By Coleman H.B. No. 1223
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the administration and operation of the Medicaid
1-3 program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter A, Chapter 533, Government Code, is
1-6 amended by adding Sections 533.0035, 533.0055, 533.0056, 533.0085,
1-7 533.0125, 533.0135, 533.016, 533.017, 533.018 and 533.019 to read
1-8 as follows:
1-9 Sec. 533.0035. LIMITATION ON NUMBER OF MANAGED CARE
1-10 ORGANIZATIONS. (a) The commission shall:
1-11 (1) evaluate the number of managed care organizations
1-12 contracted with the commission to provide health care services
1-13 within each health care service region, with a particular focus on
1-14 the market share of each managed care organization; and
1-15 (2) limit the number of managed care organizations
1-16 contracted with the commission in a manner that will promote
1-17 successful implementation of delivery of health care services to
1-18 recipients through managed care.
1-19 Sec. 533.0055. ENFORCEMENT OF REQUIRED CONTRACT PROVISIONS.
1-20 The commission shall develop and assess administrative penalties
1-21 for failure to meet required contract provisions as described by
1-22 Sec. 533.005.
2-1 Sec. 533.0056. CONTRACT MANAGEMENT. When renewing a contract
2-2 for services provided by a third party on behalf of the state
2-3 Medicaid program, the commission shall ensure that the renewal date
2-4 of that contract coincides with the beginning of a state fiscal
2-5 year.
2-6 Sec. 533.0085. OUTREACH AND MEMBER EDUCATION BY CONTRACTORS
2-7 REQUIRED. The commission shall require all entities contracted with
2-8 the state Medicaid program to:
2-9 (1) conduct outreach to locate eligible recipients;
2-10 and
2-11 (2) provide education to recipients regarding the
2-12 processes of managed care as implemented under this chapter.
2-13 Sec. 533.0125. MANAGED CARE FOR SUBSTANCE ABUSE AND
2-14 PROTECTIVE AND REGULATORY SERVICES PROHIBITED. The commission or a
2-15 health and human services agency shall not implement managed care
2-16 for substance abuse delivery or protective and regulatory services.
2-17 Sec. 533.0135. NEGOTIATION ASSISTANCE. The commission may
2-18 contract with a third party to assist with the negotiation of rates
2-19 paid to managed care organizations or any other entity contracted
2-20 with the commission or a health and human services agency to
2-21 perform administrative services for the state Medicaid program,
2-22 such as claims processing, utilization review, client enrollment,
2-23 provider enrollment, quality monitoring, or payment of claims.
2-24 Sec. 533.016. REDUCTION OF REPORTING REQUIREMENTS AND
2-25 INSPECTION PROCEDURES. (a) The commission shall:
2-26 (1) streamline on-site inspection procedures of
3-1 managed care organizations contracting with the commission under
3-2 this chapter;
3-3 (2) streamline reporting requirements for managed care
3-4 organizations contracting with the commission under this chapter,
3-5 including:
3-6 (A) combining information required to be
3-7 reported into a quarterly management report; and
3-8 (B) eliminating unnecessary or duplicative
3-9 reporting requirements.
3-10 (3) require managed care organizations contracting
3-11 with the commission under this chapter to reduce the administrative
3-12 burden placed on the providers including:
3-13 (A) reducing the complexity of forms health care
3-14 providers are required to complete;
3-15 (B) eliminating unnecessary or duplicative
3-16 reporting requirements; and
3-17 (C) adopting the uniform forms developed by the
3-18 commission under Sec. 533.018.
3-19 Sec. 533.017. ELIMINATION OF PREAUTHORIZATION REQUIREMENTS.
3-20 The commission, in cooperation with the Texas Department of
3-21 Insurance, shall:
3-22 (1) require managed care organizations providing
3-23 health care services to recipients to eliminate preauthorization
3-24 requirements for routine health care services that are customarily
3-25 approved by the managed care organizations; and
3-26 (2) develop procedures for
4-1 (A) identifying routine health care services for
4-2 which preauthorization requirements should be eliminated; and
4-3 (B) ensuring that health care providers receive
4-4 notice of health care services for which preauthorization is
4-5 required.
4-6 Sec. 533.018. UNIFORM FORMS; REQUIRED USE. (a) The
4-7 commission shall develop uniform forms for:
4-8 (1) referrals for services;
4-9 (2) credentialing of health care providers providing
4-10 health care services to recipients; and
4-11 (3) preauthorization for health care services
4-12 delivered to recipients.
4-13 (b) The commission shall require managed care organizations
4-14 to use the uniform forms developed by the commission under this
4-15 section.
4-16 (c) The commission shall revise its contracts with managed
4-17 care organizations to reflect the requirements of this section.
