1-1     By:  Coleman, et al. (Senate Sponsor - Moncrief)      H.B. No. 2896
 1-2           (In the Senate - Received from the House May 10, 1999;
 1-3     May 10, 1999, read first time and referred to Committee on Health
 1-4     Services; May 14, 1999, reported favorably, as amended, by the
 1-5     following vote:  Yeas 5, Nays 0; May 14, 1999, sent to printer.)
 1-6     COMMITTEE AMENDMENT NO. 1                             By:  Moncrief
 1-7     Amend H.B. No. 2896 as follows:
 1-8     Strike SECTION 5 of the bill in its entirety and renumber the
 1-9     remaining SECTIONS accordingly.
1-10     COMMITTEE AMENDMENT NO. 2                             By:  Moncrief
1-11           Amend H.B. No. 2896, adding an appropriately numbered SECTION
1-12     to read as follows:
1-13           "SECTION 15.  This Act takes effect only if a specific
1-14     appropriation for the implementation of this Act is provided in
1-15     H.B. No. 1 (General Appropriations Act), Acts of the 76th
1-16     Legislature, Regular Session, 1999.  If no specific appropriations
1-17     is provided in H.B. No. 1, the General Appropriations Act, this Act
1-18     has no effect."
1-19                            A BILL TO BE ENTITLED
1-20                                   AN ACT
1-21     relating to the administration and operation of the state Medicaid
1-22     program.
1-23           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-24           SECTION 1.  Subchapter B, Chapter 12, Health and Safety Code,
1-25     is amended by adding Section 12.0123 to read as follows:
1-26           Sec. 12.0123.  EXTERNAL AUDITS OF CERTAIN MEDICAID
1-27     CONTRACTORS.  (a)  In this section, "Medicaid contractor" means an
1-28     entity that:
1-29                 (1)  is not a health and human services agency as
1-30     defined by Section 531.001, Government Code; and
1-31                 (2)  under contract with or otherwise on behalf of the
1-32     department, performs one or more administrative services in
1-33     relation to the department's operation of a part of the state
1-34     Medicaid program, such as claims processing, utilization review,
1-35     client enrollment, provider enrollment, quality monitoring, or
1-36     payment of claims.
1-37           (b)  The department shall contract with an independent
1-38     auditor to perform annual independent external financial and
1-39     performance audits of any Medicaid contractor used by the
1-40     department in the department's operation of a part of the state
1-41     Medicaid program.
1-42           (c)  The department shall ensure that audit procedures
1-43     related to financial audits and performance audits are used
1-44     consistently in audits under this section.
1-45           (d)  An audit required by this section must be completed
1-46     before the end of the fiscal year immediately following the fiscal
1-47     year for which the audit is performed.
1-48           SECTION 2.  Section 533.003, Government Code, is amended to
1-49     read as follows:
1-50           Sec. 533.003.  CONSIDERATIONS IN AWARDING CONTRACTS.  In
1-51     awarding contracts to managed care organizations, the commission
1-52     shall:
1-53                 (1)  give preference to organizations that have
1-54     significant participation in the organization's provider network
1-55     from each health care provider in the region who has traditionally
1-56     provided care to Medicaid and charity care patients;
1-57                 (2)  give extra consideration to organizations that
1-58     agree to assure continuity of care for at least three months beyond
1-59     the period of Medicaid eligibility for recipients; [and]
1-60                 (3)  consider the need to use different managed care
1-61     plans to meet the needs of different populations; and
 2-1                 (4)  consider the ability of organizations to process
 2-2     Medicaid claims electronically.
