| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
| |
|
|
relating to the provision of certain benefits under Medicaid and |
|
|
the Healthy Texas Women program, including the transition of case |
|
|
management for children and pregnant women program services and |
|
|
Healthy Texas Women program services to a managed care program. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter A, Chapter 533, Government Code, is |
|
|
amended by adding Section 533.002555 to read as follows: |
|
|
Sec. 533.002555. TRANSITION OF CASE MANAGEMENT FOR CHILDREN |
|
|
AND PREGNANT WOMEN PROGRAM RECIPIENTS TO MANAGED CARE PROGRAM. (a) |
|
|
In this section, "children and pregnant women program" means the |
|
|
benefits program provided under Medicaid and administered by the |
|
|
Department of State Health Services that provides case management |
|
|
services to children who have a health condition or health risk and |
|
|
pregnant women who have a high-risk condition. |
|
|
(b) The commission shall transition to a Medicaid managed |
|
|
care model all case management services provided to recipients |
|
|
under the children and pregnant women program. In transitioning |
|
|
services under this section, the commission shall ensure a |
|
|
recipient is provided case management services through the managed |
|
|
care plan in which the recipient is enrolled. |
|
|
(c) In implementing this section, the commission shall |
|
|
ensure: |
|
|
(1) a seamless transition in case management for |
|
|
recipients receiving benefits under the children and pregnant women |
|
|
program; and |
|
|
(2) case management services provided under the |
|
|
program are not interrupted. |
|
|
SECTION 2. Subchapter F, Chapter 32, Health and Safety |
|
|
Code, is amended by amending Section 32.152 and adding Sections |
|
|
32.156 and 32.157 to read as follows: |
|
|
Sec. 32.152. [ASSESSING] PROVISION OF HEALTHY TEXAS WOMEN |
|
|
PROGRAM SERVICES THROUGH MANAGED CARE. (a) The commission shall |
|
|
contract [assess: |
|
|
[(1) the feasibility and cost-effectiveness of |
|
|
contracting] with Medicaid managed care organizations to provide |
|
|
Healthy Texas Women program services [through managed care in one |
|
|
or more health care service regions in this state if the Healthy |
|
|
Texas Women Section 1115 Demonstration Waiver is approved; and |
|
|
[(2) the potential impact of that delivery model on |
|
|
women receiving services under the program]. |
|
|
(b) In implementing this section, the commission shall: |
|
|
(1) consult with the state Medicaid managed care |
|
|
advisory committee before contracting with Medicaid managed care |
|
|
organizations to provide Healthy Texas Women program services under |
|
|
this section; |
|
|
(2) identify barriers that prevent women from |
|
|
obtaining Healthy Texas Women program services and seek |
|
|
opportunities to mitigate those barriers; and |
|
|
(3) designate Healthy Texas Women program service |
|
|
providers as significant traditional providers until at least the |
|
|
third anniversary of the date the commission initially contracts |
|
|
with Medicaid managed care organizations to provide program |
|
|
services. [This section expires September 1, 2021.] |
|
|
Sec. 32.156. INFORMATION ABOUT AVAILABILITY OF SUBSIDIZED |
|
|
HEALTH INSURANCE COVERAGE. (a) The commission and each managed |
|
|
care organization participating in the Healthy Texas Women program |
|
|
shall provide a written notice containing information about |
|
|
eligibility requirements for and enrollment in a health benefit |
|
|
plan for which an enrollee receives a premium subsidy under the |
|
|
Patient Protection and Affordable Care Act (Pub. L. No. 111-148), |
|
|
based on family income, to a woman who: |
|
|
(1) is enrolled in the Healthy Texas Women program; |
|
|
and |
|
|
(2) has a household income that is more than 100 |
|
|
percent but not more than 200 percent of the federal poverty level. |
|
|
(b) The commission, in consultation with the Texas |
|
|
Department of Insurance, shall develop the form and content of the |
|
|
notice required under this section. The notice must include: |
|
|
(1) the latest information written in clear and easily |
|
|
understood language on available options for obtaining a subsidized |
|
|
health benefit plan described by Subsection (a); and |
|
|
(2) resources for receiving assistance applying for |
|
|
and enrolling in that health benefit plan. |
|
|
Sec. 32.157. ASSESSING AUTOMATIC ENROLLMENT OF CERTAIN |
|
|
WOMEN IN MANAGED CARE. (a) Not later than January 1, 2023, the |
|
|
commission shall assess the feasibility, cost-effectiveness, and |
|
|
benefits of automatically enrolling in managed care the women who |
|
|
become pregnant while receiving services through the Healthy Texas |
|
|
Women program. The assessment must examine whether automatically |
|
|
enrolling those women leads to the delivery of prenatal care and |
|
|
services earlier in the women's pregnancies. |
|
|
(b) This section expires September 1, 2023. |
|
|
SECTION 3. Section 32.024, Human Resources Code, is amended |
|
|
by adding Subsection (l-1) to read as follows: |
|
|
(l-1) The commission shall continue to provide medical |
|
|
assistance to a woman who is eligible for medical assistance for |
|
|
pregnant women for a period of not less than six months following |
|
|
the date the woman delivers or experiences an involuntary |
|
|
miscarriage. |
|
|
SECTION 4. As soon as practicable after the effective date |
|
|
of this Act, the executive commissioner of the Health and Human |
|
|
Services Commission shall adopt rules necessary to implement the |
|
|
changes in law made by this Act. |
|
|
SECTION 5. 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 6. 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 Health and Human Services Commission may, but is not |
|
|
required to, implement a provision of this Act using other |
|
|
appropriations available for that purpose. |
|
|
SECTION 7. This Act takes effect September 1, 2021. |
|
|
|
|
|
* * * * * |