1-1 By: Zaffirini, Moncrief S.B. No. 1164 1-2 (In the Senate - Filed March 11, 1997; March 17, 1997, read 1-3 first time and referred to Committee on Health and Human Services; 1-4 April 21, 1997, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 11, Nays 0; April 21, 1997, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1164 By: Zaffirini 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to Medicaid managed care contract compliance. 1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-12 SECTION 1. Subchapter B, Chapter 32, Human Resources Code, 1-13 is amended by adding Section 32.043 to read as follows: 1-14 Sec. 32.043. MANAGED CARE CONTRACT COMPLIANCE. (a) The 1-15 department shall review each managed care organization that has 1-16 contracted with the department to provide medical assistance to 1-17 medical assistance recipients through a managed care plan issued by 1-18 the organization to determine whether the organization is prepared 1-19 to meet its contractual obligations. 1-20 (b)(1) The department shall require each managed care 1-21 organization that has contracted with the department to submit an 1-22 implementation plan not later than the 90th day before the date on 1-23 which the department plans to begin to provide medical assistance 1-24 through a managed care plan in a service area. The implementation 1-25 plan must include: 1-26 (A) specific staffing patterns by function for 1-27 all operations, including enrollment, information systems, member 1-28 services, quality improvement, claims management, case management, 1-29 and provider and enrollee training; and 1-30 (B) specific time frames for demonstrating 1-31 preparedness for implementation before the date on which the 1-32 department plans to begin to provide medical assistance through a 1-33 managed care plan in a service area. 1-34 (2) The department shall respond within five working 1-35 days if the implementation plan does not adequately meet 1-36 preparedness guidelines. 1-37 (3) The department shall require each managed care 1-38 organization that has contracted with the department to submit 1-39 status reports on the implementation plan not later than the 60th 1-40 day and the 30th day before the date on which the department plans 1-41 to begin to provide medical assistance through a managed care plan 1-42 in a service area and every 30th day after the department begins to 1-43 provide medical assistance through a managed care plan in a service 1-44 area until the 180th day of operations. 1-45 (c) The department shall conduct a compliance and readiness 1-46 review of each managed care organization that contracts with the 1-47 state not later than the 15th day before the date on which the 1-48 department plans to begin the enrollment process in a service area 1-49 and again not later than the 15th day before the date on which the 1-50 department plans to begin to provide medical assistance through a 1-51 managed care plan in a service area. The review shall include an 1-52 on-site inspection and tests of service authorization and claims 1-53 payment systems, complaint processing systems, and any other 1-54 process or system required by the contract. 1-55 (d) The department may delay enrollment of medical 1-56 assistance recipients in a managed care plan if the review reveals 1-57 that the managed care organization is not prepared to meet its 1-58 contractual obligations. 1-59 SECTION 2. This Act applies only to a contract with a 1-60 managed care organization that the Health and Human Services 1-61 Commission or an agency authorized by the commission enters into or 1-62 renews on or after the effective date of this Act. A contract with 1-63 a managed care organization that the Health and Human Services 1-64 Commission or an agency authorized by the commission enters into or 2-1 renews before the effective date of this Act is governed by the law 2-2 as it existed immediately before that date, and that law is 2-3 continued in effect for that purpose. 2-4 SECTION 3. The importance of this legislation and the 2-5 crowded condition of the calendars in both houses create an 2-6 emergency and an imperative public necessity that the 2-7 constitutional rule requiring bills to be read on three several 2-8 days in each house be suspended, and this rule is hereby suspended, 2-9 and that this Act take effect and be in force from and after its 2-10 passage, and it is so enacted. 2-11 * * * * *