By: Sparks, Perry S.B. No. 855
A BILL TO BE ENTITLED
AN ACT
relating to the authority of certain medical consenters to assume
financial responsibility for certain out-of-network medical care
provided to children in foster care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 266, Family Code, is amended by adding
Section 266.0043 to read as follows:
Sec. 266.0043. ASSUMPTION OF FINANCIAL RESPONSIBILITY BY
MEDICAL CONSENTERS. (a) In this section:
(1) "Health care provider" means an individual who is
licensed, certified, or otherwise authorized to provide health care
services in this state. The term does not include a pharmacy.
(2) "Managed care plan" has the meaning assigned by
Section 540.0001, Government Code.
(3) "Medicaid" and "Medicaid managed care
organization" have the meanings assigned by Section 521.0001,
Government Code.
(4) "Medicaid managed care plan" means a managed care
plan offered by a Medicaid managed care organization.
(5) "Medical consenter" means a person authorized to
consent to medical care for a foster child under Section
266.004(b).
(6) "Out-of-network provider" means a health care
provider who is not included in the provider network of the Medicaid
managed care plan in which a foster child is enrolled.
(7) "Pharmacy" has the meaning assigned by Section
551.003, Occupations Code.
(b) Notwithstanding any other law, a medical consenter
other than the department may assume financial responsibility for
medical care, including behavioral health services, provided to a
foster child by an out-of-network provider engaged by the medical
consenter on behalf of the child. For purposes of this section,
assuming financial responsibility may include the medical
consenter enrolling the child in a health insurance plan.
(c) The department is not liable for the cost of medical
care described by Subsection (b), unless a court orders the
department to cover the cost of the medical care.
(d) This section may not be construed to:
(1) limit or restrict a foster child's access to
Medicaid benefits, including in-network benefits provided under
the Medicaid managed care program;
(2) change or limit the rights of parents of children
in the temporary managing conservatorship of the department; or
(3) limit a court's authority to order the department
to assume financial responsibility for the cost of services
provided to a foster child by an out-of-network provider.
(e) Not later than the 10th business day after the date
medical care for which a medical consenter assumes financial
responsibility under this section is provided, the medical
consenter shall notify, in the form and manner prescribed by the
department, the child's caseworker of the provision of that care.
The department shall ensure the child's health passport includes
records of the medical care provided under this section.
SECTION 2. Subchapter Q, Chapter 540, Government Code, is
amended by adding Section 540.0807 to read as follows:
Sec. 540.0807. ACCESS TO CARE PAID FOR BY CERTAIN MEDICAL
CONSENTERS. (a) A Medicaid managed care organization may not take
adverse action to prevent or discourage a recipient from accessing
health care and related services and benefits in accordance with
Section 266.0043, Family Code.
(b) A STAR Health program managed care contract between a
Medicaid managed care organization and the commission must require
that the organization comply with Subsection (a).
(c) This section may not be construed to confer liability on
a Medicaid managed care organization for the cost of health care and
related services and benefits described by Section 266.0043(b),
Family Code.
SECTION 3. 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 4. This Act takes effect September 1, 2025.