Bill Text: TX SB1105 | 2019-2020 | 86th Legislature | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the administration and operation of Medicaid, including Medicaid managed care.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2019-05-23 - House appoints conferees-reported [SB1105 Detail]
Download: Texas-2019-SB1105-Engrossed.html
Bill Title: Relating to the administration and operation of Medicaid, including Medicaid managed care.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2019-05-23 - House appoints conferees-reported [SB1105 Detail]
Download: Texas-2019-SB1105-Engrossed.html
By: Kolkhorst, Hinojosa, Lucio | S.B. No. 1105 |
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relating to the administration and operation of Medicaid, including | ||
Medicaid managed care. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.001, Government Code, is amended by | ||
adding Subdivision (4-c) to read as follows: | ||
(4-c) "Medicaid managed care organization" means a | ||
managed care organization as defined by Section 533.001 that | ||
contracts with the commission under Chapter 533 to provide health | ||
care services to Medicaid recipients. | ||
SECTION 2. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Sections 531.021182, 531.02131, 531.02142, | ||
531.024162, and 531.0511 to read as follows: | ||
Sec. 531.021182. USE OF NATIONAL PROVIDER IDENTIFIER | ||
NUMBER. (a) In this section, "national provider identifier | ||
number" means the national provider identifier number required | ||
under Section 1128J(e), Social Security Act (42 U.S.C. Section | ||
1320a-7k(e)). | ||
(b) The commission shall transition from using a | ||
state-issued provider identifier number to using only a national | ||
provider identifier number in accordance with this section. | ||
(c) The commission shall implement a Medicaid provider | ||
management and enrollment system and, following that | ||
implementation, use only a national provider identifier number to | ||
enroll a provider in Medicaid. | ||
(d) The commission shall implement a modernized claims | ||
processing system and, following that implementation, use only a | ||
national provider identifier number to process claims for and | ||
authorize Medicaid services. | ||
Sec. 531.02131. GRIEVANCES RELATED TO MEDICAID. (a) The | ||
commission shall adopt a definition of "grievance" related to | ||
Medicaid and ensure the definition is consistent among divisions | ||
within the commission to ensure all grievances are managed | ||
consistently. | ||
(b) The commission shall standardize Medicaid grievance | ||
data reporting and tracking among divisions within the commission. | ||
(c) The commission shall implement a no-wrong-door system | ||
for Medicaid grievances reported to the commission. | ||
(d) The commission shall establish a procedure for | ||
expedited resolution of a grievance related to Medicaid that allows | ||
the commission to: | ||
(1) identify a grievance related to a Medicaid access | ||
to care issue that is urgent and requires an expedited resolution; | ||
and | ||
(2) resolve the grievance within a specified period. | ||
(e) The commission shall verify grievance data reported by a | ||
Medicaid managed care organization. | ||
(f) The commission shall: | ||
(1) aggregate Medicaid recipient and provider | ||
grievance data to provide a comprehensive data set of grievances; | ||
and | ||
(2) make the aggregated data available to the | ||
legislature and the public in a manner that does not allow for the | ||
identification of a particular recipient or provider. | ||
Sec. 531.02142. PUBLIC ACCESS TO CERTAIN MEDICAID DATA. | ||
(a) To the extent permitted by federal law, the commission in | ||
consultation and collaboration with the appropriate advisory | ||
committees related to Medicaid shall make available to the public | ||
on the commission's Internet website in an easy-to-read format data | ||
relating to the quality of health care received by Medicaid | ||
recipients and the health outcomes of those recipients. Data made | ||
available to the public under this section must be made available in | ||
a manner that does not identify or allow for the identification of | ||
individual recipients. | ||
(b) In performing its duties under this section, the | ||
commission may collaborate with an institution of higher education | ||
or another state agency with experience in analyzing and producing | ||
public use data. | ||
Sec. 531.024162. NOTICE REQUIREMENTS REGARDING DENIAL OF | ||
COVERAGE OR PRIOR AUTHORIZATION. (a) The commission shall ensure | ||
that notice sent by the commission or a Medicaid managed care | ||
organization to a Medicaid recipient or provider regarding the | ||
denial of coverage or prior authorization for a service includes: | ||
(1) information required by federal law; | ||
(2) a clear and easy-to-understand explanation of the | ||
reason for the denial for the recipient; and | ||
(3) a clinical explanation of the reason for the | ||
denial for the provider. | ||
(b) To ensure cost-effectiveness, the commission may | ||
implement the notice requirements described by Subsection (a) at | ||
the same time as other required or scheduled notice changes. | ||
Sec. 531.0511. MEDICALLY DEPENDENT CHILDREN WAIVER | ||
PROGRAM: CONSUMER DIRECTION OF SERVICES. Notwithstanding Sections | ||
531.051(c)(1) and (d), a consumer direction model implemented under | ||
Section 531.051, including the consumer-directed service option, | ||
for the delivery of services under the medically dependent children | ||
(MDCP) waiver program must allow for the delivery of all services | ||
and supports available under that program through consumer | ||
direction. | ||
SECTION 3. Section 533.00253(a)(1), Government Code, is | ||
amended to read as follows: | ||
(1) "Advisory committee" means the STAR Kids Managed | ||
Care Advisory Committee described by [ |
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533.00254. | ||
SECTION 4. Section 533.00253, Government Code, is amended | ||
by amending Subsection (c) and adding Subsections (c-1), (c-2), | ||
(f), (g), and (h) to read as follows: | ||
(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 | ||
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(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. | ||
(c-1) To improve the care needs assessment tool used for | ||
