Amend CSSB 1156 as follows:
(1) In the recital of SECTION 1 of the bill (House committee
printing, page 1, line 5), strike "Subsections (x) and (y)" and
substitute "Subsection (x)".
(2) In SECTION 1 of the bill, in proposed Section 32.024(x),
Human Resources Code (House committee printing, page 1, lines 7-9),
strike "the department may not limit benefits for the number of
medications prescribed to a recipient of prescription drug benefits
under the medical assistance program. In" and substitute "and in".
(3) In SECTION 1 of the bill, in proposed Section 32.024(x),
Human Resources Code (House committee printing, page 1, line 10),
strike "also".
(4) In SECTION 1 of the bill (House committee printing, page
1, line 21, through page 2, line 8), strike proposed Section
32.024(y), Human Resources Code.
(5) In SECTION 4 of the bill, in proposed Section 32.0271,
Human Resources Code (House committee printing, page 7, between
lines 1 and 2), insert the following:
(c) A managed care organization or a managed care plan, as
those terms are defined by Section 533.001, Government Code, may
not by contract or any other method require a physician to use the
services of a nurse first assistant in providing care to a
recipient of medical assistance.
(6) In SECTION 4 of the bill, in proposed Section
32.0271(c), Human Resources Code (House committee printing, page 7,
line 2), strike "(c)" and substitute "(d)".
(7) In SECTION 9(a) of the bill, in proposed Section
531.02103(a)(1), Government Code (House committee printing, page
26, line 12), strike "in areas of the state" and substitute "to
areas of the state and to populations".
(8) In SECTION 9(a) of the bill, in proposed Section
531.02103(a)(3), Government Code (House committee printing, page
26, line 19), strike "+ Plus".
(9) In SECTION 9(a) of the bill, in proposed Section
531.02103(a)(6), Government Code (House committee printing, page
27, lines 3 and 4), strike ", provided that the initiatives may not
apply to pharmacies participating in the vendor drug program".
(10) In SECTION 9(a) of the bill, in proposed Section
531.02103(a)(9), Government Code (House committee printing, page
27, line 14), between "services" and "as necessary", insert ",
including use of prior authorization requirements,".
(11) In SECTION 9(a) of the bill, in proposed Section
531.02103(a)(12), Government Code (House committee printing, page
27, lines 21-23), strike "by not more than five percent for cases
that exceed the established rate of reimbursement".
(12) In SECTION 9(a) of the bill, in proposed Section
531.02103(b), Government Code (House committee printing, page 27,
lines 26 and 27), strike "and shall solicit input on the need for
and effect of those strategies".
(13) In SECTION 9(a) of the bill, in proposed Section
531.02103(b), Government Code (House committee printing, page 28,
line 1), strike "may use" and substitute "shall use".
(14) In SECTION 9(a) of the bill, in proposed Section
531.02103(b), Government Code (House committee printing, page 28,
lines 2-4), strike "or may hold public hearings in the development
of agency rules and procedures and necessary state plan amendments
or waivers".
(15) In SECTION 9(a) of the bill, in proposed Section
531.02103, Government Code (House committee printing, page 28,
between lines 4 and 5), insert the following:
(c) The commission shall hold public hearings at least
quarterly regarding the development and implementation of
strategies under Subsection (a) and the development of agency
procedures and necessary state plan amendments or waivers. If the
commission proposes to adopt a rule necessary to implement a
strategy under Subsection (a), the commission shall adopt the rule
in accordance with Chapter 2001 and hold any public hearing
required by that chapter.
(16) In SECTION 9(a) of the bill (House committee printing,
page 29, line 22, through page 30, line 15), strike proposed
Section 531.02106, Government Code, and substitute the following:
Sec. 531.02106. LIMITS ON MEDICAID COST-SHARING. Before
requiring Medicaid recipients to make copayments or comply with
other cost-sharing requirements, the commission by rule shall
establish monthly limits on total copayments and other cost-sharing
requirements.
(17) In SECTION 10 of the bill, in proposed Section
531.02131, Government Code (House committee printing, page 31,
lines 3-12), strike Subsections (b), (c), and (d).
(18) In SECTION 10 of the bill, in proposed Section
531.02131(e), Government Code (House committee printing, page 31,
line 13), strike "(e) To the extent feasible and appropriate, the"
and substitute "(b) The".
(19) In SECTION 15 of the bill, in proposed Section 531.055,
Government Code (House committee printing, page 34, lines 4-17),
strike Subdivisions (1) and (2) and substitute the following:
(1) identifies the Medicaid provider reimbursement
rates established by rule for each county in this state and the
premiums paid to Medicaid managed care organizations in this state;
(2) compares the rates and premiums identified under
Subdivision (1) to:
(A) the rates and premiums paid by other health
care payors, including Medicare, in the same county or other
relevant area of the state for comparable services provided to
comparable populations; and
(B) the appropriate Medicaid rates of the top 15
industrial states as ranked by the United States Department of
Commerce Bureau of Economic Analysis based on gross state product;
(20) In the recital of SECTION 18 of the bill (House
committee printing, page 39, line 19), strike "Sections 533.0021,
533.0022, and 533.0023" and substitute "Sections 533.0021,
533.0022, 533.0023, and 533.0024".
(21) In SECTION 18 of the bill, in proposed Section
533.0021(1), Government Code (House committee printing, page 41,
lines 9-13), strike Paragraph (C) and substitute the following:
(C) ensures that the community is given an
opportunity to provide input and participate in the implementation
of the system in the health care service region by holding public
hearings in the community at which the commission takes public
comment from all persons interested in the implementation of the
system;
(22) In SECTION 18 of the bill, in proposed Section
533.0023, Government Code (House committee printing, page 42, line
25), between "SYSTEM." and "The", insert "(a)".