 2-3           SECTION 3.  Section 533.004, Government Code, is amended by
 2-4     amending Subsection (a) and adding Subsection (e) to read as
 2-5     follows:
 2-6           (a)  In providing health care services through Medicaid
 2-7     managed care to recipients in a health care service region, the
 2-8     commission shall contract with a [at least one] managed care
 2-9     organization in that region that is licensed under the Texas Health
2-10     Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
2-11     Code) to provide health care in that region and that is:
2-12                 (1)  wholly owned and operated by a hospital district
2-13     in that region;
2-14                 (2)  created by a nonprofit corporation that:
2-15                       (A)  has a contract, agreement, or other
2-16     arrangement with a hospital district in that region or with a
2-17     municipality in that region that owns a hospital licensed under
2-18     Chapter 241, Health and Safety Code, and has an obligation to
2-19     provide health care to indigent patients; and
2-20                       (B)  under the contract, agreement, or other
2-21     arrangement, assumes the obligation to provide health care to
2-22     indigent patients and leases, manages, or operates a hospital
2-23     facility owned by the hospital district or municipality; or
2-24                 (3)  created by a nonprofit corporation that has a
2-25     contract, agreement, or other arrangement with a hospital district
2-26     in that region under which the nonprofit corporation acts as an
2-27     agent of the district and assumes the district's obligation to
2-28     arrange for services under the Medicaid expansion for children as
2-29     authorized by Chapter 444, Acts of the 74th Legislature, Regular
2-30     Session, 1995.
2-31           (e)  In providing health care services through Medicaid
2-32     managed care to recipients in a health care service region, with
2-33     the exception of the Harris service area for the STAR Medicaid
2-34     managed care program, as defined by the commission as of the
2-35     initial implementation date for that service area, the commission
2-36     shall also contract with a managed care organization in that region
2-37     that holds a certificate of authority as a health maintenance
2-38     organization under Section 5, Texas Health Maintenance Organization
2-39     Act (Article 20A.05, Vernon's Texas Insurance Code), and that:
2-40                 (1)  is certified under Section 5.01(a), Medical
2-41     Practice Act (Article 4495b, Vernon's Texas Civil Statutes);
2-42                 (2)  is created by The University of Texas Medical
2-43     Branch at Galveston; and
2-44                 (3)  has obtained a certificate of authority as a
2-45     health maintenance organization to serve one or more counties in
2-46     that region from the Texas Department of Insurance before September
2-47     2, 1999.
2-48           SECTION 4.  Section 533.005, Government Code, is amended to
2-49     read as follows:
2-50           Sec. 533.005.  REQUIRED CONTRACT PROVISIONS.  A contract
2-51     between a managed care organization and the commission for the
2-52     organization to provide health care services to recipients must
2-53     contain:
2-54                 (1)  procedures to ensure accountability to the state
2-55     for the provision of health care services, including procedures for
2-56     financial reporting, quality assurance, utilization review, and
2-57     assurance of contract and subcontract compliance;
2-58                 (2)  capitation and provider payment rates that ensure
2-59     the cost-effective provision of quality health care;
2-60                 (3)  a requirement that the managed care organization
2-61     provide ready access to a person who assists recipients in
2-62     resolving issues relating to enrollment, plan administration,
2-63     education and training, access to services, and grievance
2-64     procedures;
2-65                 (4)  a requirement that the managed care organization
2-66     provide ready access to a person who assists providers in resolving
2-67     issues relating to payment, plan administration, education and
2-68     training, and grievance procedures;
2-69                 (5)  a requirement that the managed care organization
 3-1     provide information and referral about the availability of
 3-2     educational, social, and other community services that could
 3-3     benefit a recipient;
 3-4                 (6)  procedures for recipient outreach and education;
 3-5                 (7)  a requirement that the managed care organization
 3-6     make payment to a physician or provider for health care services
 3-7     rendered to a recipient under a managed care plan not later than
 3-8     the 45th day after the date a claim for payment is received with
 3-9     documentation reasonably necessary for the managed care
3-10     organization to process the claim, or within a period, not to
3-11     exceed 60 days, specified by a written agreement between the
3-12     physician or provider and the managed care organization;
3-13                 (8)  a requirement that the commission, on the date of
3-14     a recipient's enrollment in a managed care plan issued by the
3-15     managed care organization, inform the organization of the
3-16     recipient's Medicaid certification [recertification] date; and
3-17                 (9)  a requirement that the managed care organization
3-18     comply with Section 533.006 as a condition of contract retention
3-19     and renewal.
