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.
8-38 * * * * *