Bill Text: TX HB2539 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to improving the provision of Medicaid benefits to certain children, including children receiving benefits under the STAR Kids managed care program.

Spectrum: Moderate Partisan Bill (Republican 4-1)

Status: (Introduced) 2019-03-11 - Referred to Human Services [HB2539 Detail]

Download: Texas-2019-HB2539-Introduced.html
  86R1342 KFF-D
 
  By: Krause H.B. No. 2539
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to improving the provision of Medicaid benefits to certain
  children, including children receiving benefits under the STAR Kids
  managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.0213(d), Government Code, is amended
  to read as follows:
         (d)  As a part of the support and information services
  required by this section, the commission shall:
               (1)  operate a statewide toll-free assistance
  telephone number that includes relay services for persons with
  speech or hearing disabilities and assistance for persons who speak
  Spanish;
               (2)  intervene promptly with the state Medicaid office,
  managed care organizations and providers, and any other appropriate
  entity on behalf of a person who has an urgent need for medical
  services;
               (3)  assist a person who is experiencing barriers in
  the Medicaid application and enrollment process and refer the
  person for further assistance if appropriate;
               (4)  educate persons so that they:
                     (A)  understand the concept of managed care;
                     (B)  understand their rights under Medicaid,
  including grievance and appeal procedures; and
                     (C)  are able to advocate for themselves;
               (5)  collect and maintain statistical information on a
  regional basis regarding calls received by the assistance lines and
  publish quarterly reports that:
                     (A)  list the number of calls received by region;
                     (B)  identify trends in delivery and access
  problems;
                     (C)  identify recurring barriers in the Medicaid
  system; and
                     (D)  indicate other problems identified with
  Medicaid managed care;
               (6)  assist the state Medicaid office and managed care
  organizations and providers in identifying and correcting
  problems, including site visits to affected regions if necessary;
               (7)  meet the needs of all current and future Medicaid
  managed care recipients, including children receiving dental
  benefits and other recipients receiving benefits, under the:
                     (A)  STAR Medicaid managed care program;
                     (B)  STAR+PLUS [STAR + PLUS] Medicaid managed care
  program, including the Texas Dual Eligibles Integrated Care
  Demonstration Project provided under that program;
                     (C)  STAR Kids managed care program established
  under Section 533.071 [533.00253]; and
                     (D)  STAR Health program;
               (8)  incorporate support services for children
  enrolled in the child health plan established under Chapter 62,
  Health and Safety Code; and
               (9)  ensure that staff providing support and
  information services receives sufficient training, including
  training in the Medicare program for the purpose of assisting
  recipients who are dually eligible for Medicare and Medicaid, and
  has sufficient authority to resolve barriers experienced by
  recipients to health care and long-term services and supports.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.02132, 531.0601, and 531.0602 to
  read as follows:
         Sec. 531.02132.  EDUCATION PROGRAM FOR MEDICALLY DEPENDENT
  CHILDREN (MDCP) WAIVER PROGRAM. The commission shall develop an
  education program for the families of and care coordinators for
  children eligible for or receiving benefits under the medically
  dependent children (MDCP) waiver program that:
               (1)  educates the families and care coordinators about:
                     (A)  the option to receive benefits under a
  traditional fee-for-service model under Section 32.042421, Human
  Resources Code, or through the STAR Kids managed care program under
  Section 533.071; and
                     (B)  the evaluation and assessment process for
  determining eligibility for and receiving benefits under the
  medically dependent children (MDCP) waiver program; and
               (2)  provides information to families on the appeals
  process, including how to prepare for an appeal.
         Sec. 531.0601.  LONG-TERM CARE SERVICES WAIVER PROGRAM
  INTEREST LISTS.  (a)  This section applies only to a child who
  becomes ineligible for services under the medically dependent
  children (MDCP) waiver program because the child no longer meets:
               (1)  the level of care criteria for medical necessity
  for nursing facility care; or
               (2)  the age requirement for the program.
         (b)  A parent or guardian of a child who is notified by the
  commission that the child is no longer eligible for the medically
  dependent children (MDCP) waiver program may request that the
  commission:
               (1)  return the child to the interest list for the
  program unless the child is ineligible due to the child's age; or
               (2)  place the child on the interest list for another
  Section 1915(c) waiver program.