3-20           SECTION 5.  Subchapter A, Chapter 533, Government Code, is
3-21     amended by adding Section 533.0056 to read as follows:
3-22           Sec. 533.0056.  IMPLEMENTATION OF STATE-ADMINISTERED PLAN IN
3-23     REGION.  The commission may implement a pre-paid health plan model
3-24     and a primary care case management model that shall operate as one
3-25     single state-administered plan in all respects in a health care
3-26     service delivery area that is composed in part of a county or
3-27     counties that share a common border with a foreign country and
3-28     another state of the United States of America.  A primary care
3-29     provider may contract to perform services for only one model within
3-30     such state-administered plan and, in addition, may contract with a
3-31     health maintenance organization.
3-32           SECTION 6.  Section 533.006(a), Government Code, is amended
3-33     to read as follows:
3-34           (a)  The commission shall require that each managed care
3-35     organization that contracts with the commission to provide health
3-36     care services to recipients in a region:
3-37                 (1)  seek participation in the organization's provider
3-38     network from:
3-39                       (A)  each health care provider in the region who
3-40     has traditionally provided care to Medicaid recipients; [and]
3-41                       (B)  each hospital in the region that has been
3-42     designated as a disproportionate share hospital under the state
3-43     Medicaid program; and
3-44                       (C)  each specialized pediatric laboratory in the
3-45     region, including those laboratories located in children's
3-46     hospitals; and
3-47                 (2)  include in its provider network for not less than
3-48     three years:
3-49                       (A)  each health care provider in the region who:
3-50                             (i)  previously provided care to Medicaid
3-51     and charity care recipients at a significant level as prescribed by
3-52     the commission;
3-53                             (ii)  agrees to accept the prevailing
3-54     provider contract rate of the managed care organization; and
3-55                             (iii)  has the credentials required by the
3-56     managed care organization, provided that lack of board
3-57     certification or accreditation by the Joint Commission on
3-58     Accreditation of Healthcare Organizations may not be the sole
3-59     ground for exclusion from the provider network;
3-60                       (B)  each accredited primary care residency
3-61     program in the region; and
3-62                       (C)  each disproportionate share hospital
3-63     designated by the commission as a statewide significant traditional
3-64     provider.
3-65           SECTION 7.  Section 533.007(e), Government Code, is amended
3-66     to read as follows:
3-67           (e)  The commission shall conduct a compliance and readiness
3-68     review of each managed care organization that contracts with the
3-69     commission not later than the 15th day before the date on which the
 4-1     commission plans to begin the enrollment process in a region and
 4-2     again not later than the 15th day before the date on which the
 4-3     commission plans to begin to provide health care services to
 4-4     recipients in that region through managed care.  The review must
 4-5     include an on-site inspection and tests of service authorization
 4-6     and claims payment systems, including the ability of the managed
 4-7     care organization to process claims electronically, complaint
 4-8     processing systems, and any other process or system required by the
 4-9     contract.
