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Senate Bill 1207 |
Senate Author: Perry et al. |
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Effective: 9-1-19 |
House Sponsor: Krause et al. |
Senate Bill 1207 amends the Government Code to set out provisions relating to the operation and administration of Medicaid, including the Medicaid managed care program and the medically dependent children (MDCP) waiver program. The bill provides for notice requirements regarding Medicaid coverage or prior authorization denial and incomplete requests; accessibility of information regarding Medicaid prior authorization requirements; external medical reviews conducted by an independent reviewer; long‑term care services waiver program interest lists; MDCP waiver program assessments and reassessments and program quality monitoring; eligibility of certain children for the MDCP waiver program, the deaf‑blind with multiple disabilities (DBMD) waiver program, or a "Money Follows the Person" demonstration project; and a prohibition against requiring that a child reside in a nursing facility for an extended period of time to meet the MDCP waiver program eligibility requirements regarding nursing facility level of care. The bill requires the Health and Human Services Commission (HHSC) to submit a quarterly report regarding access to care for Medicaid recipients receiving benefits under the MDCP waiver program and provides for the operation of a Medicaid escalation help line through which Medicaid recipients receiving benefits under the MDCP waiver program or the DBMD waiver program and their representatives have access to assistance relating to the STAR Kids managed care program.
Senate Bill 1207 requires HHSC to consider certain changes for purposes of improving the care needs assessment tool used under the STAR Kids managed care program, to streamline the STAR Kids managed care program annual care needs reassessment process for a child who has not had a significant change in function that may affect medical necessity, and to evaluate risk‑adjustment methods used for recipients under the STAR Kids managed care program in the quality‑based payment program to ensure that higher‑volume providers are not unfairly penalized. The bill prescribes duties for the STAR Kids Managed Care Advisory Committee. The bill provides for utilization review and prior authorization procedures for a Medicaid managed care organization, an annual review of such an organization's prior authorization requirements, reconsideration following adverse determinations on certain prior authorization requests, the maximum period for a prior authorization decision, and the coordination of Medicaid wrap‑around benefits for recipients with both primary health benefit plan coverage and Medicaid coverage.
Implementation of a provision of this bill by HHSC is mandatory only if a specific appropriation is made for that purpose.