By: Zaffirini, Moncrief, Madla S.B. No. 1164 A BILL TO BE ENTITLED AN ACT 1-1 relating to Medicaid managed care contract compliance. 1-2 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-3 SECTION 1. Subchapter B, Chapter 32, Human Resources Code, 1-4 is amended by adding Section 32.043 to read as follows: 1-5 Sec. 32.043. MANAGED CARE CONTRACT COMPLIANCE. (a) The 1-6 department shall review each managed care organization that has 1-7 contracted with the department to provide medical assistance to 1-8 medical assistance recipients through a managed care plan issued by 1-9 the organization to determine whether the organization is prepared 1-10 to meet its contractual obligations. 1-11 (b)(1) The department shall require each managed care 1-12 organization that has contracted with the department to submit an 1-13 implementation plan not later than the 90th day before the date on 1-14 which the department plans to begin to provide medical assistance 1-15 through a managed care plan in a service area. The implementation 1-16 plan must include: 1-17 (A) specific staffing patterns by function for 1-18 all operations, including enrollment, information systems, member 1-19 services, quality improvement, claims management, case management, 1-20 and provider and enrollee training; and 1-21 (B) specific time frames for demonstrating 1-22 preparedness for implementation before the date on which the 1-23 department plans to begin to provide medical assistance through a 2-1 managed care plan in a service area. 2-2 (2) The department shall respond within five working 2-3 days if the implementation plan does not adequately meet 2-4 preparedness guidelines. 2-5 (3) The department shall require each managed care 2-6 organization that has contracted with the department to submit 2-7 status reports on the implementation plan not later than the 60th 2-8 day and the 30th day before the date on which the department plans 2-9 to begin to provide medical assistance through a managed care plan 2-10 in a service area and every 30th day after the department begins to 2-11 provide medical assistance through a managed care plan in a service 2-12 area until the 180th day of operations. 2-13 (c) The department shall conduct a compliance and readiness 2-14 review of each managed care organization that contracts with the 2-15 state not later than the 15th day before the date on which the 2-16 department plans to begin the enrollment process in a service area 2-17 and again not later than the 15th day before the date on which the 2-18 department plans to begin to provide medical assistance through a 2-19 managed care plan in a service area. The review shall include an 2-20 on-site inspection and tests of service authorization and claims 2-21 payment systems, complaint processing systems, and any other 2-22 process or system required by the contract. 2-23 (d) The department may delay enrollment of medical 2-24 assistance recipients in a managed care plan if the review reveals 2-25 that the managed care organization is not prepared to meet its 3-1 contractual obligations. 3-2 SECTION 2. This Act applies only to a contract with a 3-3 managed care organization that the Health and Human Services 3-4 Commission or an agency authorized by the commission enters into or 3-5 renews on or after the effective date of this Act. A contract with 3-6 a managed care organization that the Health and Human Services 3-7 Commission or an agency authorized by the commission enters into or 3-8 renews before the effective date of this Act is governed by the law 3-9 as it existed immediately before that date, and that law is 3-10 continued in effect for that purpose. 3-11 SECTION 3. The importance of this legislation and the 3-12 crowded condition of the calendars in both houses create an 3-13 emergency and an imperative public necessity that the 3-14 constitutional rule requiring bills to be read on three several 3-15 days in each house be suspended, and this rule is hereby suspended, 3-16 and that this Act take effect and be in force from and after its 3-17 passage, and it is so enacted.