76R12217 CLG-F
By Coleman, Dunnam, Hodge, McClendon H.B. No. 2896
Substitute the following for H.B. No. 2896:
By Coleman C.S.H.B. No. 2896
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the administration and operation of the state Medicaid
1-3 program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 531, Government Code, is
1-6 amended by adding Section 531.0218 to read as follows:
1-7 Sec. 531.0218. EVALUATION OF ENTITIES CONTRACTING TO OPERATE
1-8 MEDICAID PROGRAM. The commission shall evaluate and report
1-9 biennially to the legislature and governor regarding the
1-10 contractual performance and related costs of each of the
1-11 administrative entities that contract with the commission to
1-12 operate the state Medicaid program, including enrollment brokers,
1-13 external quality review organizations, primary care case management
1-14 administrators, and claims payors.
1-15 SECTION 2. Section 533.002, Government Code, is amended to
1-16 read as follows:
1-17 Sec. 533.002. PURPOSE. The commission shall implement the
1-18 Medicaid managed care program as part of the health care delivery
1-19 system developed under Chapter 532 by contracting with managed care
1-20 organizations in a manner that, to the extent possible:
1-21 (1) improves the health of Texans by:
1-22 (A) emphasizing prevention;
1-23 (B) promoting continuity of care; [and]
1-24 (C) providing a medical home for recipients; and
2-1 (D) developing strategies to encourage more
2-2 personal responsibility in health care maintenance and decisions;
2-3 (2) ensures that each recipient receives high quality,
2-4 comprehensive health care services in the recipient's local
2-5 community;
2-6 (3) encourages the training of and access to primary
2-7 care physicians and providers;
2-8 (4) maximizes cooperation with existing public health
2-9 entities, including local departments of health;
2-10 (5) provides incentives to managed care organizations
2-11 to improve the quality of health care services for recipients by
2-12 providing value-added services; and
2-13 (6) reduces administrative and other nonfinancial
2-14 barriers for recipients in obtaining health care services.
2-15 SECTION 3. Section 533.003, Government Code, is amended to
2-16 read as follows:
2-17 Sec. 533.003. CONSIDERATIONS IN AWARDING CONTRACTS. In
2-18 awarding contracts to managed care organizations, the commission
2-19 shall:
2-20 (1) give preference to organizations that have
2-21 significant participation in the organization's provider network
2-22 from each health care provider in the region who has traditionally
2-23 provided care to Medicaid and charity care patients, including
2-24 organizations that contract with school-based health centers;
2-25 (2) give extra consideration to organizations that
2-26 agree to assure continuity of care for at least three months beyond
2-27 the period of Medicaid eligibility for recipients; [and]
3-1 (3) consider the need to use different managed care
3-2 plans to meet the needs of different populations; and
3-3 (4) consider the ability of organizations to process
3-4 Medicaid claims electronically.
3-5 SECTION 4. Section 533.004, Government Code, is amended by
3-6 amending Subsection (a) and adding Subsection (e) to read as
3-7 follows:
3-8 (a) In providing health care services through Medicaid
3-9 managed care to recipients in a health care service region, the
3-10 commission shall contract with any [at least one] managed care
3-11 organization in that region that:
3-12 (1) is licensed under the Texas Health Maintenance
3-13 Organization Act (Chapter 20A, Vernon's Texas Insurance Code) to
3-14 provide health care in that region and that is:
3-15 (A) [(1)] wholly owned and operated by a
3-16 hospital district in that region;
3-17 (B) [(2)] created by a nonprofit corporation
3-18 that:
3-19 (i) [(A)] has a contract, agreement, or
3-20 other arrangement with a hospital district in that region or with a
3-21 municipality in that region that owns a hospital licensed under
3-22 Chapter 241, Health and Safety Code, and has an obligation to
3-23 provide health care to indigent patients; and
3-24 (ii) [(B)] under the contract, agreement,
3-25 or other arrangement, assumes the obligation to provide health care
3-26 to indigent patients and leases, manages, or operates a hospital
3-27 facility owned by the hospital district or municipality; or
4-1 (C) [(3)] created by a nonprofit corporation
4-2 that has a contract, agreement, or other arrangement with a
4-3 hospital district in that region under which the nonprofit
4-4 corporation acts as an agent of the district and assumes the
4-5 district's obligation to arrange for services under the Medicaid
4-6 expansion for children as authorized by Chapter 444, Acts of the
4-7 74th Legislature, Regular Session, 1995; or
4-8 (2) holds a certificate of authority as a health
4-9 maintenance organization under Article 20A.05, Insurance Code, and
4-10 that is:
4-11 (A) certified under Section 5.01(a), Medical
4-12 Practice Act (Article 4495b, Vernon's Texas Civil Statutes); and
4-13 (B) created by The University of Texas Medical
4-14 Branch at Galveston.
