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.