4-18 Sec. 533.019. UNIFORM STANDARDS FOR IDENTIFICATION OF
4-19 MEMBERS WITH DISABILITIES OR CHRONIC CONDITIONS. The commission
4-20 shall develop a uniform assessment tool for managed care
4-21 organizations to use in identifying members with a disability or
4-22 condition requiring chronic and long term care.
4-23 SECTION 2. Amend Sec. 533.012, Government Code, as follows:
4-24 Sec. 533.012. MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT
4-25 PROGRAMS[; REVIEW; REPORT]. (a) Notwithstanding any other law, the
4-26 commission may not implement Medicaid managed care pilot programs,
5-1 Medicaid behavioral health pilot programs, or Medicaid Star + Plus
5-2 pilot programs in a region [for] in which the commission [has] is
5-3 not currently operating a pilot program.[:]
5-4 [(1) received a bid from a managed care organization
5-5 to provide health care services to recipients in the region through
5-6 a managed care plan; or]
5-7 [(2) entered into a contract with a managed care
5-8 organization to provide health care services to recipients in the
5-9 region through a managed care plan.]
5-10 [(b) The commission shall:]
5-11 [(1) review any outstanding administrative and
5-12 financial issues with respect to Medicaid managed care pilot
5-13 programs, Medicaid behavioral health pilot programs, and Medicaid
5-14 Star + Plus pilot programs implemented in health care service
5-15 regions;]
5-16 [(2) review the impact of the Medicaid managed care
5-17 delivery system, including managed care organizations, prepaid
5-18 health plans, and primary care case management, on:]
5-19 [(A) physical access and program-related access
5-20 to appropriate services by recipients, including recipients who
5-21 have special health care needs;]
5-22 [(B) quality of health care delivery and patient
5-23 outcomes;]
5-24 [(C) utilization patterns of recipients;]
5-25 [(D) statewide Medicaid costs;]
5-26 [(E) coordination of care and care coordination
6-1 in Medicaid Star + Plus pilot programs;]
6-2 [(F) the level of administrative complexity for
6-3 providers, recipients, and managed care organizations;]
6-4 [(G) public hospitals, medical schools, and
6-5 other traditional providers of indigent health care; and]
6-6 [(H) competition in the marketplace and network
6-7 retention; and]
6-8 [(3) evaluate the feasibility of developing a separate
6-9 reimbursement methodology for public hospitals under a Medicaid
6-10 managed care delivery system.]
6-11 [(c) In performing its duties and functions under Subsection
6-12 (b), the commission shall seek input from the state Medicaid
6-13 managed care advisory committee created under Subchapter C. The
6-14 commission may coordinate the review required under Subsection (b)
6-15 with any other study or review the commission is required to
6-16 complete.]
6-17 [(d) Notwithstanding Subsection (a), the commission may
6-18 implement Medicaid managed care pilot programs, Medicaid behavioral
6-19 health pilot programs, and Medicaid Star + Plus pilot programs in a
6-20 region described by that subsection if the commission finds that:]
6-21 [(1) outstanding administrative and financial issues
6-22 with respect to the implementation of those programs in health care
6-23 service regions have been resolved; and]
6-24 [(2) implementation of those programs in a region
6-25 described by Subsection (a) would benefit both recipients and
6-26 providers.]
7-1 [(e) Not later than November 1, 2000, the commission shall
7-2 submit a report to the governor and the legislature that:]
7-3 [(1) states whether the outstanding administrative and
7-4 financial issues with respect to the pilot programs described by
7-5 Subsection (b)(1) have been sufficiently resolved;]
7-6 [(2) summarizes the findings of the review conducted
7-7 under Subsection (b);]
7-8 [(3) recommends which elements of the Medicaid managed
7-9 care delivery system should be applied to the traditional fee
7-10 for-service component of the state Medicaid program to achieve the
7-11 goals specified in Section 533.002(1); and]
7-12 [(4) recommends whether Medicaid managed care pilot
7-13 programs, Medicaid behavioral health pilot programs, or Medicaid
7-14 Star + Plus pilot programs should be implemented in health care
7-15 service regions described by Subsection (a).]
7-16 [(f) To the extent practicable, this section may not be
7-17 construed to affect the duty of the commission to plan the
7-18 continued expansion of Medicaid managed care pilot programs,
7-19 Medicaid behavioral health pilot programs, and Medicaid Star + Plus
7-20 pilot programs in health care service regions described by
7-21 Subsection (a) after July 1, 2001.]
7-22 [(g) Notwithstanding any other law, the commission may not
7-23 use federal medical assistance funds to implement any long-term
7-24 care integrated network pilot studies.]
7-25 [(h)] (b) This section expires July 1, [2001] 2003.
7-26 SECTION 3. This Act takes effect immediately if it receives a
8-1 vote of two-thirds of all members elected to each house, as
8-2 provided by Section 29, Article III, Texas Constitution. If this
8-3 Act does not receive the vote necessary for immediate effect, this
8-4 Act takes effect September 1, 2001.