         (c)  At the time a child's parent or guardian makes a request
  under Subsection (b), the commission shall:
               (1)  for a child who becomes ineligible for the reason
  described by Subsection (a)(1), place the child:
                     (A)  on the interest list for the medically
  dependent children (MDCP) waiver program in the first position on
  the list; or
                     (B)  except as provided by Subdivision (3), on the
  interest list for another Section 1915(c) waiver program in a
  position relative to other persons on the list that is based on the
  date the child was initially placed on the interest list for the
  medically dependent children (MDCP) waiver program;
               (2)  except as provided by Subdivision (3) and subject
  to Section 533.071(e) and Section 32.042421(b), Human Resources
  Code, for a child who becomes ineligible for the reason described by
  Subsection (a)(2), place the child on the interest list for another
  Section 1915(c) waiver program in a position relative to other
  persons on the list that is based on the date the child was
  initially placed on the interest list for the medically dependent
  children (MDCP) waiver program; or
               (3)  for a child who becomes ineligible for a reason
  described by Subsection (a) and who is already on an interest list
  for another Section 1915(c) waiver program, move the child to a
  position on the interest list relative to other persons on the list
  that is based on the date the child was initially placed on the
  interest list for the medically dependent children (MDCP) waiver
  program, if that date is earlier than the date the child was
  initially placed on the interest list for the other waiver program.
         (d)  At the time the commission provides notice to a parent
  or guardian that a child is no longer eligible for the medically
  dependent children (MDCP) waiver program, the commission shall
  inform the parent or guardian in writing about the options under
  this section for placing the child on an interest list.
         Sec. 531.0602.  MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
  PROGRAM REASSESSMENTS.  To the extent allowed by federal law, the
  commission shall require that a child participating in the
  medically dependent children (MDCP) waiver program be reassessed to
  determine whether the child meets the level of care criteria for
  medical necessity for nursing facility care only if the child has a
  significant change in function that may affect the medical
  necessity for that level of care instead of requiring that the
  reassessment be made annually.
         SECTION 3.  Section 533.0025(b), Government Code, is amended
  to read as follows:
         (b)  Except as otherwise provided by this section and Section
  32.042421, Human Resources Code, 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 4.  Section 533.0063(c), Government Code, is amended
  to read as follows:
         (c)  A managed care organization participating in the
  STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
  [Medicaid] managed care program established under Section 533.071
  [533.00253] shall, for a recipient in that program, issue a
  provider network directory for the program in paper form unless the
  recipient opts out of receiving the directory in paper form.
         SECTION 5.  Chapter 533, Government Code, is amended by
  adding Subchapter C to read as follows:
  SUBCHAPTER C.  STAR KIDS MANAGED CARE PROGRAM
         Sec. 533.072.  MEDICALLY DEPENDENT CHILD OPT-IN
  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
  traditional fee-for-service delivery model under Section
  32.042421, Human Resources Code, and into receiving benefits
  through the STAR Kids managed care program operated under Section
  533.071. 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)  Notwithstanding any other law, the commission shall
  ensure that:
               (1)  the parent or guardian of a child who opts the
  child into receiving benefits through the STAR Kids managed care
  program under this section is allowed to choose the managed care
  plan offered under the STAR Kids managed care program into which the
  child is enrolled, regardless of the health care service region in
  which the child resides; and
               (2)  a child receiving benefits through the STAR Kids
  managed care program under this section is not required to obtain
  prior authorization or a referral for the provision of specialty
  care.
         Sec. 533.073.  MANAGED CARE ORGANIZATION STANDARDIZED
  POLICIES AND PROCEDURES.  Notwithstanding any other law, including
  Section 533.005, the commission shall adopt standardized policies
  and procedures applicable to each managed care organization that
  contracts with the commission to provide health care services to
  recipients under the STAR Kids managed care program to ensure the
  provision of benefits is substantially similar across all of those
  managed care organizations. The commission shall adopt policies
  and procedures under this section that require managed care
  organizations, under the terms of the organizations' contracts, to
  implement and adhere to:
               (1)  a standard prior authorization protocol,
  including minimum time frames for approving prior authorization
  requests;
               (2)  standardized claims payment and appeal processes;
               (3)  a standard approval process for the provision of
  nonemergency transportation services;
               (4)  similar requirements for accessing therapy
  services;
               (5)  a pharmacy benefit plan that complies strictly
  with Sections 533.005(a)(23)(A), (B), and (C) and does not impose
  additional requirements or restrictions on its enrolled
  recipients; and
               (6)  a robust online recipient and provider portal that
  is designed to support transparency, accountability, and the
  coordination of services by providing the recipients and providers,
  as appropriate, access to evaluations and assessments, including
  any screening and assessment instruments, individual service
  plans, prior authorization requests, explanations of benefits, and
  referrals.
