By: Zaffirini, Moncrief S.B. No. 601
A BILL TO BE ENTITLED
AN ACT
1-1 relating to certain educational programs and support services under
1-2 a managed care Medicaid program.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 16, Article 4413(502), Revised Statutes,
1-5 is amended to read as follows:
1-6 Sec. 16. ADMINISTRATION OF MEDICAID PROGRAM. (a) On
1-7 approval by the federal government, the commission is the state
1-8 agency designated to administer federal medical assistance funds.
1-9 (b) In adopting rules implementing a managed care Medicaid
1-10 program, the commission shall establish guidelines for and require
1-11 managed care organizations to provide education programs for
1-12 providers and clients using a variety of techniques and mediums.
1-13 (c) A provider education program must include information
1-14 on:
1-15 (1) Medicaid policies, procedures, eligibility
1-16 standards, and benefits;
1-17 (2) the specific problems and needs of Medicaid
1-18 clients; and
1-19 (3) the rights and responsibilities of Medicaid
1-20 clients under the bill of rights and the bill of responsibilities
1-21 prescribed by this section.
1-22 (d) A client education program must present information in a
1-23 manner that is easy to understand. A program must include
1-24 information on:
2-1 (1) a client's rights and responsibilities under the
2-2 bill of rights and the bill of responsibilities prescribed by this
2-3 section;
2-4 (2) how to access health care services;
2-5 (3) how to access complaint procedures and the
2-6 client's right to bypass the managed care organization's internal
2-7 complaint system and use the notice and appeal procedures otherwise
2-8 required by the Medicaid program;
2-9 (4) Medicaid policies, procedures, eligibility
2-10 standards, and benefits;
2-11 (5) the policies and procedures of the managed care
2-12 organization; and
2-13 (6) the importance of prevention, early intervention,
2-14 and appropriate use of services.
2-15 (e) The commission by rule shall adopt a bill of rights and
2-16 a bill of responsibilities for each person enrolled in the Medicaid
2-17 program. The bill of rights must address a client's right to:
2-18 (1) respect, dignity, privacy, confidentiality, and
2-19 nondiscrimination;
2-20 (2) a reasonable opportunity to choose a health care
2-21 plan and primary care provider and to change to another plan or
2-22 provider in a reasonable manner;
2-23 (3) consent to or refuse treatment and actively
2-24 participate in treatment decisions;
2-25 (4) ask questions and receive complete information
2-26 relating to the client's medical condition and treatment options;
2-27 (5) access each available complaint process, receive a
3-1 timely response to a complaint, and receive a fair hearing; and
3-2 (6) timely access to care that does not have any
3-3 communication or physical access barriers.
3-4 (f) The bill of responsibilities must address a client's
3-5 responsibility to:
3-6 (1) learn and understand each right the client has
3-7 under the Medicaid program;
3-8 (2) abide by the health plan and Medicaid policies and
3-9 procedures;
3-10 (3) share information relating to the client's health
3-11 status with the primary care provider and become fully informed
3-12 about service and treatment options; and
3-13 (4) actively participate in decisions relating to
3-14 service and treatment options, make personal choices, and take
3-15 action to maintain the client's health.
3-16 (g) The commission shall provide support and information
3-17 services to a person enrolled in or applying for Medicaid coverage
3-18 who experiences barriers to receiving services. The commission
3-19 shall give emphasis to providing support and services to a person
3-20 with an urgent or immediate medical or support need. The
3-21 commission may provide those services by contracting with a
3-22 nonprofit organization that is not involved in providing health
3-23 care, health insurance, or health benefits.
3-24 SECTION 2. The importance of this legislation and the
3-25 crowded condition of the calendars in both houses create an
3-26 emergency and an imperative public necessity that the
3-27 constitutional rule requiring bills to be read on three several
4-1 days in each house be suspended, and this rule is hereby suspended,
4-2 and that this Act take effect and be in force from and after its
4-3 passage, and it is so enacted.