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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of benefits to certain Medicaid |
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recipients with complex medical needs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Section 533.038, Government Code, |
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is amended to read as follows: |
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Sec. 533.038. COORDINATION OF BENEFITS; CONTINUITY OF |
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SPECIALTY CARE FOR CERTAIN RECIPIENTS. |
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SECTION 2. Section 533.038, Government Code, is amended by |
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amending Subsection (g) and adding Subsections (h) and (i) to read |
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as follows: |
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(g) The commission shall develop a clear and easy process, |
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to be implemented through a contract, that allows a recipient with |
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complex medical needs who has established a relationship with a |
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specialty provider to continue receiving care from that provider, |
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regardless of whether the recipient has primary health benefit plan |
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coverage in addition to Medicaid coverage. |
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(h) If a recipient who has complex medical needs and who |
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does not have primary health benefit plan coverage wants to |
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continue to receive care from a specialty provider that is not in |
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the provider network of the Medicaid managed care organization |
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offering the managed care plan in which the recipient is enrolled, |
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the managed care organization shall negotiate a single-case |
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agreement with the specialty provider. Until the Medicaid managed |
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care organization and the specialty provider enter into the |
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single-case agreement, the specialty provider shall be reimbursed |
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in accordance with the applicable reimbursement methodology |
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specified in commission rule, including 1 T.A.C. Section 353.4. |
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(i) A single-case agreement entered into under this section |
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is not considered accessing an out-of-network provider for the |
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purposes of Medicaid managed care organization network adequacy |
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requirements. |
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SECTION 3. Section 531.0601(f), Government Code, is |
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repealed. |
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SECTION 4. The Health and Human Services Commission is |
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required to implement a provision of this Act only if the |
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legislature appropriates money to the commission specifically for |
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that purpose. If the legislature does not appropriate money |
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specifically for that purpose, the commission may, but is not |
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required to, implement a provision of this Act using other |
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appropriations that are available for that purpose. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. This Act takes effect September 1, 2021. |