         Sec. 533.074.  STANDARDS FOR DETERMINING MEDICAL NECESSITY.
  The commission shall establish standards that govern the processes,
  criteria, and guidelines under which managed care organizations
  determine the medical necessity of a health care service provided
  through the STAR Kids managed care program. In establishing
  standards under this section, the commission shall ensure that the
  treating provider or other neutral third party makes the
  determination of medical necessity rather than a care coordinator
  or other professional employed by the managed care organization.
         Sec. 533.075.  PROVIDER NETWORK REQUIREMENTS.  
  Notwithstanding any other law, the commission shall require a
  managed care organization that contracts with the commission to
  provide health care services to recipients under the STAR Kids
  managed care program to:
               (1)  include significant traditional providers in the
  organization's provider network for the duration of the
  organization's contract with the commission; and
               (2)  include at least two providers of a particular
  health care service in order to satisfy network adequacy
  requirements.
         Sec. 533.076.  PROVIDER MONITORING PROGRAM.  (a)  
  Notwithstanding Section 533.005(a)(22), the commission, in
  consultation with the STAR Kids Managed Care Advisory Committee
  established under Section 533.00254 or a successor committee, the
  advisory committee established under Section 534.183, and other
  organizations with relevant expertise the commission determines
  appropriate, shall ensure a contract between the commission and a
  managed care organization to provide health care services to
  children receiving benefits under the medically dependent children
  (MDCP) waiver program through the STAR Kids managed care program in
  accordance with Sections 531.071(e) and 533.072 contains a
  requirement that the managed care organization develop a monitoring
  program that uses individual and consumer-based quality metrics
  designed specifically with the needs of the recipient population in
  mind for purposes of measuring the quality of health care services
  provided by the organization's provider network.
         (b)  Based on metrics designed under Subsection (a), each
  managed care organization that contracts with the commission as
  described by that subsection shall perform evaluations and audits
  of the organization's provider network.
         Sec. 533.077.  PROVIDER PROTECTIONS.  (a)  Notwithstanding
  any other law, the commission shall require a managed care
  organization that contracts with the commission to provide health
  care services to recipients under the STAR Kids managed care
  program to:
               (1)  obtain the express approval of a recipient's
  parent or guardian before selecting a provider for the recipient or
  changing that provider; and
               (2)  reimburse a provider for a service at a rate that
  is at least 75 percent of the reimbursement rate paid for the same
  service under the traditional fee-for-service delivery model
  implemented under Section 32.042421, Human Resources Code.
         (b)  The commission shall establish a complaints process for
  providers contracting with managed care organizations that
  contract with the commission to provide health care services to
  recipients under the STAR Kids managed care program under which the
  providers are:
               (1)  confident their complaints will be appropriately
  considered and resolved and will not be referred back to the managed
  care organization; and
               (2)  protected from retaliatory action by the managed
  care organization.
         Sec. 533.078.  REGIONAL REVIEW PANELS. (a)  The commission
  shall establish regional review panels to review denials based on
  medical necessity issued by managed care organizations that
  contract with the commission to provide health care services under
  the STAR Kids managed care program. The panels must be composed of
  at least six but not more than eight members and must include:
               (1)  the parent or guardian of a child with an
  intellectual or developmental disability who has complex medical
  needs;
               (2)  an advocate for children with an intellectual or
  developmental disability;
               (3)  a representative of primary care physicians
  participating in the STAR Medicaid managed care program or the STAR
  Kids managed care program; and
               (4)  a representative of health care providers, other
  than primary care physicians, participating in the STAR Medicaid
  managed care program or the STAR Kids managed care program.
         (b)  The executive commissioner or the executive
  commissioner's designee shall appoint a presiding member of each
  regional review panel established under this section.
         (c)  Each regional review panel shall meet at least quarterly
  at the call of the presiding officer.
         (d)  Each member of a regional review panel serves without
  compensation.
         (e)  A regional review panel established under this section
  shall:
               (1)  review denials described by Subsection (a) for
  which there are requests for the commission to conduct a fair
  hearing before the commission conducts its fair hearing; 
               (2)  make a determination regarding whether to uphold
  or overturn the denial; and 
               (3)  notify all parties and the commission of the
  regional review panel's determination under Subdivision (2).
