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Senate Bill 348 |
Senate Author: Schwertner et al. |
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Effective: 5-18-13 |
House Sponsor: Kolkhorst |
Senate Bill 348 amends the Government Code to require the Health and Human Services Commission's (HHSC) office of contract management to establish an annual utilization review process for managed care organizations participating in the STAR + PLUS Medicaid managed care program that includes, among other topics to be determined by HHSC, a thorough investigation of each managed care organization's procedures for determining whether a recipient should be enrolled in the STAR + PLUS home and community-based services and supports program. The bill specifies the process by which managed care organizations are to be reviewed by the office each fiscal year, but requires the office to use the newly established utilization review process to review each managed care organization participating in the STAR + PLUS Medicaid managed care program during the state fiscal biennium ending August 31, 2015. The bill requires HHSC, in conjunction with the office, to provide an annual report to the standing committees of the senate and house of representatives with jurisdiction over the Medicaid program regarding the utilization reviews and the efficiency of the program, the first of which must be provided not later than December 1, 2014. The bill prohibits a service provider who contracts with a managed care organization from being held liable for the good faith provision of services based on an authorization from the organization if a utilization review results in a determination to recoup money from the organization.