4-15 (e) For purposes of a managed care organization described by
4-16 Subsection (a)(2), "health care service region" or "region" means
4-17 the service area for which the managed care organization has
4-18 obtained a certificate of authority as a health maintenance
4-19 organization from the Texas Department of Insurance before
4-20 September 2, 1999.
4-21 SECTION 5. Section 533.005, Government Code, is amended to
4-22 read as follows:
4-23 Sec. 533.005. REQUIRED CONTRACT PROVISIONS. A contract
4-24 between a managed care organization and the commission for the
4-25 organization to provide health care services to recipients must
4-26 contain:
4-27 (1) procedures to ensure accountability to the state
5-1 for the provision of health care services, including procedures for
5-2 financial reporting, quality assurance, utilization review, and
5-3 assurance of contract and subcontract compliance;
5-4 (2) capitation and provider payment rates that ensure
5-5 the cost-effective provision of quality health care;
5-6 (3) a requirement that the managed care organization
5-7 provide ready access to a person who assists recipients in
5-8 resolving issues relating to enrollment, plan administration,
5-9 education and training, access to services, and grievance
5-10 procedures;
5-11 (4) a requirement that the managed care organization
5-12 provide ready access to a person who assists providers in resolving
5-13 issues relating to payment, plan administration, education and
5-14 training, and grievance procedures;
5-15 (5) a requirement that the managed care organization
5-16 provide information and referral about the availability of
5-17 educational, social, and other community services that could
5-18 benefit a recipient;
5-19 (6) procedures for recipient outreach and education;
5-20 (7) a requirement that the managed care organization
5-21 make payment to a physician or provider for health care services
5-22 rendered to a recipient under a managed care plan not later than
5-23 the 45th day after the date a claim for payment is received with
5-24 documentation reasonably necessary for the managed care
5-25 organization to process the claim, or within a period, not to
5-26 exceed 60 days, specified by a written agreement between the
5-27 physician or provider and the managed care organization;
6-1 (8) a requirement that the commission, on the date of
6-2 a recipient's enrollment in a managed care plan issued by the
6-3 managed care organization, inform the organization of the
6-4 recipient's Medicaid certification [recertification] date; and
6-5 (9) a requirement that the managed care organization
6-6 comply with Section 533.006 as a condition of contract retention
6-7 and renewal.
6-8 SECTION 6. Subchapter A, Chapter 533, Government Code, is
6-9 amended by adding Sections 533.0055 and 533.0056 to read as
6-10 follows:
6-11 Sec. 533.0055. REVIEW OF PROPOSED CONTRACT BY PRIVATE
6-12 ENTITY. (a) The commission shall contract with a private entity
6-13 to review each proposed contract between the commission and a
6-14 managed care organization to provide health care services to
6-15 recipients in a region under this chapter. In conducting a review
6-16 under this section, a private entity shall consider:
6-17 (1) the adequacy of current and proposed premium rates
6-18 in each region;
6-19 (2) sanctions for failure to meet performance goals;
6-20 (3) the ability of the managed care organization to
6-21 meet its contractual obligations and the specific time frames for
6-22 performance under the contract;
6-23 (4) the ability of the managed care organization to
6-24 process Medicaid claims electronically; and
6-25 (5) any other issues as directed by the commission.
6-26 (b) The commission shall enter into a contract with a
6-27 private entity to review a proposed contract under Subsection (a)
7-1 not later than the 180th day before the contract renewal date for
7-2 the region to which the proposed contract applies.
7-3 (c) Not later than the 120th day before the contract renewal
7-4 date for the region to which the proposed contract applies, a
7-5 private entity reviewing a proposed contract under Subsection (a)
7-6 shall issue a report to the commission stating the findings of its
7-7 review, including any recommendations for changes.
7-8 (d) The commission may make any necessary changes to a
7-9 proposed contract based on the findings of a review conducted by a
7-10 private entity under this section.
