1-1     By:  Nelson                                            S.B. No. 284
 1-2           (In the Senate - Filed January 18, 2001; January 22, 2001,
 1-3     read first time and referred to Committee on Health and Human
 1-4     Services; April 23, 2001, reported adversely, with favorable
 1-5     Committee Substitute by the following vote:  Yeas 7, Nays 0;
 1-6     April 23, 2001, sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 284                   By:  Carona
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to streamlining reporting requirements and inspection
1-11     procedures under the Medicaid managed care program.
1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13           SECTION 1.  Subchapter A, Chapter 533, Government Code, is
1-14     amended by adding Sections 533.0055, 533.016, 533.017, and 533.018
1-15     to read as follows:
1-16           Sec. 533.0055.  EVALUATION OF REPORTING REQUIREMENTS AND
1-17     INSPECTION PROCEDURES.  (a)  The commission shall:
1-18                 (1)  evaluate on-site inspection procedures of managed
1-19     care organizations contracting with the commission under this
1-20     chapter and evaluate methods to streamline those procedures to
1-21     assist the commission in determining necessary and effective
1-22     quality control measures and required data;
1-23                 (2)  evaluate methods to streamline reporting
1-24     requirements for managed care organizations contracting with the
1-25     commission under this chapter, including:
1-26                       (A)  combining information required to be
1-27     reported into a quarterly management report;
1-28                       (B)  eliminating unnecessary or duplicative
1-29     reporting requirements; and
1-30                       (C)  requiring managed care organizations to use
1-31     uniform forms developed by the commission for referrals for
1-32     services and credentialing of health care providers providing
1-33     health care services to recipients; and
1-34                 (3)  require managed care organizations contracting
1-35     with the commission under this chapter to evaluate reporting
1-36     requirements for health care providers to identify methods of
1-37     reducing the administrative burden placed on the providers,
1-38     including:
1-39                       (A)  reducing the complexity of forms health care
1-40     providers are required to complete; and
1-41                       (B)  eliminating unnecessary or duplicative
1-42     reporting requirements.
1-43           (b)  The commission shall submit a report to the legislature
1-44     regarding the evaluation of and methods for streamlining on-site
1-45     inspection procedures and reporting requirements for managed care
1-46     organizations and health care providers providing health care
1-47     services to recipients.  The report must include recommendations on
1-48     which methods should be implemented and a schedule for
1-49     implementation.
1-50           (c)  This section expires September 1, 2002.
1-51           Sec. 533.016.  INTERAGENCY SHARING OF INFORMATION.  The
1-52     commission shall require a health and human services agency
1-53     implementing the Medicaid managed care program to provide to each
1-54     other health and human services agency implementing the Medicaid
1-55     managed care program information reported to that agency by a
1-56     managed care organization or health care provider providing
1-57     services to recipients.
1-58           Sec. 533.017.  INTERAGENCY MEMORANDUM OF UNDERSTANDING.  The
1-59     chief executive officers of the commission, the Texas Department of
1-60     Insurance, and, if appropriate, health and human services agencies
1-61     shall execute and provide to all Medicaid health maintenance
1-62     organizations interagency memoranda of understanding that maximize
1-63     interagency coordination and eliminate existing and prevent future
1-64     duplicative monitoring, regulation, and enforcement policies and
 2-1     processes.
 2-2           Sec. 533.018.  SINGLE AUDIT INSTRUMENT.  (a)  The commission
 2-3     and the Texas Department of Insurance shall develop a single audit
 2-4     instrument to be used by the commission and health and human
 2-5     services agencies and their contractors and the Texas Department of
 2-6     Insurance and their contractors for regularly scheduled,
 2-7     comprehensive, on-site readiness, performance, compliance, or other
 2-8     reviews, audits, and examinations of Medicaid health maintenance
 2-9     organizations and shall specify in detail the process the agencies
2-10     shall use to amend the single audit instrument.
2-11           (b)  The single audit instrument to be developed by the
2-12     commission and the Texas Department of Insurance shall:
2-13                 (1)  include a means for assessing compliance with all
2-14     applicable state, federal, accreditation, and contractual
2-15     requirements that each respective agency is authorized to enforce,
2-16     including financial, actuarial, operational, quality of care, and
2-17     other requirements, on a regular, periodic basis;
2-18                 (2)  include the means for assessing compliance of
2-19     documents, records, and electronic files that the commission or the
2-20     Texas Department of Insurance requires Medicaid health maintenance
2-21     organizations to submit for review in advance of or as an
2-22     alternative to an on-site review, audit, or examination; and
2-23                 (3)  include the means for assessing compliance through
2-24     on-site reviews, audits, and examinations, including document
2-25     review, testing or review of electronic systems, and observation
2-26     and interviews of Medicaid health maintenance organization
2-27     employees.
2-28           SECTION 2.  The Health and Human Services Commission and the
2-29     Texas Department of Insurance shall complete the interagency
2-30     memoranda of understanding required by Section 533.017, Government
2-31     Code, as added by this Act, and the single audit instrument
2-32     required by Section 533.018, Government Code, as added by this Act,
2-33     not later than November 30, 2001.
2-34           SECTION 3.  The Health and Human Services Commission shall
2-35     submit the report required by Subsection (b), Section 533.0055,
2-36     Government Code, as added by this Act, not later than November 1,
2-37     2002.
2-38           SECTION 4.  This Act takes effect immediately if it receives
2-39     a vote of two-thirds of all the members elected to each house, as
2-40     provided by Section 39, Article III, Texas Constitution.  If this
2-41     Act does not receive the vote necessary for immediate effect, this
2-42     Act takes effect September 1, 2001.
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