By Kitchen H.B. No. 3386
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 implementation of Medicaid managed care pilot programs.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 533.012, Government Code, is amended to
1-5 read as follows:
1-6 Sec. 533.012. [MORATORIUM ON] IMPLEMENTATION OF CERTAIN
1-7 PILOT PROGRAMS[; REVIEW; REPORT]. (a) Notwithstanding any other
1-8 law, the commission shall [may not] implement Medicaid managed care
1-9 pilot programs[, Medicaid behavioral health pilot programs, or
1-10 Medicaid Star + Plus pilot programs] in [a] regions [for] in which
1-11 the commission [has not] is not currently operating a pilot program
1-12 unless the commission determines that implementation of such a
1-13 program would not be feasible or beneficial in a particular
1-14 region.[:]
1-15 [(1) received a bid from a managed care organization
1-16 to provide health care services to recipients in the region through
1-17 a managed care plan; or]
1-18 [(2) entered into a contract with a managed care
1-19 organization to provide health care services to recipients in the
1-20 region through a managed care plan.]
1-21 [(b) The commission shall:]
1-22 [(1) review any outstanding administrative and
1-23 financial issues with respect to Medicaid managed care pilot
2-1 programs, Medicaid behavioral health pilot programs, and Medicaid
2-2 Star + Plus pilot programs implemented in health care service
2-3 regions;]
2-4 [(2) review the impact of the Medicaid managed care
2-5 delivery system, including managed care organizations, prepaid
2-6 health plans, and primary care case management, on:]
2-7 [(A) physical access and program-related access
2-8 to appropriate services by recipients, including recipients who
2-9 have special health care needs;]
2-10 [(B) quality of health care delivery and patient
2-11 outcomes;]
2-12 [(C) utilization patterns of recipients;]
2-13 [(D) statewide Medicaid costs;]
2-14 [(E) coordination of care and care coordination
2-15 in Medicaid Star + Plus pilot programs;]
2-16 [(F) the level of administrative complexity for
2-17 providers, recipients, and managed care organizations;]
2-18 [(G) public hospitals, medical schools, and
2-19 other traditional providers of indigent health care; and]
2-20 [(H) competition in the marketplace and network
2-21 retention; and]
2-22 [(3) evaluate the feasibility of developing a separate
2-23 reimbursement methodology for public hospitals under a Medicaid
2-24 managed care delivery system.]
2-25 [(c) In performing its duties and functions under Subsection
2-26 (b), the commission shall seek input from the state Medicaid
3-1 managed care advisory committee created under Subchapter C. The
3-2 commission may coordinate the review required under Subsection (b)
3-3 with any other study or review the commission is required to
3-4 complete.]
3-5 [(d) Notwithstanding Subsection (a), the commission may
3-6 implement Medicaid managed care pilot programs, Medicaid behavioral
3-7 health pilot programs, and Medicaid Star + Plus pilot programs in a
3-8 region described by that subsection if the commission finds that:]
3-9 [(1) outstanding administrative and financial issues
3-10 with respect to the implementation of those programs in health care
3-11 service regions have been resolved; and]
3-12 [(2) implementation of those programs in a region
3-13 described by Subsection (a) would benefit both recipients and
3-14 providers.]
3-15 [(e) Not later than November 1, 2000, the commission shall
3-16 submit a report to the governor and the legislature that:]
3-17 [(1) states whether the outstanding administrative and
3-18 financial issues with respect to the pilot programs described by
3-19 Subsection (b)(1) have been sufficiently resolved;]
3-20 [(2) summarizes the findings of the review conducted
3-21 under Subsection (b);]
3-22 [(3) recommends which elements of the Medicaid managed
3-23 care delivery system should be applied to the traditional
3-24 fee-for-service component of the state Medicaid program to achieve
3-25 the goals specified in Section 533.002(1); and]
3-26 [(4) recommends whether Medicaid managed care pilot
4-1 programs, Medicaid behavioral health pilot programs, or Medicaid
4-2 Star + Plus pilot programs should be implemented in health care
4-3 service regions described by Subsection (a).]
4-4 [(f) To the extent practicable, this section may not be
4-5 construed to affect the duty of the commission to plan the
4-6 continued expansion of Medicaid managed care pilot programs,
4-7 Medicaid behavioral health pilot programs, and Medicaid Star + Plus
4-8 pilot programs in health care service regions described by
4-9 Subsection (a) after July 1, 2001.]
4-10 [(g) Notwithstanding any other law, the commission may not
4-11 use federal medical assistance funds to implement any long-term
4-12 care integrated network pilot studies.]
4-13 [(h) This section expires July 1, 2001.]
4-14 SECTION 2. If before implementing any provision of this Act
4-15 a state agency determines that a waiver or authorization from a
4-16 federal agency is necessary for implementation of that provision,
4-17 the agency affected by the provision shall request the waiver or
4-18 authorization and may delay implementing that provision until the
4-19 waiver or authorization is granted.
4-20 SECTION 3. This Act takes effect immediately if it receives
4-21 a vote of two-thirds of all members elected to each house, as
4-22 provided by Section 29, Article III, Texas Constitution. If this
4-23 Act does not receive the vote necessary for immediate effect, this
4-24 Act takes effect September 1, 2001.