7-11 Sec. 533.0056. IMPLEMENTATION OF STATE-ADMINISTERED PLAN IN
7-12 REGION. The commission may not implement more than one
7-13 state-administered managed care plan in a health care service
7-14 region.
7-15 SECTION 7. Section 533.006(a), Government Code, is amended
7-16 to read as follows:
7-17 (a) The commission shall require that each managed care
7-18 organization that contracts with the commission to provide health
7-19 care services to recipients in a region:
7-20 (1) seek participation in the organization's provider
7-21 network from:
7-22 (A) each health care provider in the region who
7-23 has traditionally provided care to Medicaid recipients; [and]
7-24 (B) each hospital in the region that has been
7-25 designated as a disproportionate share hospital under the state
7-26 Medicaid program; and
7-27 (C) each specialized pediatric laboratory in the
8-1 region, including those laboratories located in children's
8-2 hospitals; and
8-3 (2) include in its provider network for not less than
8-4 three years:
8-5 (A) each health care provider in the region who:
8-6 (i) previously provided care to Medicaid
8-7 and charity care recipients at a significant level as prescribed by
8-8 the commission;
8-9 (ii) agrees to accept the prevailing
8-10 provider contract rate of the managed care organization; and
8-11 (iii) has the credentials required by the
8-12 managed care organization, provided that lack of board
8-13 certification or accreditation by the Joint Commission on
8-14 Accreditation of Healthcare Organizations may not be the sole
8-15 ground for exclusion from the provider network;
8-16 (B) each accredited primary care residency
8-17 program in the region; and
8-18 (C) each disproportionate share hospital
8-19 designated by the commission as a statewide significant traditional
8-20 provider.
8-21 SECTION 8. Section 533.007(e), Government Code, is amended
8-22 to read as follows:
8-23 (e) The commission shall conduct a compliance and readiness
8-24 review of each managed care organization that contracts with the
8-25 commission not later than the 15th day before the date on which the
8-26 commission plans to begin the enrollment process in a region and
8-27 again not later than the 15th day before the date on which the
9-1 commission plans to begin to provide health care services to
9-2 recipients in that region through managed care. The review must
9-3 include an on-site inspection and tests of service authorization
9-4 and claims payment systems, including the ability of the managed
9-5 care organization to process claims electronically, complaint
9-6 processing systems, and any other process or system required by the
9-7 contract.
9-8 SECTION 9. Section 533.0075, Government Code, is amended to
9-9 read as follows:
9-10 Sec. 533.0075. RECIPIENT ENROLLMENT. The commission shall:
9-11 (1) encourage recipients to choose appropriate managed
9-12 care plans and primary health care providers by:
9-13 (A) providing initial information to recipients
9-14 and providers in a region about the need for recipients to choose
9-15 plans and providers not later than the 90th day before the date on
9-16 which the commission plans to begin to provide health care services
9-17 to recipients in that region through managed care;
9-18 (B) providing follow-up information before
9-19 assignment of plans and providers and after assignment, if
9-20 necessary, to recipients who delay in choosing plans and providers;
9-21 and
9-22 (C) allowing plans and providers to provide
9-23 information to recipients or engage in marketing activities under
9-24 marketing guidelines established by the commission under Section
9-25 533.008 after the commission approves the information or
9-26 activities;
9-27 (2) consider the following factors in assigning
10-1 managed care plans and primary health care providers to recipients
10-2 who fail to choose plans and providers:
10-3 (A) the importance of maintaining existing
10-4 provider-patient and physician-patient relationships, including
10-5 relationships with specialists, public health clinics, and
10-6 community health centers;
10-7 (B) to the extent possible, the need to assign
10-8 family members to the same providers and plans; and
10-9 (C) geographic convenience of plans and
10-10 providers for recipients; [and]
10-11 (3) retain responsibility for enrollment and
10-12 disenrollment of recipients in managed care plans, except that the
10-13 commission may delegate the responsibility to an independent
10-14 contractor who receives no form of payment from, and has no
10-15 financial ties to, any managed care organization;
10-16 (4) develop and implement an expedited process for
10-17 determining eligibility for and enrolling pregnant women and
10-18 newborn infants in managed care plans;
10-19 (5) ensure immediate access to prenatal services and
10-20 newborn care for pregnant women and newborn infants enrolled in
10-21 managed care plans, including ensuring that a pregnant woman may
10-22 obtain an appointment with an obstetrical care provider for an
10-23 initial maternity evaluation not later than the 30th day after the
10-24 date the woman applies for Medicaid;
10-25 (6) implement a process to reduce or eliminate the
10-26 number of recipients classified as "on hold" with respect to the
10-27 delivery of services under managed care plans or, in the
11-1 alternative, develop a method for continued payment to managed care
11-2 organizations to avoid interruptions in recipient care; and
11-3 (7) temporarily assign Medicaid-eligible newborn
11-4 infants to the traditional fee-for-service component of the state
11-5 Medicaid program for a period not to exceed the earlier of:
11-6 (A) 60 days; or
11-7 (B) the date on which the Texas Department of
11-8 Human Services has completed the newborn's Medicaid eligibility
11-9 determination, including assignment of the newborn's Medicaid
11-10 eligibility number.
