AN ACT 1-1 relating to health care services under the state Medicaid program 1-2 for children with special health care needs. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 ARTICLE 1 1-5 SECTION 1.01. Section 16A, Article 4413(502), Revised 1-6 Statutes, is amended by amending Subsection (n) and adding 1-7 Subsections (o), (p), and (q) to read as follows: 1-8 (n) In cooperation with the Texas Department of Health, the 1-9 commission shall: 1-10 (1) monitor and assess health care services provided 1-11 under the state Medicaid program to children with special health 1-12 care needs who receive services under a managed care plan or under 1-13 the regular Medicaid program; 1-14 (2) adopt specific quality of care standards 1-15 applicable to health care services provided under managed care 1-16 plans to children with special health care needs; and 1-17 (3) undertake initiatives to develop, test, and 1-18 implement optimal methods for delivery of appropriate, 1-19 comprehensive, and cost-effective health care services to children 1-20 with special health care needs under managed care plans, including 1-21 the coordination of health care services with educational programs 1-22 and other social and community services, and the promotion of 1-23 family involvement and support. 2-1 (o) The commission may not require a child with special 2-2 health care needs who receives supplemental security income from 2-3 the federal government to enroll in a managed care plan to receive 2-4 health care services provided under the state Medicaid program. 2-5 The commission may require children with special health care needs 2-6 or classes of children with special health care needs to enroll in 2-7 a managed care plan or primary care case management program in a 2-8 geographic service area of the state Medicaid program if the 2-9 commission: 2-10 (1) determines the enrollment will improve the 2-11 availability of appropriate and comprehensive health care services 2-12 to the enrolling child or children; and 2-13 (2) establishes procedures under which the commission 2-14 may exempt a child from required enrollment for good cause. 2-15 (p) In cooperation with the Texas Department of Health, the 2-16 commission by rule shall prescribe qualifications for 2-17 classification of a child as a "child with special health care 2-18 needs" for purposes of Subsections (n) and (o) of this section. In 2-19 prescribing qualifications, the commission must include children 2-20 with: 2-21 (1) severe disabilities; 2-22 (2) medically complex or fragile conditions; and 2-23 (3) rare, complex, or chronic health care conditions 2-24 that are likely to last at least one year and result in limitations 2-25 of function and activities in comparison with healthy children of 3-1 the same age. 3-2 (q) This section expires September 1, 2001. 3-3 ARTICLE 2 3-4 SECTION 2.01. Subchapter B, Chapter 532, Government Code, as 3-5 added by Acts of the 75th Legislature, Regular Session, 1997, 3-6 relating to nonsubstantive additions to and corrections in enacted 3-7 codes, is amended by adding Section 532.112 to read as follows: 3-8 Sec. 532.112. CHILDREN WITH SPECIAL HEALTH CARE NEEDS. 3-9 (a) In cooperation with the Texas Department of Health, the 3-10 commission shall: 3-11 (1) monitor and assess health care services provided 3-12 under the state Medicaid program to children with special health 3-13 care needs who receive services under a managed care plan or under 3-14 the regular Medicaid program; 3-15 (2) adopt specific quality of care standards 3-16 applicable to health care services provided under managed care 3-17 plans to children with special health care needs; and 3-18 (3) undertake initiatives to develop, test, and 3-19 implement optimal methods for delivery of appropriate, 3-20 comprehensive, and cost-effective health care services to children 3-21 with special health care needs under managed care plans, including 3-22 the coordination of health care services with educational programs 3-23 and other social and community services, and the promotion of 3-24 family involvement and support. 3-25 (b) The commission may not require a child with special 4-1 health care needs who receives supplemental security income from 4-2 the federal government to enroll in a managed care plan to receive 4-3 health care services provided under the state Medicaid program. 4-4 The commission may require children with special health care needs 4-5 or classes of children with special health care needs to enroll in 4-6 a managed care plan or primary care case management program in a 4-7 geographic service area of the state Medicaid program if the 4-8 commission: 4-9 (1) determines the enrollment will improve the 4-10 availability of appropriate and comprehensive health care services 4-11 to the enrolling child or children; and 4-12 (2) establishes procedures under which the commission 4-13 may exempt a child from required enrollment for good cause. 4-14 (c) The commission by rule shall prescribe qualifications 4-15 for classification of a child as a "child with special health care 4-16 needs" for purposes of this section. In prescribing 4-17 qualifications, the commission must include children with: 4-18 (1) severe disabilities; 4-19 (2) medically complex or fragile conditions; and 4-20 (3) rare, complex, or chronic health care conditions 4-21 that are likely to last at least one year and result in limitations 4-22 of function and activities in comparison with healthy children of 4-23 the same age. 4-24 ARTICLE 3 4-25 SECTION 3.01. Article 1 of this Act takes effect on the 5-1 first date that it may take effect under Section 39, Article III, 5-2 Texas Constitution. 5-3 SECTION 3.02. If H.B. No. 1845 or S.B. No. 898, Acts of the 5-4 75th Legislature, Regular Session, 1997, relating to nonsubstantive 5-5 additions to and corrections in enacted codes, becomes law, 5-6 Subsections (n), (o), (p), and (q), Section 16A, Article 4413(502), 5-7 Revised Statutes, as amended or added by Article 1 of this Act, 5-8 expire September 1, 1997. 5-9 SECTION 3.03. Article 2 of this Act takes effect September 5-10 1, 1997, but only if H.B. No. 1845 or S.B. No. 898, Acts of the 5-11 75th Legislature, Regular Session, 1997, relating to nonsubstantive 5-12 additions to and corrections in enacted codes, becomes law. 5-13 SECTION 3.04. The importance of this legislation and the 5-14 crowded condition of the calendars in both houses create an 5-15 emergency and an imperative public necessity that the 5-16 constitutional rule requiring bills to be read on three several 5-17 days in each house be suspended, and this rule is hereby suspended, 5-18 and that this Act take effect and be in force according to its 5-19 terms, and it is so enacted. _______________________________ _______________________________ President of the Senate Speaker of the House I hereby certify that S.B. No. 1165 passed the Senate on April 28, 1997, by the following vote: Yeas 31, Nays 0. _______________________________ Secretary of the Senate I hereby certify that S.B. No. 1165 passed the House on May 16, 1997, by the following vote: Yeas 141, Nays 0, two present not voting. _______________________________ Chief Clerk of the House Approved: _______________________________ Date _______________________________ Governor