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Senate Bill 1096 |
Senate Author: Perry et al. |
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Effective: 9-1-19 |
House Sponsor: Oliverson et al. |
Senate Bill 1096 amends the Government Code to require the Health and Human Services Commission (HHSC), at least biennially, to conduct a utilization review on a sample of cases for children enrolled in the STAR Kids Medicaid managed care program to ensure that all imposed clinical prior authorizations are based on publicly available clinical criteria and are not being used to negatively impact a recipient's access to care. The bill requires the STAR Kids Managed Care Advisory Committee, or a successor committee, to explore the feasibility of adopting a private duty nursing assessment for use in the STAR Kids Medicaid managed care program and provide recommendations to HHSC on adopting a private duty nursing assessment tool that would streamline the documentation for prior authorization of private duty nursing. The bill provides for prior authorization procedures required to be used by a managed care organization (MCO) for a hospitalized STAR Kids Medicaid managed care program recipient and revises the required contents of a Medicaid contract between an MCO and HHSC with regard to prior authorizations for prescription drugs under the program. Implementation of a provision of this bill by HHSC is mandatory only if a specific appropriation is made for that purpose.