11-11 SECTION 10. Subchapter A, Chapter 533, Government Code, is
11-12 amended by adding Section 533.0076 to read as follows:
11-13 Sec. 533.0076. ELIGIBILITY DETERMINATION AND ENROLLMENT;
11-14 PILOT PROGRAM. (a) Not later than November 1, 1999, the
11-15 commission shall develop and implement a pilot program to simplify,
11-16 to the extent possible, the process for determining eligibility for
11-17 and enrolling recipients in managed care plans. The commission
11-18 shall implement the pilot program in a single county in a region in
11-19 which the commission has implemented Medicaid managed care.
11-20 (b) In developing the pilot program, the commission, to the
11-21 extent possible, shall use continuous eligibility procedures and
11-22 eliminate the use of resource requirements for determining
11-23 eligibility. The commission shall evaluate:
11-24 (1) the net financial impact of the pilot program on
11-25 Medicaid costs in the county;
11-26 (2) the impact of the pilot program on health outcomes
11-27 in the county; and
12-1 (3) any other Medicaid-related issues the commission
12-2 considers necessary.
12-3 (c) Not later than November 1, 2002, the commission shall
12-4 submit to the legislature a report concerning the pilot program
12-5 required by this section, including any recommendations for
12-6 legislative action.
12-7 (d) This section expires September 1, 2003.
12-8 SECTION 11. Subchapter A, Chapter 533, Government Code, is
12-9 amended by adding Sections 533.012-533.016 to read as follows:
12-10 Sec. 533.012. MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT
12-11 PROGRAMS; REVIEW; REPORT. (a) Notwithstanding any other law, the
12-12 commission, after May 1, 2000, may not implement Medicaid managed
12-13 care pilot programs, Medicaid behavioral health pilot programs, or
12-14 Medicaid Star + Plus pilot programs in a region for which the
12-15 commission has not:
12-16 (1) received a bid from a managed care organization to
12-17 provide health care services to recipients in the region through a
12-18 managed care plan; or
12-19 (2) entered into a contract with a managed care
12-20 organization to provide health care services to recipients in the
12-21 region through a managed care plan.
12-22 (b) The commission shall:
12-23 (1) review any outstanding administrative and
12-24 financial issues with respect to Medicaid managed care pilot
12-25 programs, Medicaid behavioral health pilot programs, and Medicaid
12-26 Star + Plus pilot programs implemented in health care service
12-27 regions, including the effects of the eligibility system,
13-1 enrollment brokers, primary care case management administrators,
13-2 and administrative functions on the quality and availability of
13-3 health care;
13-4 (2) review the obligations and duties of the
13-5 commission and each health and human services agency operating part
13-6 of the state Medicaid program with respect to the administration of
13-7 the managed care component of the program and the resources
13-8 required by each operating agency to meet those obligations and
13-9 duties;
13-10 (3) review the impact of the Medicaid managed care
13-11 delivery system, including managed care organizations, prepaid
13-12 health plans, and primary care case management, on:
13-13 (A) physical access and program-related access
13-14 to appropriate services by recipients, including recipients who
13-15 have special health care needs;
13-16 (B) quality of health care delivery and patient
13-17 outcomes;
13-18 (C) utilization patterns of recipients;
13-19 (D) statewide Medicaid costs;
13-20 (E) coordination of care and care coordination
13-21 in Medicaid Star + Plus pilot programs;
13-22 (F) the level of administrative complexity for
13-23 providers, recipients, and managed care organizations;
13-24 (G) public hospitals, medical schools, and other
13-25 traditional providers of indigent health care; and
13-26 (H) competition in the marketplace and network
13-27 retention;
14-1 (4) evaluate the feasibility of implementing a payment
14-2 system based on patient severity and risk, including the
14-3 implementation of health status screening for patients to determine
14-4 which patients need case management or other interventions;
14-5 (5) evaluate the progress of the state with respect to
14-6 the development of reliable and informative data relating to
14-7 services provided to recipients enrolled in managed care plans; and
14-8 (6) review the costs incurred and any savings realized
14-9 by the state in implementing Medicaid managed care, including the
14-10 costs incurred and savings realized by each model of the Medicaid
14-11 managed care delivery system, including managed care organizations,
14-12 primary care case management systems, and partially capitated
14-13 health plans.
