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Senate Bill 1648 |
Senate Author: Perry |
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Effective: 9-1-21 |
House Sponsor: Krause et al. |
Senate Bill 1648 amends the Government Code and Human Resources Code to require the Health and Human Services Commission (HHSC) to take the following actions relating to the provision of benefits under the Medicaid program:
· coordinate with the Department of Family and Protective Services to develop and implement a process to review a denial of services under the Medicaid managed care program on the basis of medical necessity for foster care youth;
· ensure that a health care provider is allowed to enter a variable schedule into the electronic visit verification system;
· study the feasibility of creating an online portal for individuals to request to be placed and check the individual's placement on a Medicaid waiver program interest list;
· develop a protocol in the ombudsman office to improve the capture and updating of contact information for an individual who contacts the office regarding Medicaid waiver programs or services;
· develop a procedure to verify that a Medicaid recipient or their parent or legal guardian is informed regarding the consumer direction model and provided the option to choose to receive care under that model and, if applicable, to document declination of that model;
· develop and implement a pilot program to provide coordinated care through a health home to children with complex medical conditions; and
· provide Medicaid reimbursement for preventive dental services for an adult recipient with a disability who is enrolled in the STAR+PLUS Medicaid managed care program.
Senate Bill 1648 clarifies that a continuity of specialty care protection for Medicaid recipients with complex medical needs applies regardless of whether the recipient has primary health benefit plan coverage in addition to Medicaid coverage. The bill requires a Medicaid managed care organization (MCO) to make a good‑faith effort to negotiate a single‑case agreement with a specialty provider who is not in the MCO's provider network for a recipient enrolled in a managed care plan offered by the MCO who has complex medical needs and wants to continue to receive care from that specialty provider. The bill provides for the reimbursement of the specialty provider until the MCO and the specialty provider enter into the single‑case agreement.
Senate Bill 1648 repeals the expiration date for statutory provisions relating to long‑term care services waiver program interest lists for children who become ineligible for the medically dependent children waiver program. Implementation of a provision of this bill by HHSC is mandatory only if a specific appropriation is made for that purpose.