74R11660 MLR-D By Zaffirini, Moncrief, et al. S.B. No. 600 Substitute the following for S.B. No. 600: By Berlanga, et al. C.S.S.B. No. 600 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the development of certain standards and complaint 1-3 system guidelines for managed care organizations covering Medicaid 1-4 clients. 1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-6 SECTION 1. Subchapter B, Chapter 12, Health and Safety Code, 1-7 is amended by adding Section 12.017 to read as follows: 1-8 Sec. 12.017. MANAGED CARE ORGANIZATIONS: MEDICAID PROGRAM. 1-9 (a) Except as provided by Section 533.045, the department shall 1-10 develop for managed care organizations that serve Medicaid clients 1-11 performance, operation, quality of care, marketing, and financial 1-12 standards and standards relating to children's access to good 1-13 quality health care services. In developing the standards, the 1-14 department shall include measures to monitor and assess the 1-15 performance of managed care organizations relating to the health 1-16 status and outcome of care for Medicaid clients. 1-17 (b) In establishing standards under this section, the 1-18 department shall ensure that: 1-19 (1) to the extent possible, each Medicaid client can 1-20 receive good quality health care services in the client's local 1-21 community; 1-22 (2) plans serving children have adequate capacity to 1-23 provide pediatric care; and 1-24 (3) plans provide timely access and appropriate 2-1 referrals for specialty care. 2-2 SECTION 2. Subchapter B, Chapter 533, Health and Safety 2-3 Code, is amended by adding Section 533.045 to read as follows: 2-4 Sec. 533.045. MANAGED CARE ORGANIZATIONS: MEDICAID PROGRAM. 2-5 The department shall develop performance, operation, quality of 2-6 care, marketing, and financial standards for the provision by 2-7 managed care organizations of mental health and mental retardation 2-8 services to Medicaid clients. 2-9 SECTION 3. Chapter 1, Insurance Code, is amended by adding 2-10 Article 1.61 to read as follows: 2-11 Art. 1.61. MEDICAID MANAGED CARE ORGANIZATION: FISCAL 2-12 SOLVENCY AND COMPLAINT SYSTEM GUIDELINES. In conjunction with the 2-13 Texas Department of Health, the department shall establish fiscal 2-14 solvency standards and complaint system guidelines for managed care 2-15 organizations that serve Medicaid clients. Guidelines must require 2-16 that information regarding a managed care organization's complaint 2-17 process be made available in an appropriate communication format to 2-18 each Medicaid client when the person enrolls in the program. 2-19 SECTION 4. This Act takes effect September 1, 1995. 2-20 SECTION 5. The importance of this legislation and the 2-21 crowded condition of the calendars in both houses create an 2-22 emergency and an imperative public necessity that the 2-23 constitutional rule requiring bills to be read on three several 2-24 days in each house be suspended, and this rule is hereby suspended.