4-10           SECTION 8.  Section 533.0075, Government Code, is amended to
4-11     read as follows:
4-12           Sec. 533.0075.  RECIPIENT ENROLLMENT.  The commission shall:
4-13                 (1)  encourage recipients to choose appropriate managed
4-14     care plans and primary health care providers by:
4-15                       (A)  providing initial information to recipients
4-16     and providers in a region about the need for recipients to choose
4-17     plans and providers not later than the 90th day before the date on
4-18     which the commission plans to begin to provide health care services
4-19     to recipients in that region through managed care;
4-20                       (B)  providing follow-up information before
4-21     assignment of plans and providers and after assignment, if
4-22     necessary, to recipients who delay in choosing plans and providers;
4-23     and
4-24                       (C)  allowing plans and providers to provide
4-25     information to recipients or engage in marketing activities under
4-26     marketing guidelines established by the commission under Section
4-27     533.008 after the commission approves the information or
4-28     activities;
4-29                 (2)  consider the following factors in assigning
4-30     managed care plans and primary health care providers to recipients
4-31     who fail to choose plans and providers:
4-32                       (A)  the importance of maintaining existing
4-33     provider-patient and physician-patient relationships, including
4-34     relationships with specialists, public health clinics, and
4-35     community health centers;
4-36                       (B)  to the extent possible, the need to assign
4-37     family members to the same providers and plans; and
4-38                       (C)  geographic convenience of plans and
4-39     providers for recipients; [and]
4-40                 (3)  retain responsibility for enrollment and
4-41     disenrollment of recipients in managed care plans, except that the
4-42     commission may delegate the responsibility to an independent
4-43     contractor who receives no form of payment from, and has no
4-44     financial ties to, any managed care organization;
4-45                 (4)  develop and implement a process to increase the
4-46     number of providers qualified to determine presumptive eligibility
4-47     for pregnant women and newborn infants in managed care plans;
4-48                 (5)  ensure immediate access to prenatal services and
4-49     newborn care for pregnant women and newborn infants enrolled in
4-50     managed care plans, including ensuring that a pregnant woman may
4-51     obtain an appointment with an obstetrical care provider for an
4-52     initial maternity evaluation not later than the 30th day after the
4-53     date the woman applies for Medicaid; and
4-54                 (6)  temporarily assign Medicaid-eligible newborn
4-55     infants to the traditional fee-for-service component of the state
4-56     Medicaid program for a period not to exceed the earlier of:
4-57                       (A)  60 days; or
4-58                       (B)  the date on which the Texas Department of
4-59     Human Services has completed the newborn's Medicaid eligibility
4-60     determination, including assignment of the newborn's Medicaid
4-61     eligibility number.
4-62           SECTION 9.  Subchapter A, Chapter 533, Government Code, is
4-63     amended by adding Sections 533.012-533.015 to read as follows:
4-64           Sec. 533.012.  MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT
4-65     PROGRAMS; REVIEW; REPORT.  (a)   Notwithstanding any other law, the
4-66     commission may not implement Medicaid managed care pilot programs,
4-67     Medicaid behavioral health pilot programs, or Medicaid Star + Plus
4-68     pilot programs in a region for which the commission has not:
4-69                 (1)  received a bid from a managed care organization to
 5-1     provide health care services to recipients in the region through a
 5-2     managed care plan; or
 5-3                 (2)  entered into a contract with a managed care
 5-4     organization to provide health care services to recipients in the
 5-5     region through a managed care plan.
 5-6           (b)  The commission shall:
 5-7                 (1)  review any outstanding administrative and
 5-8     financial issues with respect to Medicaid managed care pilot
 5-9     programs, Medicaid behavioral health pilot programs, and Medicaid
5-10     Star + Plus pilot programs implemented in health care service
5-11     regions; and
5-12                 (2)  review the impact of the Medicaid managed care
5-13     delivery system, including managed care organizations, prepaid
5-14     health plans, and primary care case management, on:
5-15                       (A)  physical access and program-related access
5-16     to appropriate services by recipients, including recipients who
5-17     have special health care needs;
5-18                       (B)  quality of health care delivery and patient
5-19     outcomes;
5-20                       (C)  utilization patterns of recipients;
5-21                       (D)  statewide Medicaid costs;
5-22                       (E)  coordination of care and care coordination
5-23     in Medicaid Star + Plus pilot programs;
5-24                       (F)  the level of administrative complexity for
5-25     providers, recipients, and managed care organizations;
5-26                       (G)  public hospitals, medical schools, and other
5-27     traditional providers of indigent health care; and
5-28                       (H)  competition in the marketplace and network
5-29     retention.