         (f)  If a regional review panel upholds a denial, the
  recipient or provider, as applicable, may further pursue a fair
  hearing with the commission.  If a regional review panel overturns a
  denial, the managed care organization is bound by the determination
  but may appeal the determination to the commission. 
         (g)  The commission is not bound by a determination of a
  regional review panel under this section.
         (h)  The executive commissioner shall adopt rules necessary
  to implement this section. 
         SECTION 6.  Section 533.00253, Government Code, is
  transferred to Subchapter C, Chapter 533, Government Code, as added
  by this Act, redesignated as Section 533.071, Government Code, and
  amended to read as follows:
         Sec. 533.071  [533.00253].  STAR KIDS [MEDICAID] MANAGED
  CARE PROGRAM. (a)  In this section:
               (1)  "Advisory committee" means the STAR Kids Managed
  Care Advisory Committee established under Section 533.00254 or a
  successor committee.
               (2)  "Health home" means a primary care provider
  practice, or, if appropriate, a specialty care provider practice,
  incorporating several features, including comprehensive care
  coordination, family-centered care, and data management, that are
  focused on improving outcome-based quality of care and increasing
  patient and provider satisfaction under Medicaid.
               (3)  "Potentially preventable event" has the meaning
  assigned by Section 536.001.
         (b)  Except as provided by Section 32.042421, Human
  Resources Code, 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.
         (c)  The commission may require that care management
  services made available as provided by Subsection (b)(7):
               (1)  incorporate best practices, as determined by the
  commission;
               (2)  integrate with a nurse advice line to ensure
  appropriate redirection rates;
               (3)  use an identification and stratification
  methodology that identifies recipients who have the greatest need
  for services;
               (4)  provide a care needs assessment for a recipient
  that is comprehensive, holistic, consumer-directed,
  evidence-based, and takes into consideration social and medical
  issues, for purposes of prioritizing the recipient's needs that
  threaten independent living;
               (5)  are delivered through multidisciplinary care
  teams located in different geographic areas of this state that use
  in-person contact with recipients and their caregivers;
               (6)  identify immediate interventions for transition
  of care;
               (7)  include monitoring and reporting outcomes that, at
  a minimum, include:
                     (A)  recipient quality of life;
                     (B)  recipient satisfaction; and
                     (C)  other financial and clinical metrics
  determined appropriate by the commission; and
               (8)  use innovations in the provision of services.
         (d)  The commission shall provide Medicaid benefits through
  the STAR Kids managed care program operated [established] under
  this section to a child [children] who is [are] receiving benefits
  under the medically dependent children (MDCP) waiver program if the
  parent or guardian of the medically dependent child opts the child
  into receiving benefits through the STAR Kids managed care program
  in accordance with Section 533.072.  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.
         (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 under the STAR Kids managed care program
  to under:
               (1)  the STAR+PLUS [STAR + PLUS] Medicaid managed care
  program; or
               (2)  if the child is receiving benefits under the
  medically dependent children (MDCP) waiver program and the
  commission determines it is more appropriate, another Medicaid
  waiver program, as defined by Section 534.001.
         (f)  The commission shall ensure that the plan described by
  Subsection (e):
               (1)  protects the recipient's continuity of care; 
               (2)  if applicable and to the maximum extent possible,
  avoids placing a recipient on an interest list for a Medicaid waiver
  program, as defined by Section 534.001; and
               (3)  provides for[.  The plan must ensure that]
  coordination between the STAR Kids managed care program and the
  STAR+PLUS Medicaid managed care program or other Medicaid waiver
  program beginning [programs begins] when a recipient reaches 18
  years of age.
         SECTION 7.  Section 533.00254(f), Government Code, is
  amended to read as follows:
         (f)  On the first anniversary of the date the commission
  completes implementation of the STAR Kids [Medicaid] managed care
  program under Section 533.071 [533.00253]:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         SECTION 8.  Section 533.0063(c), Government Code, is amended
  to read as follows:
         (c)  A managed care organization participating in the
  STAR+PLUS [STAR + PLUS] Medicaid managed care program or STAR Kids
  [Medicaid] managed care program operated [established] under
  Section 533.071 [533.00253] shall, for a recipient in that program,
  issue a provider network directory for the program in paper form
  unless the recipient opts out of receiving the directory in paper
  form.
