By: Perry  S.B. No. 1648
         (In the Senate - Filed March 11, 2021; March 24, 2021, read
  first time and referred to Committee on Health & Human Services;
  May 3, 2021, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 9, Nays 0; May 3, 2021, sent
  to printer.)
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 1648 By:  Miles
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the provision of benefits to certain Medicaid
  recipients with complex medical needs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Section 533.038, Government Code,
  is amended to read as follows:
         Sec. 533.038.  COORDINATION OF BENEFITS; CONTINUITY OF
  SPECIALTY CARE FOR CERTAIN RECIPIENTS.
         SECTION 2.  Section 533.038, Government Code, is amended by
  amending Subsection (g) and adding Subsections (h) and (i) to read
  as follows:
         (g)  The commission shall develop a clear and easy process,
  to be implemented through a contract, that allows a recipient with
  complex medical needs who has established a relationship with a
  specialty provider to continue receiving care from that provider,
  regardless of whether the recipient has primary health benefit plan
  coverage in addition to Medicaid coverage.
         (h)  If a recipient who has complex medical needs and who
  does not have primary health benefit plan coverage wants to
  continue to receive care from a specialty provider that is not in
  the provider network of the Medicaid managed care organization
  offering the managed care plan in which the recipient is enrolled,
  the managed care organization shall negotiate a single-case
  agreement with the specialty provider. Until the Medicaid managed
  care organization and the specialty provider enter into the
  single-case agreement, the specialty provider shall be reimbursed
  in accordance with the applicable reimbursement methodology
  specified in commission rule, including 1 T.A.C. Chapter 355.
         (i)  A single-case agreement entered into under this section
  is not considered accessing an out-of-network provider for the
  purposes of Medicaid managed care organization network adequacy
  requirements.
         SECTION 3.  Section 531.0601(f), Government Code, is
  repealed.
         SECTION 4.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money to the commission 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 that are available for that purpose.
         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.  This Act takes effect September 1, 2021.
 
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