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.