1-1 By: Zaffirini, Moncrief S.B. No. 601
1-2 (In the Senate - Filed February 16, 1995; February 16, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; March 16, 1995, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 9, Nays 0;
1-6 March 16, 1995, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 601 By: Zaffirini
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to certain educational programs and support services under
1-11 a managed care Medicaid program.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 16, Article 4413(502), Revised Statutes,
1-14 is amended to read as follows:
1-15 Sec. 16. ADMINISTRATION OF MEDICAID PROGRAM. (a) On
1-16 approval by the federal government, the commission is the state
1-17 agency designated to administer federal medical assistance funds.
1-18 (b) In adopting rules implementing a managed care Medicaid
1-19 program, the commission shall establish guidelines for and require
1-20 managed care organizations to provide education programs for
1-21 providers and clients using a variety of techniques and mediums.
1-22 (c) A provider education program must include information
1-23 on:
1-24 (1) Medicaid policies, procedures, eligibility
1-25 standards, and benefits;
1-26 (2) the specific problems and needs of Medicaid
1-27 clients; and
1-28 (3) the rights and responsibilities of Medicaid
1-29 clients under the bill of rights and the bill of responsibilities
1-30 prescribed by this section.
1-31 (d) A client education program must present information in a
1-32 manner that is easy to understand. A program must include
1-33 information on:
1-34 (1) a client's rights and responsibilities under the
1-35 bill of rights and the bill of responsibilities prescribed by this
1-36 section;
1-37 (2) how to access health care services;
1-38 (3) how to access complaint procedures and the
1-39 client's right to bypass the managed care organization's internal
1-40 complaint system and use the notice and appeal procedures otherwise
1-41 required by the Medicaid program;
1-42 (4) Medicaid policies, procedures, eligibility
1-43 standards, and benefits;
1-44 (5) the policies and procedures of the managed care
1-45 organization; and
1-46 (6) the importance of prevention, early intervention,
1-47 and appropriate use of services.
1-48 (e) The commission by rule shall adopt a bill of rights and
1-49 a bill of responsibilities for each person enrolled in the Medicaid
1-50 program. The bill of rights must address a client's right to:
1-51 (1) respect, dignity, privacy, confidentiality, and
1-52 nondiscrimination;
1-53 (2) a reasonable opportunity to choose a health care
1-54 plan and primary care provider and to change to another plan or
1-55 provider in a reasonable manner;
1-56 (3) consent to or refuse treatment and actively
1-57 participate in treatment decisions;
1-58 (4) ask questions and receive complete information
1-59 relating to the client's medical condition and treatment options;
1-60 (5) access each available complaint process, receive a
1-61 timely response to a complaint, and receive a fair hearing; and
1-62 (6) timely access to care that does not have any
1-63 communication or physical access barriers.
1-64 (f) The bill of responsibilities must address a client's
1-65 responsibility to:
1-66 (1) learn and understand each right the client has
1-67 under the Medicaid program;
1-68 (2) abide by the health plan and Medicaid policies and
2-1 procedures;
2-2 (3) share information relating to the client's health
2-3 status with the primary care provider and become fully informed
2-4 about service and treatment options; and
2-5 (4) actively participate in decisions relating to
2-6 service and treatment options, make personal choices, and take
2-7 action to maintain the client's health.
2-8 (g) The commission shall provide support and information
2-9 services to a person enrolled in or applying for Medicaid coverage
2-10 who experiences barriers to receiving services. The commission
2-11 shall give emphasis to providing support and services to a person
2-12 with an urgent or immediate medical or support need. The
2-13 commission may provide those services by contracting with a
2-14 nonprofit organization that is not involved in providing health
2-15 care, health insurance, or health benefits.
2-16 SECTION 2. The importance of this legislation and the
2-17 crowded condition of the calendars in both houses create an
2-18 emergency and an imperative public necessity that the
2-19 constitutional rule requiring bills to be read on three several
2-20 days in each house be suspended, and this rule is hereby suspended,
2-21 and that this Act take effect and be in force from and after its
2-22 passage, and it is so enacted.
2-23 * * * * *