         SECTION 9.  Chapter 534, Government Code, is amended by
  adding Subchapter D-1 to read as follows:
  SUBCHAPTER D-1. ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
         Sec. 534.181.  DEFINITIONS. In this subchapter:
               (1)  "Health care service region" has the meaning
  assigned by Section 533.001.
               (2)  "Pilot program" means the pilot program
  implemented under this subchapter.
         Sec. 534.182.  ALTERNATIVE SERVICE DELIVERY PILOT PROGRAM
  IMPLEMENTATION. (a) The commission shall develop and implement a
  pilot program to test alternative methods for delivering Medicaid
  benefits to children with an intellectual or developmental
  disability, including children receiving benefits under the
  medically dependent children (MDCP) waiver program, who are
  otherwise receiving some or all of those benefits through the STAR
  Medicaid managed care program or the STAR Kids managed care
  program.  The commission shall design the pilot program in a manner
  that allows the commission to determine whether the alternative
  delivery methods:
               (1)  achieve cost savings and efficiencies in the
  delivery of Medicaid acute care services and long-term services and
  supports; and
               (2)  improve the quality of and access to the services
  described by Subdivision (1).
         (b)  The pilot program must:
               (1)  be conducted in each health care service region of
  this state, begin not later than September 1, 2020, and operate for
  at least 24 months;
               (2)  include a total of at least 2,000 Medicaid
  recipients receiving benefits under the STAR Medicaid managed care
  program, and a total of at least 2,000 Medicaid recipients
  receiving benefits under the STAR Kids managed care program; and
               (3)  be designed in a manner that ensures continuity of
  care and the receipt of Medicaid acute care services and long-term
  services and supports for program participants.
         (c)  Recipient participation in the pilot program must be
  voluntary.
         Sec. 534.183.  ADVISORY COMMITTEE. (a) In developing the
  pilot program, the executive commissioner shall seek input from
  stakeholders by establishing an advisory committee to make
  recommendations to the commission on pilot program goals, outcome
  measures, and evaluation processes.
         (b)  The advisory committee must be composed of at least
  eight members who have expertise in and knowledge of the care needs
  of potential pilot program participants, including:
               (1)  a representative of the commission;
               (2)  the parent or guardian of a child with an
  intellectual or developmental disability who has complex medical
  needs;
               (3)  an advocate for children with an intellectual or
  developmental disability;
               (4)  a representative of primary care physicians
  participating in the STAR Medicaid managed care program or the STAR
  Kids managed care program; and
               (5)  a representative of health care providers, other
  than primary care physicians, participating in the STAR Medicaid
  managed care program or the STAR Kids managed care program.
         (c)  The executive commissioner shall appoint a member of the
  advisory committee as the presiding officer.
         (d)  The advisory committee shall meet at least quarterly at
  the call of the presiding officer.
         (e)  A member of the advisory committee serves without
  compensation.
         (f)  The advisory committee is subject to the requirements of
  Chapter 551.
         Sec. 534.184.  REPORTING REQUIREMENT. (a)  The commission
  shall conduct an initial evaluation of the pilot program and submit
  a written report on that evaluation not later than September 1,
  2021, to:
               (1)  the legislature, including the standing
  committees of the house of representatives and senate having
  primary jurisdiction over Medicaid;
               (2)  the advisory committee established under Section
  534.183; and
               (3)  the STAR Kids Managed Care Advisory Committee
  established under Section 533.00254 or a successor committee.
         (b)  The commission shall conduct a final evaluation of the
  pilot program and submit a written report on that evaluation to the
  entities described under Subsection (a) not later than September 1,
  2022. 
         (c)  Each evaluation required under this section must
  include:
               (1)  an evaluation of the success of the pilot program
  in achieving the program's goals; and
               (2)  recommendations for legislation that identify any
  statutory requirements that are impairing the success of the
  program or that may impair permanent implementation of a program
  delivery model.
         Sec. 534.185.  MORATORIUM ON IMPLEMENTATION OF CERTAIN LAW.
  Notwithstanding any other law, including Subchapter E, the
  commission may not expand on or after December 1, 2019, the delivery
  of Medicaid acute care services or long-term services and supports
  to children with an intellectual or developmental disability under
  the STAR Medicaid managed care program or the STAR Kids managed care
  program until the commission submits to the legislature the report
  on the final evaluation required under Section 534.184.
         Sec. 534.186.  EXPIRATION.  This subchapter expires
  September 1, 2022.
