Bill Text: TX HB1470 | 2019-2020 | 86th Legislature | Introduced

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Bill Title: Relating to allowing the parents or guardians of certain medically dependent children to opt out of the STAR Kids managed care program under Medicaid.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2019-02-27 - Referred to Human Services [HB1470 Detail]

Download: Texas-2019-HB1470-Introduced.html

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86R1880 KFF-D
By: Raymond H.B. No. 1470

A BILL TO BE ENTITLED
AN ACT
relating to allowing the parents or guardians of certain medically
dependent children to opt out of the STAR Kids managed care program
under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.0025(b), Government Code, is amended
to read as follows:
(b) Except as otherwise provided by this section and Section
533.002531 and notwithstanding any other law, the commission shall
provide Medicaid acute care services through the most
cost-effective model of Medicaid capitated managed care as
determined by the commission. The commission shall require
mandatory participation in a Medicaid capitated managed care
program for all persons eligible for Medicaid acute care benefits,
but may implement alternative models or arrangements, including a
traditional fee-for-service arrangement, if the commission
determines the alternative would be more cost-effective or
efficient.
SECTION 2. Sections 533.00253(b) and (d), Government Code,
are amended to read as follows:
(b) Except as provided by Section 533.002531 and subject
[Subject] to Section 533.0025, the commission shall operate[, in
consultation with the Children's Policy Council established under
Section 22.035, Human Resources Code, establish] a mandatory STAR
Kids capitated managed care program tailored to provide Medicaid
benefits to children with disabilities. The managed care program
[developed] under this section must:
(1) provide Medicaid benefits that are customized to
meet the health care needs of recipients under the program through a
defined system of care;
(2) better coordinate care of recipients under the
program;
(3) improve the health outcomes of recipients;
(4) improve recipients' access to health care
services;
(5) achieve cost containment and cost efficiency;
(6) reduce the administrative complexity of
delivering Medicaid benefits;
(7) reduce the incidence of unnecessary
institutionalizations and potentially preventable events by
ensuring the availability of appropriate services and care
management;
(8) require a health home; and
(9) coordinate and collaborate with long-term care
service providers and long-term care management providers, if
recipients are receiving long-term services and supports outside of
the managed care organization.
(d) The commission shall provide Medicaid benefits through
the STAR Kids managed care program operated [established] under
this section to children who are receiving benefits under the
medically dependent children (MDCP) waiver program, except that the
parent or guardian of a medically dependent child may opt the child
out of receiving benefits through the STAR Kids managed care
program in accordance with Section 533.002531. The commission
shall ensure that the STAR Kids managed care program provides all of
the benefits provided under the medically dependent children (MDCP)
waiver program to the extent necessary to implement this
subsection.
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.002531 to read as follows:
Sec. 533.002531. STAR KIDS MANAGED CARE PROGRAM: OPT-OUT
ALTERNATIVE. (a) The commission shall provide a process by which
the parent or guardian of a child receiving benefits under the
medically dependent children (MDCP) waiver program may opt the
medically dependent child out of receiving benefits through the
STAR Kids managed care program operated under Section 533.00253 and
elect instead to have the child receive benefits through a
traditional fee-for-service arrangement. The commission shall
ensure that any transition in the delivery of benefits to a child
under this section is completed in a manner that protects
continuity of care.
(b) The parent or guardian of a medically dependent child
who opts the child out of receiving benefits through the STAR Kids
managed care program may not opt to return the child to receiving
benefits through the STAR Kids managed care program or any other
capitated managed care model for a period of at least two years.
(c) If a parent or guardian of a medically dependent child
opts the child out of receiving benefits through the STAR Kids
managed care program, the commission shall monitor:
(1) whether, after the child transitioned to the
traditional fee-for-service arrangement, the child's:
(A) utilization of benefits increased; and
(B) wellness improved; and
(2) the satisfaction of the child's parent or guardian
with the provision of benefits under the fee-for-service
arrangement.
(d) To the same extent required under Section 533.00253(e),
the commission shall ensure that there is a plan for transitioning
the provision of Medicaid benefits to recipients 21 years of age or
older from the fee-for-service arrangement provided under this
section to the STAR + PLUS Medicaid managed care program that
protects continuity of care. The plan must ensure that the
coordination begins when the recipient reaches 18 years of age.
SECTION 4. 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 5. This Act takes effect September 1, 2019.