76R16016 CLG-F
By Moncrief S.B. No. 1331
Substitute the following for S.B. No. 1331:
By Maxey C.S.S.B. No. 1331
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to an assessment of the effectiveness of Medicaid managed
1-3 care contracts.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 12, Health and Safety Code,
1-6 is amended by adding Section 12.0123 to read as follows:
1-7 Sec. 12.0123. EXTERNAL AUDITS OF CERTAIN MEDICAID
1-8 CONTRACTORS. (a) In this section, "Medicaid contractor" means an
1-9 entity that:
1-10 (1) is not a health and human services agency as
1-11 defined by Section 531.001, Government Code; and
1-12 (2) under contract with or otherwise on behalf of the
1-13 department, performs one or more administrative services in
1-14 relation to the department's operation of a part of the state
1-15 Medicaid program, such as claims processing, utilization review,
1-16 client enrollment, provider enrollment, quality monitoring, or
1-17 payment of claims.
1-18 (b) The department shall contract with an independent
1-19 auditor to perform annual independent external financial and
1-20 performance audits of any Medicaid contractor used by the
1-21 department in the department's operation of a part of the state
1-22 Medicaid program.
1-23 (c) The department shall ensure that audit procedures
2-1 related to financial audits and performance audits are used
2-2 consistently in audits under this section.
2-3 (d) An audit required by this section must be completed
2-4 before the end of the fiscal year immediately following the fiscal
2-5 year for which the audit is performed.
2-6 SECTION 2. Subchapter A, Chapter 533, Government Code, is
2-7 amended by adding Section 533.012 to read as follows:
2-8 Sec. 533.012. MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT
2-9 PROGRAMS; REVIEW; REPORT. (a) Notwithstanding any other law, the
2-10 commission may not implement Medicaid managed care pilot programs,
2-11 Medicaid behavioral health pilot programs, or Medicaid Star + Plus
2-12 pilot programs in a region for which the commission has not:
2-13 (1) received a bid from a managed care organization to
2-14 provide health care services to recipients in the region through a
2-15 managed care plan; or
2-16 (2) entered into a contract with a managed care
2-17 organization to provide health care services to recipients in the
2-18 region through a managed care plan.
2-19 (b) The commission shall:
2-20 (1) review any outstanding administrative and
2-21 financial issues with respect to Medicaid managed care pilot
2-22 programs, Medicaid behavioral health pilot programs, and Medicaid
2-23 Star + Plus pilot programs implemented in health care service
2-24 regions; and
2-25 (2) review the impact of the Medicaid managed care
2-26 delivery system, including managed care organizations, prepaid
2-27 health plans, and primary care case management, on:
3-1 (A) physical access and program-related access
3-2 to appropriate services by recipients, including recipients who
3-3 have special health care needs;
3-4 (B) quality of health care delivery and patient
3-5 outcomes;
3-6 (C) utilization patterns of recipients;
3-7 (D) statewide Medicaid costs;
3-8 (E) coordination of care and care coordination
3-9 in Medicaid Star + Plus pilot programs;
3-10 (F) the level of administrative complexity for
3-11 providers, recipients, and managed care organizations;
3-12 (G) public hospitals, medical schools, and other
3-13 traditional providers of indigent health care; and
3-14 (H) competition in the marketplace and network
3-15 retention.
3-16 (c) In performing its duties and functions under Subsection
3-17 (b), the commission shall consult with Medicaid providers, medical
3-18 professional organizations, managed care organizations, consumers,
3-19 state agencies, and political subdivisions with a constitutional or
3-20 statutory obligation to provide health care for indigent persons.
3-21 The commission may coordinate the review required under Subsection
3-22 (b) with any other study or review the commission is required to
3-23 complete.
3-24 (d) Notwithstanding Subsection (a), the commission may
3-25 implement Medicaid managed care pilot programs, Medicaid behavioral
3-26 health pilot programs, and Medicaid Star + Plus pilot programs in a
3-27 region described by that subsection if the commission finds that:
4-1 (1) outstanding administrative and financial issues
4-2 with respect to the implementation of those programs in health care
4-3 service regions have been resolved; and
4-4 (2) implementation of those programs in a region
4-5 described by Subsection (a) would benefit both recipients and
4-6 providers.
4-7 (e) Not later than November 1, 2000, the commission shall
4-8 submit a report to the governor and the legislature that:
4-9 (1) states whether the outstanding administrative and
4-10 financial issues with respect to the pilot programs described by
4-11 Subsection (b)(1) have been sufficiently resolved;
4-12 (2) summarizes the findings of the review conducted
4-13 under Subsection (b);
4-14 (3) recommends which elements of the Medicaid managed
4-15 care delivery system should be applied to the traditional
4-16 fee-for-service component of the state Medicaid program to achieve
4-17 the goals specified in Section 533.002(1); and
4-18 (4) recommends whether Medicaid managed care pilot
4-19 programs, Medicaid behavioral health pilot programs, or Medicaid
4-20 Star + Plus pilot programs should be implemented in health care
4-21 service regions described by Subsection (a).
4-22 (f) To the extent practicable, this section may not be
4-23 construed to affect the duty of the commission to plan the
4-24 continued expansion of Medicaid managed care pilot programs,
4-25 Medicaid behavioral health pilot programs, and Medicaid Star + Plus
4-26 pilot programs in health care service regions described by
4-27 Subsection (a) after July 1, 2001.
5-1 (g) This section expires July 1, 2001.
5-2 SECTION 3. If before implementing any provision of this Act
5-3 a state agency determines that a waiver or other authorization from
5-4 a federal agency is necessary for implementation, the Health and
5-5 Human Services Commission shall request the waiver or authorization
5-6 and may delay implementing that provision until the waiver or
5-7 authorization is granted.
5-8 SECTION 4. The importance of this legislation and the
5-9 crowded condition of the calendars in both houses create an
5-10 emergency and an imperative public necessity that the
5-11 constitutional rule requiring bills to be read on three several
5-12 days in each house be suspended, and this rule is hereby suspended,
5-13 and that this Act take effect and be in force from and after its
5-14 passage, and it is so enacted.