         SECTION 10.  Section 32.0212, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0212.  DELIVERY OF MEDICAL ASSISTANCE.  Except as
  provided by Section 32.042421 and notwithstanding
  [Notwithstanding] any other law [and subject to Section 533.0025,
  Government Code], the commission shall provide medical assistance
  for acute care services through the Medicaid managed care system in
  accordance with [implemented under] Chapter 533, Government Code,
  or another Medicaid capitated managed care program.
         SECTION 11.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.042421 to read as follows:
         Sec. 32.042421.  DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN
  RECIPIENTS UNDER THE MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
  PROGRAM. (a)  The commission shall establish a program to provide
  medical assistance benefits under a traditional fee-for-service
  delivery model to a recipient who is a child receiving benefits
  under the medically dependent children (MDCP) waiver program,
  including a recipient who is a participant in the health insurance
  premium payment program under Section 32.0422.
         (b)  To the same extent required under Section 533.071(e),
  Government Code, 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 delivery model
  provided under this section to the STAR+PLUS Medicaid managed care
  program or, if appropriate, a Medicaid waiver program, as defined
  by Section 534.001, Government Code, that protects continuity of
  care. The plan must ensure that the coordination begins when the
  recipient reaches 18 years of age.
         (c)  The executive commissioner shall adopt rules necessary
  to implement this section.
         SECTION 12.  As soon as practicable after the effective date
  of this Act, the Health and Human Services Commission shall conduct
  a study to identify incentives the commission could implement to
  increase the number of physicians and other health care providers
  contracting with managed care organizations to provide services to
  children with complex medical needs who are recipients under
  Medicaid. Not later than December 1, 2021, the commission shall
  submit a report of its findings under the study to the standing
  committees of the house of representatives and senate having
  primary jurisdiction over the Medicaid program.
         SECTION 13.  (a)  As soon as possible after the effective
  date of this Act, the Health and Human Services Commission shall
  identify each child who became ineligible for services under the
  medically dependent children (MDCP) waiver program on or after June
  1, 2016, and before the effective date of this Act.
         (b)  Section 531.0601, Government Code, as added by this Act,
  applies to:
               (1)  a child who becomes ineligible for the medically
  dependent children (MDCP) waiver program on or after the effective
  date of this Act; and
               (2)  a child identified under Subsection (a) of this
  section.
         SECTION 14.  Section 531.0602, Government Code, as added by
  this Act, applies only to a reassessment of a child's eligibility
  for the medically dependent children (MDCP) waiver program made on
  or after the effective date of this Act.
         SECTION 15.  Not later than December 1, 2019, the executive
  commissioner of the Health and Human Services Commission shall
  establish the advisory committee required by Section 534.183,
  Government Code, as added by this Act.
         SECTION 16.  (a)  Not later than September 1, 2020, and
  subject to Subsections (b) and (c) of this section, the Health and
  Human Services Commission shall:
               (1)  adopt the standardized policies and procedures
  required by Section 533.073, Government Code, as added by this Act,
  for managed care organizations participating in the STAR Kids
  managed care program;
               (2)  establish the standards for determining medical
  necessity required by Section 533.074, Government Code, as added by
  this Act, and applicable to managed care organizations
  participating in the STAR Kids managed care program;
               (3)  implement the provider protections required under
  Section 533.077, Government Code, as added by this Act; and
               (4)  establish the regional review panels required by
  Section 533.078, Government Code, as added by this Act.
         (b)  The Health and Human Services Commission shall ensure
  that a contract between the commission and a managed care
  organization to provide Medicaid benefits to recipients under the
  STAR Kids managed care program operated under Section 533.071,
  Government Code, as transferred, redesignated, and amended by this
  Act, that is entered into or renewed on or after the effective date
  of this Act complies with the provisions of Subchapter C, Chapter
  533, Government Code, as added by this Act.
         (c)  The Health and Human Services Commission shall seek to
  amend contracts entered into with managed care organizations to
  provide Medicaid benefits to recipients under the STAR Kids managed
  care program operated under Section 533.071, Government Code, as
  transferred, redesignated, and amended by this Act, before the
  effective date of this Act to ensure those contracts comply with the
  provisions of Subchapter C, Chapter 533, Government Code, as added
  by this Act. To the extent of a conflict between a provision of that
  subchapter and a term of a contract with a managed care organization
  entered into before the effective date of this Act, the contract
  provision prevails.
         SECTION 17.  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 18.  This Act takes effect September 1, 2019.
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