By: Nelson S.B. No. 284
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to streamlining reporting requirements and inspection
1-3 procedures under the Medicaid managed care 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 533.0055, 533.016, 533.017, and 533.018
1-7 to read as follows:
1-8 Sec. 533.0055. EVALUATION OF REPORTING REQUIREMENTS AND
1-9 INSPECTION PROCEDURES. (a) The commission shall:
1-10 (1) evaluate on-site inspection procedures of managed
1-11 care organizations contracting with the commission under this
1-12 chapter and evaluate methods to streamline those procedures to
1-13 assist the commission in determining necessary and effective
1-14 quality control measures and required data;
1-15 (2) evaluate methods to streamline reporting
1-16 requirements for managed care organizations contracting with the
1-17 commission under this chapter, including:
1-18 (A) combining information required to be
1-19 reported into a quarterly management report;
1-20 (B) eliminating unnecessary or duplicative
1-21 reporting requirements; and
1-22 (C) requiring managed care organizations to use
1-23 uniform forms developed by the commission for referrals for
1-24 services and credentialing of health care providers providing
1-25 health care services to recipients; and
2-1 (3) require managed care organizations contracting
2-2 with the commission under this chapter to evaluate reporting
2-3 requirements for health care providers to identify methods of
2-4 reducing the administrative burden placed on the providers,
2-5 including:
2-6 (A) reducing the complexity of forms health care
2-7 providers are required to complete; and
2-8 (B) eliminating unnecessary or duplicative
2-9 reporting requirements.
2-10 (b) The commission shall submit a report to the legislature
2-11 regarding the evaluation of and methods for streamlining on-site
2-12 inspection procedures and reporting requirements for managed care
2-13 organizations and health care providers providing health care
2-14 services to recipients. The report must include recommendations on
2-15 which methods should be implemented and a schedule for
2-16 implementation.
2-17 (c) This section expires September 1, 2002.
2-18 Sec. 533.016. INTERAGENCY SHARING OF INFORMATION. The
2-19 commission shall require a health and human services agency
2-20 implementing the Medicaid managed care program to provide to each
2-21 other health and human services agency implementing the Medicaid
2-22 managed care program information reported to that agency by a
2-23 managed care organization or health care provider providing
2-24 services to recipients.
2-25 Sec. 533.017. INTERAGENCY MEMORANDUM OF UNDERSTANDING. The
2-26 chief executive officers of the commission, the Texas Department of
3-1 Insurance, and, if appropriate, health and human services agencies
3-2 shall execute and provide to all Medicaid health maintenance
3-3 organizations interagency memoranda of understanding that maximize
3-4 interagency coordination and eliminate existing and prevent future
3-5 duplicative monitoring, regulation, and enforcement policies and
3-6 processes.
3-7 Sec. 533.018. SINGLE AUDIT INSTRUMENT. (a) The commission
3-8 and the Texas Department of Insurance shall develop a single audit
3-9 instrument to be used by the commission and health and human
3-10 services agencies and their contractors and the Texas Department of
3-11 Insurance and their contractors for regularly scheduled,
3-12 comprehensive, on-site readiness, performance, compliance, or other
3-13 reviews, audits, and examinations of Medicaid health maintenance
3-14 organizations and shall specify in detail the process the agencies
3-15 shall use to amend the single audit instrument.
3-16 (b) The single audit instrument to be developed by the
3-17 commission and the Texas Department of Insurance shall:
3-18 (1) include a means for assessing compliance with all
3-19 applicable state, federal, accreditation, and contractual
3-20 requirements that each respective agency is authorized to enforce,
3-21 including financial, actuarial, operational, quality of care, and
3-22 other requirements, on a regular, periodic basis;
3-23 (2) include the means for assessing compliance of
3-24 documents, records, and electronic files that the commission or the
3-25 Texas Department of Insurance requires Medicaid health maintenance
3-26 organizations to submit for review in advance of or as an
4-1 alternative to an on-site review, audit, or examination; and
4-2 (3) include the means for assessing compliance through
4-3 on-site reviews, audits, and examinations, including document
4-4 review, testing or review of electronic systems, and observation
4-5 and interviews of Medicaid health maintenance organization
4-6 employees.
4-7 SECTION 2. The Health and Human Services Commission and the
4-8 Texas Department of Insurance shall complete the interagency
4-9 memoranda of understanding required by Section 533.017, Government
4-10 Code, as added by this Act, and the single audit instrument
4-11 required by Section 533.018, Government Code, as added by this Act,
4-12 not later than November 30, 2001.
4-13 SECTION 3. The Health and Human Services Commission shall
4-14 submit the report required by Subsection (b), Section 533.0055,
4-15 Government Code, as added by this Act, not later than November 1,
4-16 2002.
4-17 SECTION 4. This Act takes effect immediately if it receives
4-18 a vote of two-thirds of all the members elected to each house, as
4-19 provided by Section 39, Article III, Texas Constitution. If this
4-20 Act does not receive the vote necessary for immediate effect, this
4-21 Act takes effect September 1, 2001.