1-1     By:  Zaffirini, Moncrief                              S.B. No. 1165

 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. 1165               By:  Zaffirini

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to health care services under the state Medicaid program

1-11     for children with special health care needs.

1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-13                                  ARTICLE 1

1-14           SECTION 1.01.  Section 16A, Article 4413(502), Revised

1-15     Statutes, is amended by amending Subsection (n) and adding

1-16     Subsections (o), (p), and (q) to read as follows:

1-17           (n)  In cooperation with the Texas Department of Health, the

1-18     commission shall:

1-19                 (1)  monitor and assess health care services provided

1-20     under the state Medicaid program to children with special health

1-21     care needs who receive services under a managed care plan or under

1-22     the regular Medicaid program;

1-23                 (2)  adopt specific quality of care standards

1-24     applicable to health care services provided under managed care

1-25     plans to children with special health care needs; and

1-26                 (3)  undertake initiatives to develop, test, and

1-27     implement optimal methods for delivery of appropriate,

1-28     comprehensive, and cost-effective health care services to children

1-29     with special health care needs under managed care plans, including

1-30     the coordination of health care services with educational programs

1-31     and other social and community services, and the promotion of

1-32     family involvement and support.

1-33           (o)  The commission may not require a child with special

1-34     health care needs who receives supplemental security income from

1-35     the federal government to enroll in a managed care plan to receive

1-36     health care services provided under the state Medicaid program.

1-37     The commission may require children with special health care needs

1-38     or classes of children with special health care needs to enroll in

1-39     a managed care plan or primary care case management program in a

1-40     geographic service area of the state Medicaid program if the

1-41     commission:

1-42                 (1)  determines the enrollment will improve the

1-43     availability of appropriate and comprehensive health care services

1-44     to the enrolling child or children; and

1-45                 (2)  establishes procedures under which the commission

1-46     may exempt a child from required enrollment for good cause.

1-47           (p)  In cooperation with the Texas Department of Health, the

1-48     commission by rule shall prescribe qualifications for

1-49     classification of a child as a "child with special health care

1-50     needs" for purposes of Subsections (n) and (o) of this section.  In

1-51     prescribing qualifications, the commission must include children

1-52     with:

1-53                 (1)  severe disabilities;

1-54                 (2)  medically complex or fragile conditions; and

1-55                 (3)  rare, complex, or chronic health care conditions

1-56     that are likely to last at least one year and result in limitations

1-57     of function and activities in comparison with healthy children of

1-58     the same age.

1-59           (q)  This section expires September 1, 2001.

1-60                                  ARTICLE 2

1-61           SECTION 2.01.  Subchapter B, Chapter 532, Government Code, as

1-62     added by Acts of the 75th Legislature, Regular Session, 1997,

1-63     relating to nonsubstantive additions to and corrections in enacted

1-64     codes, is amended by adding Section 532.112 to read as follows:

 2-1           Sec. 532.112.  CHILDREN WITH SPECIAL HEALTH CARE NEEDS.

 2-2     (a)  In cooperation with the Texas Department of Health, the

 2-3     commission shall:

 2-4                 (1)  monitor and assess health care services provided

 2-5     under the state Medicaid program to children with special health

 2-6     care needs who receive services under a managed care plan or under

 2-7     the regular Medicaid program;

 2-8                 (2)  adopt specific quality of care standards

 2-9     applicable to health care services provided under managed care

2-10     plans to children with special health care needs; and

2-11                 (3)  undertake initiatives to develop, test, and

2-12     implement optimal methods for delivery of appropriate,

2-13     comprehensive, and cost-effective health care services to children

2-14     with special health care needs under managed care plans, including

2-15     the coordination of health care services with educational programs

2-16     and other social and community services, and the promotion of

2-17     family involvement and support.

2-18           (b)  The commission may not require a child with special

2-19     health care needs who receives supplemental security income from

2-20     the federal government to enroll in a managed care plan to receive

2-21     health care services provided under the state Medicaid program.

2-22     The commission may require children with special health care needs

2-23     or classes of children with special health care needs to enroll in

2-24     a managed care plan or primary care case management program in a

2-25     geographic service area of the state Medicaid program if the

2-26     commission:

2-27                 (1)  determines the enrollment will improve the

2-28     availability of appropriate and comprehensive health care services

2-29     to the enrolling child or children; and

2-30                 (2)  establishes procedures under which the commission

2-31     may exempt a child from required enrollment for good cause.

2-32           (c)  The commission by rule shall prescribe qualifications

2-33     for classification of a child as a "child with special health care

2-34     needs" for purposes of this section.  In prescribing

2-35     qualifications, the commission must include children with:

2-36                 (1)  severe disabilities;

2-37                 (2)  medically complex or fragile conditions; and

2-38                 (3)  rare, complex, or chronic health care conditions

2-39     that are likely to last at least one year and result in limitations

2-40     of function and activities in comparison with healthy children of

2-41     the same age.

2-42                                  ARTICLE 3

2-43           SECTION 3.01.  Article 1 of this Act takes effect on the

2-44     first date that it may take effect under Section 39, Article III,

2-45     Texas Constitution.

2-46           SECTION 3.02.  If H.B. No. 1845 or S.B. No. 898, Acts of the

2-47     75th Legislature, Regular Session, 1997, relating to nonsubstantive

2-48     additions to and corrections in enacted codes, becomes law,

2-49     Subsections (n), (o), (p), and (q), Section 16A, Article 4413(502),

2-50     Revised Statutes, as amended or added by Article 1 of this Act,

2-51     expire September 1, 1997.

2-52           SECTION 3.03.  Article 2 of this Act takes effect September

2-53     1, 1997, but only if H.B. No. 1845 or S.B. No. 898, Acts of the

2-54     75th Legislature, Regular Session, 1997, relating to nonsubstantive

2-55     additions to and corrections in enacted codes, becomes law.

2-56           SECTION 3.04.  The importance of this legislation and the

2-57     crowded condition of the calendars in both houses create an

2-58     emergency and an imperative public necessity that the

2-59     constitutional rule requiring bills to be read on three several

2-60     days in each house be suspended, and this rule is hereby suspended,

2-61     and that this Act take effect and be in force according to its

2-62     terms, and it is so enacted.

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