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79R4772 RMB-D

By:  Villarreal                                                   H.B. No. 2325



A BILL TO BE ENTITLED

AN ACT

relating to the review of certain data and information provided 
under the Medicaid managed care program.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter A, Chapter 533, Government Code, is 
amended by adding Section 533.019 to read as follows:
	Sec. 533.019.  ANNUAL RECORDS REVIEW.  (a)  The commission 
shall conduct an annual review of the records of a managed care 
organization that contracts with the commission to determine the 
accuracy and completeness of encounter data and other information 
received from the managed care organization.  The records review 
must include an examination of the following information regarding 
children who are enrollees in the organization's managed care plan:
		(1)  the number and type of physical examinations of 
those children that are performed during a period prescribed by the 
commission to determine whether the child is receiving the 
examinations in accordance with the requirements of the Texas 
Health Steps program;
		(2)  the percentage of those children who are tested 
for lead poisoning at 12 months of age;
		(3)  the number of those children who demonstrate high 
levels of lead in their blood in subsequent tests for lead poisoning 
after a remediation plan has been recommended and implemented; and
		(4)  information about the total number of children 
showing symptoms of dental disease, including the type of dental 
disease and the degree to which the dental disease has advanced.
	(b)  The commission may contract with a public or private 
entity to conduct the records review required by this section.
	(c)  Not later than December 1 of each year, the commission 
shall submit a report to the legislature regarding the results of 
the records review conducted under this section.
	SECTION 2.  If before implementing any provision of this Act 
a state agency determines that a waiver or authorization from a 
federal agency is necessary for implementation of that provision, 
the agency affected by the provision shall request the waiver or 
authorization and may delay implementing that provision until the 
waiver or authorization is granted.
	SECTION 3.  This Act takes effect September 1, 2005.