(23) In SECTION 18 of the bill, at the end of proposed
Section 533.0023, Government Code (House committee printing, page
43, between lines 1 and 2), insert the following:
(b) The commissioner of health and human services shall
adopt rules and obtain public input in accordance with Chapter 2001
before making substantive changes to policies or programs under the
Medicaid managed care program.
Sec. 533.0024. RESOLUTION OF IMPLEMENTATION ISSUES. The
commission shall conduct a meeting at least quarterly with managed
care organizations that contract with the commission under this
chapter and health care providers to identify and resolve
implementation issues with respect to the Medicaid managed care
program.
(24) Strike SECTION 19 of the bill (House committee
printing, page 43, lines 2-24) and renumber subsequent SECTIONS of
the bill accordingly.
(25) In SECTION 21(a) of the bill, in amended Section
533.005, Government Code (House committee printing, page 46, lines
1-13), strike proposed Subdivisions (11) and (12) and substitute
the following:
(11) a process by which the commission is required to:
(A) provide in writing to the managed care
organization the projected fiscal impact on the state and managed
care organizations that contract with the commission under this
chapter of proposed Medicaid managed care program, benefit, or
contract changes; and
(B) negotiate in good faith regarding
appropriate operational and financial changes to the contract with
the managed care organization before implementing those changes;
(12) a requirement that the managed care organization
providing services to recipients under a Medicaid STAR + Plus pilot
program:
(A) have an appropriate number of clinically
trained case managers within the Medicaid STAR + Plus pilot program
service delivery area to manage medically complex patients; and
(B) implement disease management programs that
address the medical conditions of the Medicaid STAR + Plus pilot
program population, including persons with HIV infection, AIDS, or
sickle cell anemia;
(13) a requirement that the renewal date of the
contract coincide with the beginning of the state fiscal year; and
(14) a requirement that the managed care organization
reimburse health care providers for an appropriate emergency
medical screening that is within the capability of the hospital's
emergency department, including ancillary services routinely
available to the emergency department, and that is provided to
determine whether:
(A) an emergency medical or psychiatric
condition exists; and
(B) additional medical examination and treatment
is required to stabilize the emergency medical or psychiatric
condition.
(26) In the recital of SECTION 22(a) of the bill (House
committee printing, page 46, line 25), strike "533.016-533.0208"
and substitute "533.016-533.0207".
(27) In SECTION 22(a) of the bill, in proposed Section
533.018(a)(2), Government Code (House committee printing, page 53,
lines 11 and 12), strike "monitoring, regulation," and substitute
"monitoring, reporting, reviewing of forms, regulation,".
(28) In SECTION 22(a) of the bill, strike proposed Section
533.018(b), Government Code (House committee printing, page 53,
line 14, through page 57, line 6), and substitute the following:
(b) The memorandum of understanding under this section must:
(1) maximize the use of electronic filing of
information by managed care organizations contracting with the
commission under this chapter;
(2) specify the process by which the commission and
the Texas Department of Insurance will jointly schedule a single
on-site visit that satisfies the requirements of all state agencies
regarding regularly scheduled, comprehensive compliance monitoring
of and enforcement efforts with respect to managed care
organizations contracting with the commission under this chapter;
(3) require that interagency orientation and training
are scheduled and conducted to ensure that agency staff members are
familiar with the obligation to eliminate and prevent duplicative
monitoring and enforcement activities; and
(4) ensure coordination to eliminate and prevent
duplication regarding policy development and implementation,
procurement, cost estimates, electronic systems issues, and
monitoring and enforcement activities with respect to managed care
organizations that serve recipients as well as enrollees in the
state child health plan under Chapter 62, Health and Safety Code.
(29) In SECTION 22(a) of the bill, in the heading to
proposed Section 533.019, Government Code (House committee
printing, page 57, line 7), between "533.019." and "OPERATIONAL",
insert "INTEGRATED".
(30) In SECTION 22(a) of the bill, in proposed Section
533.019(a), Government Code (House committee printing, page 57,
line 9), strike "an operational and financial" and substitute "an
integrated operational and financial".
(31) In SECTION 22(a) of the bill, in proposed Section
533.019(b), Government Code (House committee printing, page 57,
line 14), strike "the operational and financial" and substitute
"the integrated operational and financial".
(32) In SECTION 22(a) of the bill, in proposed Section
533.019(c), Government Code (House committee printing, page 58,
lines 7 and 8), between "the" and "operational and financial",
insert "integrated".
(33) In SECTION 22(a) of the bill, strike proposed Section
533.0208, Government Code (House committee printing, page 62, line
20, through page 63, line 12).
(34) In SECTION 22 of the bill, following Subsection (a) of
that SECTION (House committee printing, page 63, between lines 12
and 13), insert the following and reletter subsequent subsections
of that SECTION accordingly:
(b) Not later than March 1, 2002, the Health and Human
Services Commission and each appropriate health and human services
agency implementing part of the Medicaid managed care program under
Chapter 533, Government Code, shall complete the requirements for
reducing and coordinating reporting requirements and inspection
procedures as required by Section 533.017, Government Code, as
added by this Act.
(35) In SECTION 22(c) of the bill (House committee printing,
page 63, line 21), strike "the operational and financial" and
substitute "the integrated operational and financial".
(36) Strike SECTION 22(f) of the bill (House committee
printing, page 64, lines 9-16).
(37) In SECTION 26(b) of the bill (House committee printing,
page 68, lines 5 and 6), strike "Implementation of Section
533.0208, Government Code, as added by this Act, is governed by
Section 22 of this Act."