5-30           (c)  In performing its duties and functions under Subsection
5-31     (b), the commission shall seek input from the state Medicaid
5-32     managed care advisory committee created under Subchapter C.  The
5-33     commission may coordinate the review required under Subsection (b)
5-34     with any other study or review the commission is required to
5-35     complete.
5-36           (d)  Notwithstanding Subsection (a), the commission may
5-37     implement Medicaid managed care pilot programs, Medicaid
5-38     behavioral health pilot programs, and Medicaid Star + Plus pilot
5-39     programs in a region described by that subsection if the commission
5-40     finds that:
5-41                 (1)  outstanding administrative and financial issues
5-42     with respect to the implementation of those programs in health care
5-43     service regions have been resolved; and
5-44                 (2)  implementation of those programs in a region
5-45     described by Subsection (a) would benefit both recipients and
5-46     providers.
5-47           (e)  Not later than November 1, 2000, the commission shall
5-48     submit a report to the governor and the legislature that:
5-49                 (1)  states whether the outstanding administrative and
5-50     financial issues with respect to the pilot programs described by
5-51     Subsection (b)(1) have been sufficiently resolved;
5-52                 (2)  summarizes the findings of the review conducted
5-53     under Subsection (b);
5-54                 (3)  recommends which elements of the Medicaid managed
5-55     care delivery system should be applied to the traditional
5-56     fee-for-service component of the state Medicaid program to achieve
5-57     the goals specified in Section 533.002(1); and
5-58                 (4)  recommends whether Medicaid managed care pilot
5-59     programs, Medicaid behavioral health pilot programs, or Medicaid
5-60     Star + Plus pilot programs should be implemented in health care
5-61     service regions described by Subsection (a).
5-62           (f)  To the extent practicable, this section may not be
5-63     construed to affect the duty of the commission to plan the
5-64     continued expansion of Medicaid managed care pilot programs,
5-65     Medicaid behavioral health pilot programs, and Medicaid Star + Plus
5-66     pilot programs in health care service regions described by
5-67     Subsection (a) after July 1, 2001.
5-68           (g)  This section expires July 1, 2001.
5-69           Sec. 533.013.  PREMIUM PAYMENT RATE DETERMINATION; REVIEW AND
 6-1     COMMENT.  (a)  In determining premium payment rates paid to a
 6-2     managed care organization under a managed care plan, the commission
 6-3     shall consider:
 6-4                 (1)  the regional variation in costs of health care
 6-5     services;
 6-6                 (2)  the range and type of health care services to be
 6-7     covered by premium payment rates;
 6-8                 (3)  the number of managed care plans in a region;
 6-9                 (4)  the current and projected number of recipients in
6-10     each region, including the current and projected number for each
6-11     category of recipient;
6-12                 (5)  the ability of the managed care plan to meet costs
6-13     of operation under the proposed premium payment rates;
6-14                 (6)  the applicable requirements of the federal
6-15     Balanced Budget Act of 1997 and implementing regulations that
6-16     require adequacy of premium payments to managed care organizations
6-17     participating in the state Medicaid program;
6-18                 (7)  the adequacy of the management fee paid for
6-19     assisting enrollees of Supplemental Security Income (SSI) (42
6-20     U.S.C. Section 1381 et seq.) who are voluntarily enrolled in the
6-21     managed care plan;
6-22                 (8)  the impact of reducing premium payment rates for
6-23     the category of recipients who are pregnant; and
6-24                 (9)  the ability of the managed care plan to pay under
6-25     the proposed premium payment rates inpatient and outpatient
6-26     hospital provider payment rates that are comparable to the
6-27     inpatient and outpatient hospital provider payment rates paid by
6-28     the commission under a primary care case management model or a
6-29     partially capitated model.
