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
1-24 managed care plan in a service area.
2-1 (2) The department shall respond within five working
2-2 days if the implementation plan does not adequately meet
2-3 preparedness guidelines.
2-4 (3) The department shall require each managed care
2-5 organization that has contracted with the department to submit
2-6 status reports on the implementation plan not later than the 60th
2-7 day and the 30th day before the date on which the department plans
2-8 to begin to provide medical assistance through a managed care plan
2-9 in a service area and every 30th day after the department begins to
2-10 provide medical assistance through a managed care plan in a service
2-11 area until the 180th day of operations.
2-12 (c) The department shall conduct a compliance and readiness
2-13 review of each managed care organization that contracts with the
2-14 state not later than the 15th day before the date on which the
2-15 department plans to begin the enrollment process in a service area
2-16 and again not later than the 15th day before the date on which the
2-17 department plans to begin to provide medical assistance through a
2-18 managed care plan in a service area. The review shall include an
2-19 on-site inspection and tests of service authorization and claims
2-20 payment systems, complaint processing systems, and any other
2-21 process or system required by the contract.
2-22 (d) The department may delay enrollment of medical
2-23 assistance recipients in a managed care plan if the review reveals
2-24 that the managed care organization is not prepared to meet its
2-25 contractual obligations.
2-26 SECTION 2. This Act applies only to a contract with a
2-27 managed care organization that the Health and Human Services
3-1 Commission or an agency authorized by the commission enters into or
3-2 renews on or after the effective date of this Act. A contract with
3-3 a 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 before the effective date of this Act is governed by the law
3-6 as it existed immediately before that date, and that law is
3-7 continued in effect for that purpose.
3-8 SECTION 3. The importance of this legislation and the
3-9 crowded condition of the calendars in both houses create an
3-10 emergency and an imperative public necessity that the
3-11 constitutional rule requiring bills to be read on three several
3-12 days in each house be suspended, and this rule is hereby suspended,
3-13 and that this Act take effect and be in force from and after its
3-14 passage, and it is so enacted.
3-15 COMMITTEE AMENDMENT NO. 1
3-16 Amend S.B. No. 1164 in SECTION 1 of the bill, in the added
3-17 Section 32.043(b)(2), Human Resources Code (page 2, line 2, Senate
3-18 Engrossment), by striking "five" and substituting "ten".
3-19 Berlanga
3-20 COMMITTEE AMENDMENT NO. 2
3-21 Amend S.B. No. 1164 by adding the following appropriately
3-22 numbered section to the bill and renumbering existing sections of
3-23 the bill appropriately:
3-24 SECTION ____. (a) As part of the routine monitoring
3-25 responsibilities of the Health and Human Services Commission, the
3-26 commission shall evaluate the STAR PLUS Medicaid managed care
3-27 long-term care pilot project, including:
4-1 (1) consumer, family, and provider satisfaction with
4-2 the project;
4-3 (2) funding, regulatory, and statutory adjustments
4-4 needed to improve the project; and
4-5 (3) the overall quality of care provided by the
4-6 project compared to the quality of care provided by the traditional
4-7 fee-for-service Medicaid long-term care program.
4-8 (b) Not later than January 1, 1999, the commission shall
4-9 submit a report relating to the evaluation to the governor,
4-10 lieutenant governor, the speaker of the house of representatives,
4-11 the Senate Health and Human Services Committee, and the House
4-12 Public Health Committee.
4-13 Berlanga