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 - Dead) 2019-03-11 - Referred to Human Services [HB2539 Detail]
Download: Texas-2019-HB2539-Introduced.html
86R1342 KFF-D | ||
By: Krause | H.B. No. 2539 |
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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 [ |
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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 [ |
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(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 [ |
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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 [ |
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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 [ |
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commission shall operate[ |
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program tailored to provide Medicaid benefits to children with | ||
disabilities. The managed care program [ |
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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 [ |
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this section to a child [ |
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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 [ |
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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[ |
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coordination between the STAR Kids managed care program and the | ||
STAR+PLUS Medicaid managed care program or other Medicaid waiver | ||
program beginning [ |
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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 [ |
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program under Section 533.071 [ |
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(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 [ |
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[ |
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Section 533.071 [ |
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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 | ||
[ |
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for acute care services through the Medicaid managed care system in | ||
accordance with [ |
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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. |