14-14 (c) The review conducted by the commission under Subsection
14-15 (b)(6) must include an evaluation of Medicaid managed care programs
14-16 in other states to determine the cost-effectiveness of using a
14-17 single managed care delivery model described by that subsection in
14-18 a service area or a mixture of those delivery models in a service
14-19 area.
14-20 (d) In performing its duties and functions under Subsection
14-21 (b), the commission shall seek input from the state Medicaid
14-22 managed care advisory committee created under Subchapter C.
14-23 (e) Notwithstanding Subsection (a), the commission may
14-24 implement Medicaid managed care pilot programs, Medicaid
14-25 behavioral health pilot programs, and Medicaid Star + Plus pilot
14-26 programs in a region described by that subsection if the commission
14-27 finds that:
15-1 (1) outstanding administrative and financial issues
15-2 with respect to the implementation of those programs in health care
15-3 service regions have been resolved; and
15-4 (2) implementation of those programs in a region
15-5 described by Subsection (a) would benefit both recipients and
15-6 providers.
15-7 (f) Not later than November 1, 2000, the commission shall
15-8 submit a report to the governor and the legislature that:
15-9 (1) states whether the outstanding administrative and
15-10 financial issues with respect to the pilot programs described by
15-11 Subsection (b)(1) have been sufficiently resolved;
15-12 (2) summarizes the findings of the review conducted
15-13 under Subsection (b);
15-14 (3) recommends which elements of the Medicaid managed
15-15 care delivery system should be applied to the traditional
15-16 fee-for-service component of the state Medicaid program to achieve
15-17 the goals specified in Section 533.002(1); and
15-18 (4) recommends whether Medicaid managed care pilot
15-19 programs, Medicaid behavioral health pilot programs, or Medicaid
15-20 Star + Plus pilot programs should be implemented in health care
15-21 service regions described by Subsection (a).
15-22 (g) To the extent practicable, this section may not be
15-23 construed to affect the duty of the commission to plan the
15-24 continued expansion of Medicaid managed care pilot programs,
15-25 Medicaid behavioral health pilot programs, and Medicaid Star + Plus
15-26 pilot programs in health care service regions described by
15-27 Subsection (a) after July 1, 2001.
16-1 (h) This section expires July 1, 2001.
16-2 Sec. 533.013. PREMIUM PAYMENT RATE DETERMINATION; REVIEW AND
16-3 COMMENT. (a) In determining premium payment rates paid to a
16-4 managed care organization under a managed care plan, the commission
16-5 shall consider:
16-6 (1) the regional variation in costs of health care
16-7 services;
16-8 (2) the range and type of health care services to be
16-9 covered by capitation and provider payment rates;
16-10 (3) the number of managed care plans in a region;
16-11 (4) the current and projected number of recipients in
16-12 each region, including the current and projected number for each
16-13 category of recipient;
16-14 (5) the ability of the managed care plan to meet costs
16-15 of operation under the proposed premium payment rates;
16-16 (6) the applicable requirements of the federal
16-17 Balanced Budget Act of 1997 and implementing regulations that
16-18 require adequacy of premium payments to managed care organizations
16-19 participating in the state Medicaid program;
16-20 (7) the adequacy of the management fee paid for
16-21 assisting enrollees of Supplemental Security Income (SSI) (42
16-22 U.S.C. Section 1381 et seq.) who are voluntarily enrolled in the
16-23 managed care plan;
16-24 (8) the impact of reducing capitation and provider
16-25 payment rates for the category of recipients who are pregnant; and
16-26 (9) the ability of the managed care plan to pay under
16-27 the proposed premium payment rates inpatient and outpatient
17-1 hospital provider payment rates that are comparable to the
17-2 inpatient and outpatient hospital provider payment rates paid by
17-3 the commission under a primary care case management model or a
17-4 partially capitated model.
