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. 2-63 * * * * *