74R11659 MLR-D
By Zaffirini, Moncrief, et al. S.B. No. 601
Substitute the following for S.B. No. 601:
By Berlanga, et al. C.S.S.B. No. 601
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to certain educational programs and support services under
1-3 a managed care Medicaid program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 16, Article 4413(502), Revised Statutes,
1-6 is amended to read as follows:
1-7 Sec. 16. ADMINISTRATION OF MEDICAID PROGRAM. (a) On
1-8 approval by the federal government, the commission is the state
1-9 agency designated to administer federal medical assistance funds.
1-10 (b) In adopting rules implementing a managed care Medicaid
1-11 program, the commission shall establish guidelines for and require
1-12 managed care organizations to provide education programs for
1-13 providers and clients using a variety of techniques and mediums.
1-14 (c) A provider education program must include information
1-15 on:
1-16 (1) Medicaid policies, procedures, eligibility
1-17 standards, and benefits;
1-18 (2) the specific problems and needs of Medicaid
1-19 clients; and
1-20 (3) the rights and responsibilities of Medicaid
1-21 clients under the bill of rights and the bill of responsibilities
1-22 prescribed by this section.
1-23 (d) A client education program must present information in a
1-24 manner that is easy to understand. A program must include
2-1 information on:
2-2 (1) a client's rights and responsibilities under the
2-3 bill of rights and the bill of responsibilities prescribed by this
2-4 section;
2-5 (2) how to access health care services;
2-6 (3) how to access complaint procedures and the
2-7 client's right to bypass the managed care organization's internal
2-8 complaint system and use the notice and appeal procedures otherwise
2-9 required by the Medicaid program;
2-10 (4) Medicaid policies, procedures, eligibility
2-11 standards, and benefits;
2-12 (5) the policies and procedures of the managed care
2-13 organization; and
2-14 (6) the importance of prevention, early intervention,
2-15 and appropriate use of services.
2-16 (e) The commission by rule shall adopt a bill of rights and
2-17 a bill of responsibilities for each person enrolled in the Medicaid
2-18 program. The bill of rights must address a client's right to:
2-19 (1) respect, dignity, privacy, confidentiality, and
2-20 nondiscrimination;
2-21 (2) a reasonable opportunity to choose a health care
2-22 plan and primary care provider and to change to another plan or
2-23 provider in a reasonable manner;
2-24 (3) consent to or refuse treatment and actively
2-25 participate in treatment decisions;
2-26 (4) ask questions and receive complete information
2-27 relating to the client's medical condition and treatment options,
3-1 including specialty care;
3-2 (5) access each available complaint process, receive a
3-3 timely response to a complaint, and receive a fair hearing; and
3-4 (6) timely access to care that does not have any
3-5 communication or physical access barriers.
3-6 (f) The bill of responsibilities must address a client's
3-7 responsibility to:
3-8 (1) learn and understand each right the client has
3-9 under the Medicaid program;
3-10 (2) abide by the health plan and Medicaid policies and
3-11 procedures;
3-12 (3) share information relating to the client's health
3-13 status with the primary care provider and become fully informed
3-14 about service and treatment options; and
3-15 (4) actively participate in decisions relating to
3-16 service and treatment options, make personal choices, and take
3-17 action to maintain the client's health.
3-18 (g) The commission shall provide support and information
3-19 services to a person enrolled in or applying for Medicaid coverage
3-20 who experiences barriers to receiving health care services. The
3-21 commission shall give emphasis to assisting a person with an urgent
3-22 or immediate medical or support need. The commission may provide
3-23 support and information services by contracting with a nonprofit
3-24 organization that is not involved in providing health care, health
3-25 insurance, or health benefits. As a part of the support and
3-26 information services required by this subsection, the commission or
3-27 nonprofit organization shall:
4-1 (1) operate a statewide toll-free assistance telephone
4-2 number that includes TDD lines and assistance for persons who speak
4-3 Spanish;
4-4 (2) intervene promptly with the state Medicaid office,
4-5 managed care organizations and providers, the Texas Department of
4-6 Health, and any other appropriate entity on behalf of a person who
4-7 has an urgent need for medical services;
4-8 (3) assist a person who is experiencing barriers in
4-9 the Medicaid application and enrollment process, and refer the
4-10 person for further assistance if appropriate;
4-11 (4) educate persons so that they:
4-12 (A) understand the concept of managed care;
4-13 (B) understand their rights under the Medicaid
4-14 program, including grievance and appeal procedures; and
4-15 (C) are able to advocate for themselves;
4-16 (5) collect and maintain statistical information on a
4-17 regional basis regarding calls received by the assistance lines and
4-18 publish quarterly reports that:
4-19 (A) list the number of calls received by region;
4-20 (B) identify trends in delivery and access
4-21 problems;
4-22 (C) identify recurring barriers in the Medicaid
4-23 system; and
4-24 (D) indicate other problems identified with
4-25 Medicaid managed care; and
4-26 (6) assist the state Medicaid office, managed care
4-27 organizations and providers, and the Texas Department of Health in
5-1 identifying and correcting problems, including site visits to
5-2 affected regions if necessary.
5-3 SECTION 2. The importance of this legislation and the
5-4 crowded condition of the calendars in both houses create an
5-5 emergency and an imperative public necessity that the
5-6 constitutional rule requiring bills to be read on three several
5-7 days in each house be suspended, and this rule is hereby suspended,
5-8 and that this Act take effect and be in force from and after its
5-9 passage, and it is so enacted.