By: Zaffirini, Moncrief, Madla S.B. No. 1165
A BILL TO BE ENTITLED
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.