6-30           (b)  In determining the maximum premium payment rates paid to
6-31     a managed care organization that is licensed under the Texas Health
6-32     Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
6-33     Code), the commission may not discount premium payment rates in an
6-34     amount that is more than the amount necessary to meet federal
6-35     budget neutrality requirements for projected fee-for-service costs
6-36     unless:
6-37                 (1)  a historical review of managed care financial
6-38     results among managed care organizations in the service area served
6-39     by the organization demonstrates that additional savings are
6-40     warranted;
6-41                 (2)  a review of Medicaid fee-for-service delivery in
6-42     the service area served by the organization has historically shown
6-43     a significant overutilization by recipients of certain services
6-44     covered by the premium payment rates in comparison to utilization
6-45     patterns throughout the rest of the state; or
6-46                 (3)  a review of Medicaid fee-for-service delivery in
6-47     the service area served by the organization has historically shown
6-48     an above-market cost for services for which there is substantial
6-49     evidence that Medicaid managed care delivery will reduce the cost
6-50     of those services.
6-51           (c)  The premium payment rates paid to a managed care
6-52     organization that is licensed under the Texas Health Maintenance
6-53     Organization Act (Chapter 20A, Vernon's Texas Insurance Code) shall
6-54     be established by a competitive bid process but may not exceed the
6-55     maximum premium payment rates established by the commission under
6-56     Subsection (b).
6-57           (d)  Subsection (b) applies only to a managed care
6-58     organization with respect to Medicaid managed care pilot programs,
6-59     Medicaid behavioral health pilot programs, and Medicaid Star + Plus
6-60     pilot programs implemented in a health care service region after
6-61     June 1, 1999.
6-62           Sec. 533.014.  PROFIT SHARING.  (a)  The commission shall
6-63     adopt rules regarding the sharing of profits earned by a managed
6-64     care organization through a managed care plan providing health care
6-65     services under a contract with the commission under this chapter.
6-66           (b)  Any amount received by the state under this section
6-67     shall be deposited in the general revenue fund for the purpose of
6-68     funding Medicaid outreach and education activities.
6-69           Sec. 533.015.  COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES.
 7-1     To the extent possible, the commission shall coordinate all
 7-2     external oversight activities to minimize duplication of oversight
 7-3     of managed care plans under the state Medicaid program and
 7-4     disruption of operations under those plans.
 7-5           SECTION 10.  Chapter 533, Government Code, is amended by
 7-6     adding Subchapter C to read as follows:
 7-7                    SUBCHAPTER C.  STATEWIDE ADVISORY COMMITTEE
 7-8           Sec. 533.041.  APPOINTMENT AND COMPOSITION.  (a)  The
 7-9     commission shall appoint a state Medicaid managed care advisory
7-10     committee.  The advisory committee consists of representatives of:
7-11                 (1)  hospitals;
7-12                 (2)  managed care organizations;
7-13                 (3)  primary care providers;
7-14                 (4)  state agencies;
7-15                 (5)  consumer advocates representing low-income
7-16     recipients;
7-17                 (6)  consumer advocates representing recipients with a
7-18     disability;
7-19                 (7)  parents of children who are recipients;
7-20                 (8)  rural providers;
7-21                 (9)  advocates for children with special health care
7-22     needs;
7-23                 (10)  pediatric health care providers, including
7-24     specialty providers;
7-25                 (11)  long-term care providers, including nursing home
7-26     providers;
7-27                 (12)  obstetrical care providers;
7-28                 (13)  community-based organizations serving low-income
7-29     children and their families; and
7-30                 (14)  community-based organizations engaged in
7-31     perinatal services and outreach.
7-32           (b)  The advisory committee must include a member of each
7-33     regional Medicaid managed care advisory committee appointed by the
7-34     commission under Subchapter B.
7-35           Sec. 533.042.  MEETINGS.  The advisory committee shall meet
7-36     at least quarterly and is subject to Chapter 551.
