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.