purposes of a care needs assessment provided as a component of care | ||
management services and to improve the initial assessment and | ||
reassessment processes, the commission in consultation and | ||
collaboration with the STAR Kids Managed Care Advisory Committee | ||
shall consider changes that will: | ||
(1) reduce the amount of time needed to complete the | ||
care needs assessment initially and at reassessment; and | ||
(2) improve training and consistency in the completion | ||
of the care needs assessment using the tool and in the initial | ||
assessment and reassessment processes across different Medicaid | ||
managed care organizations and different service coordinators | ||
within the same Medicaid managed care organization. | ||
(c-2) To the extent feasible and allowed by federal law, the | ||
commission shall streamline the STAR Kids managed care program | ||
annual care needs reassessment process for a child who has not had a | ||
significant change in function that may affect medical necessity. | ||
(f) Using existing resources, the executive commissioner in | ||
consultation and collaboration with the STAR Kids Managed Care | ||
Advisory Committee shall determine the feasibility of providing | ||
Medicaid benefits to children enrolled in the STAR Kids managed | ||
care program under: | ||
(1) an accountable care organization model in | ||
accordance with guidelines established by the Centers for Medicare | ||
and Medicaid Services; or | ||
(2) an alternative model developed by or in | ||
collaboration with the Centers for Medicare and Medicaid Services | ||
Innovation Center. | ||
(g) Not later than December 1, 2022, the commission shall | ||
prepare and submit a written report to the legislature of the | ||
executive commissioner's determination under Subsection (f). | ||
(h) Subsections (f) and (g) and this subsection expire | ||
September 1, 2023. | ||
SECTION 5. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Sections 533.00254 and 533.0031 to read as | ||
follows: | ||
Sec. 533.00254. STAR KIDS MANAGED CARE ADVISORY COMMITTEE. | ||
(a) The STAR Kids Managed Care Advisory Committee established by | ||
the executive commissioner under Section 531.012 shall: | ||
(1) advise the commission on the operation of the STAR | ||
Kids managed care program under Section 533.00253; and | ||
(2) make recommendations for improvements to that | ||
program. | ||
(b) On December 31, 2023: | ||
(1) the advisory committee is abolished; and | ||
(2) this section expires. | ||
Sec. 533.0031. MEDICAID MANAGED CARE PLAN ACCREDITATION. | ||
(a) A managed care plan offered by a Medicaid managed care | ||
organization must be accredited by a nationally recognized | ||
accreditation organization. The commission may choose whether to | ||
require all managed care plans offered by Medicaid managed care | ||
organizations to be accredited by the same organization or to allow | ||
for accreditation by different organizations. | ||
(b) The commission may use the data, scoring, and other | ||
information provided to or received from an accreditation | ||
organization in the commission's contract oversight processes. | ||
SECTION 6. The Health and Human Services Commission shall | ||
issue a request for information to seek information and comments | ||
regarding contracting with a managed care organization to arrange | ||
for or provide a managed care plan under the STAR Kids managed care | ||
program established under Section 533.00253, Government Code, as | ||
amended by this Act, throughout the state instead of on a regional | ||
basis. | ||
SECTION 7. (a) Using available resources, the Health and | ||
Human Services Commission shall report available data on the 30-day | ||
limitation on reimbursement for inpatient hospital care provided to | ||
Medicaid recipients enrolled in the STAR+PLUS Medicaid managed care | ||
program under 1 T.A.C. Section 354.1072(a)(1) and other applicable | ||
law. To the extent data is available on the subject, the commission | ||
shall also report on: | ||
(1) the number of Medicaid recipients affected by the | ||
limitation and their clinical outcomes; and | ||
(2) the impact of the limitation on reducing | ||
unnecessary Medicaid inpatient hospital days and any cost savings | ||
achieved by the limitation under Medicaid. | ||
(b) Not later than December 1, 2020, the Health and Human | ||
Services Commission shall submit the report containing the data | ||
described by Subsection (a) of this section to the governor, the | ||
legislature, and the Legislative Budget Board. The report required | ||
under this subsection may be combined with any other report | ||
required by this Act or other law. | ||
SECTION 8. The Health and Human Services Commission shall | ||
implement: | ||
(1) the Medicaid provider management and enrollment | ||
system required by Section 531.021182(c), Government Code, as added | ||
by this Act, not later than September 1, 2020; and | ||
(2) the modernized claims processing system required | ||
by Section 531.021182(d), Government Code, as added by this Act, | ||
not later than September 1, 2023. | ||
SECTION 9. Not later than March 1, 2020, the Health and | ||
Human Services Commission shall: | ||
(1) develop a plan to improve the care needs | ||
assessment tool and the initial assessment and reassessment | ||
processes as required by Sections 533.00253(c-1) and (c-2), | ||
Government Code, as added by this Act; and | ||
(2) post the plan on the commission's Internet | ||
website. | ||
SECTION 10. The Health and Human Services Commission shall | ||
require that a managed care plan offered by a managed care | ||
organization with which the commission enters into or renews a | ||
contract under Chapter 533, Government Code, on or after the | ||
effective date of this Act comply with Section 533.0031, Government | ||
Code, as added by this Act, not later than September 1, 2022. | ||
SECTION 11. 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 12. The Health and Human Services Commission is | ||
required to implement a provision of this Act only if the | ||
legislature appropriates money specifically for that purpose. If | ||
the legislature does not appropriate money specifically for that | ||
purpose, the commission may, but is not required to, implement a | ||
provision of this Act using other appropriations available for that | ||
purpose. | ||
SECTION 13. This Act takes effect September 1, 2019. |