17-5 (b) In determining the maximum premium payment rates paid to
17-6 a managed care organization that is licensed under the Texas Health
17-7 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
17-8 Code), the commission may not discount premium payment rates in an
17-9 amount that is more than the amount necessary to meet federal
17-10 budget neutrality requirements for projected fee-for-service costs
17-11 unless:
17-12 (1) a historical review of managed care financial
17-13 results among managed care organizations in the service area served
17-14 by the organization demonstrates that additional savings are
17-15 warranted;
17-16 (2) a review of Medicaid fee-for-service delivery in
17-17 the service area served by the organization has historically shown
17-18 a significant overutilization by recipients of all services covered
17-19 by the premium payment rates in comparison to utilization patterns
17-20 throughout the rest of the state; or
17-21 (3) a review of Medicaid fee-for-service delivery in
17-22 the service area served by the organization has historically shown
17-23 an above-market cost for services in which there is substantial
17-24 evidence that Medicaid managed care delivery will reduce the cost
17-25 of those services.
17-26 (c) The premium payment rates paid to a managed care
17-27 organization that is licensed under the Texas Health Maintenance
18-1 Organization Act (Chapter 20A, Vernon's Texas Insurance Code) shall
18-2 be established by a competitive bid process but may not exceed the
18-3 maximum premium payment rates established by the commission under
18-4 Subsection (b).
18-5 Sec. 533.014. PROFIT SHARING. (a) The commission shall
18-6 adopt rules regarding the sharing of profits earned by a managed
18-7 care organization through a managed care plan providing health care
18-8 services under a contract with the commission under this chapter.
18-9 (b) Any amount received by the state under this section
18-10 shall be deposited in the general revenue fund for the purpose of
18-11 funding Medicaid outreach and education activities.
18-12 Sec. 533.015. COORDINATION OF EXTERNAL OVERSIGHT AND UNIFORM
18-13 DOCUMENT REVIEW. (a) The commission shall coordinate all external
18-14 oversight activities to minimize duplication of oversight of
18-15 managed care plans under the state Medicaid program and disruption
18-16 of operations under those plans.
18-17 (b) The commission shall develop and administer a single
18-18 uniform procedure for the review of documents a managed care
18-19 organization under contract with the commission under this chapter
18-20 is required to submit for state approval. Each agency involved in
18-21 administering Medicaid managed care for acute care, long-term care,
18-22 or behavioral health services shall use the procedure developed by
18-23 the commission under this subsection to review documents submitted
18-24 by managed care organizations.
18-25 Sec. 533.016. COORDINATION OF MEDICAID LONG-TERM CARE. If
18-26 the commission delegates all or part of its functions, powers, and
18-27 duties related to long-term care under Section 532.002 or
19-1 Subchapter B or C, Chapter 532, including the operation of pilot
19-2 projects, the commission shall:
19-3 (1) designate a single health and human services
19-4 agency to serve as lead agency to ameliorate the impact of multiple
19-5 agencies with responsibility for functions related to long-term
19-6 care; and
19-7 (2) ensure that long-term care is administered by each
19-8 of the appropriate health and human services agencies as
19-9 efficiently and effectively as if long-term care were being
19-10 administered by a single state agency.
19-11 SECTION 12. Chapter 533, Government Code, is amended by
19-12 adding Subchapter C to read as follows:
19-13 SUBCHAPTER C. STATEWIDE ADVISORY COMMITTEE
19-14 Sec. 533.041. APPOINTMENT AND COMPOSITION. (a) The
19-15 commission shall appoint a state Medicaid managed care advisory
19-16 committee. The advisory committee consists of representatives of:
19-17 (1) hospitals;
19-18 (2) managed care organizations;
19-19 (3) primary care providers;
19-20 (4) state agencies;
19-21 (5) consumer advocates representing low-income
19-22 recipients;
19-23 (6) consumer advocates representing recipients with a
19-24 disability;
19-25 (7) parents of children who are recipients;
19-26 (8) rural providers;
19-27 (9) advocates for children with special health care
20-1 needs;
20-2 (10) pediatric health care providers, including
20-3 specialty providers;
20-4 (11) obstetrical care providers;
20-5 (12) community-based organizations serving low-income
20-6 children and their families; and
20-7 (13) community-based organizations engaged in
20-8 perinatal services and outreach.