7-37           Sec. 533.043.  POWERS AND DUTIES.  The advisory committee
7-38     shall:
7-39                 (1)  provide recommendations to the commission on the
7-40     statewide implementation and operation of Medicaid managed care;
7-41                 (2)  assist the commission with issues relevant to
7-42     Medicaid managed care to improve the policies established for and
7-43     programs operating under  Medicaid managed care, including the
7-44     early and periodic screening, diagnosis, and treatment program,
7-45     provider and patient education issues, and patient eligibility
7-46     issues; and
7-47                 (3)  disseminate or make available to each regional
7-48     advisory committee appointed under Subchapter B information on best
7-49     practices with respect to Medicaid managed care that is obtained
7-50     from a regional advisory committee.
7-51           Sec. 533.044.  OTHER LAW.  Except as provided by this
7-52     subchapter, the advisory committee is subject to Chapter 2110.
7-53           SECTION 11.  Section 2.07(c), Chapter 1153, Acts of the 75th
7-54     Legislature, Regular Session, 1997, is amended to read as follows:
7-55           (c)  As soon as possible after development of the new
7-56     provider contract, the commission and each agency operating part of
7-57     the state Medicaid program by rule shall require each provider who
7-58     enrolled in the program before completion of the new contract to
7-59     reenroll in the program under the new contract or modify the
7-60     provider's existing contract in accordance with commission or
7-61     agency procedures as necessary to comply with the requirements of
7-62     the new contract.  The commission shall study the feasibility of
7-63     authorizing providers to reenroll in the program online or through
7-64     other electronic means.  On completion of the study, if the
7-65     commission determines that an online or other electronic method for
7-66     reenrollment of providers is feasible, the commission shall develop
7-67     and implement the electronic method of reenrollment for providers
7-68     not later than September 1, 2000.  A provider must reenroll in the
7-69     state Medicaid program or make the necessary contract modifications
 8-1     not later than March 31, 2000 [September 1, 1999], to retain
 8-2     eligibility to participate in the program, unless the commission
 8-3     implements under this subsection an electronic method of
 8-4     reenrollment for providers, in which event, a provider must
 8-5     reenroll or make the contractual modifications not later than
 8-6     September 1, 2000.  The commission by rule may extend a
 8-7     reenrollment deadline prescribed by this subsection if a
 8-8     significant number of providers, as determined by the commission,
 8-9     have not met the reenrollment requirements by the applicable
8-10     deadline.
8-11           SECTION 12.  (a)  Not later than January 1, 2000, the Health
8-12     and Human Services Commission shall implement the process for
8-13     increasing the number of providers qualified to determine the
8-14     presumptive eligibility of certain recipients in Medicaid managed
8-15     care plans required by Section 533.0075(4), Government Code, as
8-16     added by this Act.
8-17           (b)  The Health and Human Services Commission shall report
8-18     quarterly to the standing committees of the senate and house of
8-19     representatives with primary jurisdiction over Medicaid managed
8-20     care regarding the status of the expedited process described by
8-21     Subsection (a) of this section.  The commission shall submit
8-22     quarterly reports under this subsection until the commission
8-23     determines the process is fully implemented and functioning
8-24     successfully.
8-25           SECTION 13.  If before implementing any provision of this Act
8-26     a state agency determines that a waiver or other authorization from
8-27     a federal agency is necessary for implementation, the Health and
8-28     Human Services Commission shall request the waiver or authorization
8-29     and may delay implementing that provision until the waiver or
8-30     authorization is granted.
8-31           SECTION 14.  The importance of this legislation and the
8-32     crowded condition of the calendars in both houses create an
8-33     emergency and an imperative public necessity that the
8-34     constitutional rule requiring bills to be read on three several
8-35     days in each house be suspended, and this rule is hereby suspended,
8-36     and that this Act take effect and be in force from and after its
8-37     passage, and it is so enacted.
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