a |
|---|
| 53 | 53 | | federal agency is necessary for implementation of that provision, |
|---|
| 54 | 54 | | the agency affected by the provision shall request the waiver or |
|---|
| 55 | 55 | | authorization and may delay implementing that provision until the |
|---|
| 56 | 56 | | waiver or authorization is granted. |
|---|
| 57 | 57 | | SECTION 5. This Act takes effect September 1, 2023. |
|---|