S.B. No. 600 AN ACT 1-1 relating to the development of certain standards and complaint 1-2 system guidelines for managed care organizations covering Medicaid 1-3 clients. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter B, Chapter 12, Health and Safety Code, 1-6 is amended by adding Section 12.017 to read as follows: 1-7 Sec. 12.017. MANAGED CARE ORGANIZATIONS: MEDICAID PROGRAM. 1-8 (a) Except as provided by Section 533.045, the department shall 1-9 develop for managed care organizations that serve Medicaid clients 1-10 performance, operation, quality of care, marketing, and financial 1-11 standards and standards relating to children's access to good 1-12 quality health care services. In developing the standards, the 1-13 department shall include measures to monitor and assess the 1-14 performance of managed care organizations relating to the health 1-15 status and outcome of care for Medicaid clients. 1-16 (b) In establishing standards under this section, the 1-17 department shall ensure that: 1-18 (1) to the extent possible, each Medicaid client can 1-19 receive good quality health care services in the client's local 1-20 community; 1-21 (2) plans serving children have adequate capacity to 1-22 provide pediatric care; and 1-23 (3) plans provide timely access and appropriate 1-24 referrals for specialty care. 2-1 SECTION 2. Subchapter B, Chapter 533, Health and Safety 2-2 Code, is amended by adding Section 533.045 to read as follows: 2-3 Sec. 533.045. MANAGED CARE ORGANIZATIONS: MEDICAID PROGRAM. 2-4 The department shall develop performance, operation, quality of 2-5 care, marketing, and financial standards for the provision by 2-6 managed care organizations of mental health and mental retardation 2-7 services to Medicaid clients. 2-8 SECTION 3. Chapter 1, Insurance Code, is amended by adding 2-9 Article 1.61 to read as follows: 2-10 Art. 1.61. MEDICAID MANAGED CARE ORGANIZATION: FISCAL 2-11 SOLVENCY AND COMPLAINT SYSTEM GUIDELINES. In conjunction with the 2-12 Texas Department of Health, the department shall establish fiscal 2-13 solvency standards and complaint system guidelines for managed care 2-14 organizations that serve Medicaid clients. Guidelines must require 2-15 that information regarding a managed care organization's complaint 2-16 process be made available in an appropriate communication format to 2-17 each Medicaid client when the person enrolls in the program. 2-18 SECTION 4. This Act takes effect September 1, 1995. 2-19 SECTION 5. The importance of this legislation and the 2-20 crowded condition of the calendars in both houses create an 2-21 emergency and an imperative public necessity that the 2-22 constitutional rule requiring bills to be read on three several 2-23 days in each house be suspended, and this rule is hereby suspended.