Bill Text: TX SB791 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the accreditation of and a recipient's enrollment in a Medicaid managed care plan.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-03-01 - Referred to Health & Human Services [SB791 Detail]

Download: Texas-2019-SB791-Introduced.html
  86R5368 MM-F
 
  By: Buckingham S.B. No. 791
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the accreditation of and a recipient's enrollment in a
  Medicaid managed care plan.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0031 to read as follows:
         Sec. 533.0031.  MEDICAID MANAGED CARE PLAN ACCREDITATION.  
  Notwithstanding Section 533.004 or any other law requiring the
  commission to contract with a managed care organization to provide
  health care services to recipients, the commission may contract
  with a managed care organization to provide those services only if
  the managed care plan offered by the organization is accredited by a
  nationally recognized accrediting entity.
         SECTION 2.  Section 533.0075, Government Code, is amended to
  read as follows:
         Sec. 533.0075.  RECIPIENT ENROLLMENT.  (a) The commission
  shall:
               (1)  encourage recipients to choose appropriate
  managed care plans and primary health care providers by:
                     (A)  providing initial information to recipients
  and providers in a region about the need for recipients to choose
  plans and providers not later than the 90th day before the date on
  which a managed care organization plans to begin to provide health
  care services to recipients in that region through managed care;
                     (B)  providing follow-up information before
  assignment of plans and providers and after assignment, if
  necessary, to recipients who delay in choosing plans and providers
  after receiving the initial information under Paragraph (A); and
                     (C)  allowing plans and providers to provide
  information to recipients or engage in marketing activities under
  marketing guidelines established by the commission under Section
  533.008 after the commission approves the information or
  activities;
               (2)  consider the following factors in assigning
  managed care plans and primary health care providers to recipients
  who fail to choose plans and providers:
                     (A)  the importance of maintaining existing
  provider-patient and physician-patient relationships, including
  relationships with specialists, public health clinics, and
  community health centers;
                     (B)  to the extent possible, the need to assign
  family members to the same providers and plans; and
                     (C)  geographic convenience of plans and
  providers for recipients;
               (3)  retain responsibility for enrollment and
  disenrollment of recipients in managed care plans, except that the
  commission may delegate the responsibility to an independent
  contractor who receives no form of payment from, and has no
  financial ties to, any managed care organization;
               (4)  develop and implement an expedited process for
  determining eligibility for and enrolling pregnant women and
  newborn infants in managed care plans; and
               (5)  ensure immediate access to prenatal services and
  newborn care for pregnant women and newborn infants enrolled in
  managed care plans, including ensuring that a pregnant woman may
  obtain an appointment with an obstetrical care provider for an
  initial maternity evaluation not later than the 30th day after the
  date the woman applies for Medicaid.
         (b)  The commission shall, notwithstanding any other law,
  implement an automatic enrollment process under which an applicant
  determined eligible to receive Medicaid benefits through managed
  care is automatically enrolled, at the time the applicant is
  determined eligible for those benefits, in a Medicaid managed care
  plan chosen by the applicant or, if the applicant fails to choose a
  plan, by the commission.
         SECTION 3.  Section 533.0076(c), Government Code, is amended
  to read as follows:
         (c)  The commission shall allow a recipient who is enrolled
  in a managed care plan under this chapter to disenroll from that
  plan and enroll in another managed care plan[:
               [(1)]  at any time for cause in accordance with federal
  law[; and
               [(2)     once for any reason after the periods described
  by Subsections (a) and (b)].
         SECTION 4.  Section 533.0025(h), Government Code, is
  repealed.
         SECTION 5.  Section 533.0031, Government Code, as added by
  this Act, applies to a contract entered into or renewed on or after
  the effective date of this Act. A contract entered into or renewed
  before that date is governed by the law in effect immediately before
  the effective date of this Act, and that law is continued in effect
  for that purpose.
         SECTION 6.  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 7.  This Act takes effect September 1, 2019.
feedback