20-9 (b) The advisory committee must include a member of each
20-10 regional Medicaid managed care advisory committee appointed by the
20-11 commission under Subchapter B.
20-12 Sec. 533.042. MEETINGS. The advisory committee shall meet
20-13 at least quarterly and is subject to Chapter 551.
20-14 Sec. 533.043. POWERS AND DUTIES. The advisory committee
20-15 shall:
20-16 (1) provide recommendations to the commission on the
20-17 statewide implementation and operation of Medicaid managed care;
20-18 (2) assist the commission with issues relevant to
20-19 Medicaid managed care to improve the policies established for and
20-20 programs operating under Medicaid managed care, including the
20-21 early and periodic screening, diagnosis, and treatment program,
20-22 provider and patient education issues, and patient eligibility
20-23 issues; and
20-24 (3) disseminate or make available to each regional
20-25 advisory committee appointed under Subchapter B information on best
20-26 practices with respect to Medicaid managed care that is obtained
20-27 from a regional advisory committee.
21-1 Sec. 533.044. OTHER LAW. Except as provided by this
21-2 subchapter, the advisory committee is subject to Chapter 2110.
21-3 SECTION 13. Section 2.07(c), Chapter 1153, Acts of the 75th
21-4 Legislature, Regular Session, 1997, is amended to read as follows:
21-5 (c) As soon as possible after development of the new
21-6 provider contract, the commission and each agency operating part of
21-7 the state Medicaid program by rule shall require each provider who
21-8 enrolled in the program before completion of the new contract to
21-9 reenroll in the program under the new contract or modify the
21-10 provider's existing contract in accordance with commission or
21-11 agency procedures as necessary to comply with the requirements of
21-12 the new contract. The commission shall study the feasibility of
21-13 authorizing providers to reenroll in the program online or through
21-14 other electronic means. On completion of the study, if the
21-15 commission determines that an online or other electronic method for
21-16 reenrollment of providers is feasible, the commission shall develop
21-17 and implement the electronic method of reenrollment for providers
21-18 not later than September 1, 2000. A provider must reenroll in the
21-19 state Medicaid program or make the necessary contract modifications
21-20 not later than March 31, 2000 [September 1, 1999], to retain
21-21 eligibility to participate in the program, unless the commission
21-22 implements under this subsection an electronic method of
21-23 reenrollment for providers, in which event, a provider must
21-24 reenroll or make the contractual modifications not later than
21-25 September 1, 2000. The commission by rule may extend a
21-26 reenrollment deadline prescribed by this subsection if a
21-27 significant number of providers, as determined by the commission,
22-1 have not met the reenrollment requirements by the applicable
22-2 deadline.
22-3 SECTION 14. (a) Not later than January 1, 2000, the Health
22-4 and Human Services Commission shall implement the expedited process
22-5 for determining eligibility for and enrollment of certain
22-6 recipients in Medicaid managed care plans required by Section
22-7 533.0075(4), Government Code, as added by this Act.
22-8 (b) The Health and Human Services Commission shall report
22-9 quarterly to the standing committees of the senate and house of
22-10 representatives with primary jurisdiction over Medicaid managed
22-11 care regarding the status of the expedited process described by
22-12 Subsection (a) of this section. The commission shall submit
22-13 quarterly reports under this subsection until the commission
22-14 determines the process is fully implemented and functioning
22-15 successfully.
22-16 SECTION 15. If before implementing any provision of this Act
22-17 a state agency determines that a waiver or other authorization from
22-18 a federal agency is necessary for implementation, the Health and
22-19 Human Services Commission shall request the waiver or authorization
22-20 and may delay implementing that provision until the waiver or
22-21 authorization is granted.
22-22 SECTION 16. (a) Except as provided by Subsection (b), this
22-23 Act takes effect September 1, 1999.
22-24 (b) Section 533.013, Government Code, as added by this Act,
22-25 takes effect on the first date that it may take effect under
22-26 Section 39, Article III, Texas Constitution.
22-27 SECTION 17. The importance of this legislation and the
23-1 crowded condition of the calendars in both houses create an
23-2 emergency and an imperative public necessity that the
23-3 constitutional rule requiring bills to be read on three several
23-4 days in each house be suspended, and this rule is hereby suspended,
23-5 and that this Act take effect and be in force according to its
23-6 terms, and it is so enacted.