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A BILL TO BE ENTITLED
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AN ACT
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relating to clarification of Section 533.0075, Government Code, and |
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validation of certain acts and decisions made by the Health and |
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Human Services Commission in construing a contract entered into |
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under that section. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. CLARIFICATION OF INTENT OF LEGISLATION. (a) In |
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1993, Texas began the transition to managed care for certain |
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recipients of Medicaid services, with pilot programs in Travis |
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County and the tri-county area of Jefferson, Chambers, and |
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Galveston counties. Since that time, Medicaid managed care has |
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been implemented in six additional services areas: Bexar, Tarrant, |
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Lubbock, Harris, Dallas, El Paso, and Nueces bringing total |
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enrollment in Medicaid managed care to more than 2,500,000. |
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(b) In 1999, the Legislature enacted H.B. No. 2896 and H.B. |
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No. 2641. Both bills included identical amendments to Section |
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533.0075, Government Code, which was originally enacted in 1997 and |
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addressed recipient enrollment in managed care programs. |
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(c) The 1999 amendments added Subdivisions (4), (5), and (6) |
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to Section 533.0075, Government Code. Subdivision (4) required the |
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Health and Human Services Commission to develop and implement an |
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expedited process for determining eligibility for and enrolling |
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pregnant women and newborn infants in managed care plans. |
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Subdivision (5) required the commission to ensure immediate access |
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to prenatal services and newborn care for pregnant women and |
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newborn infants enrolled in managed care plans. Subdivision (6) |
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required the commission to temporarily assign newborn infants to |
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the traditional fee-for-services component of Medicaid for a period |
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not to exceed 60 days or the date on which the newborn's eligibility |
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determination is completed. |
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(d) The Legislature, in enacting subdivisions (4), (5), and |
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(6) of Section 533.0075, understood that the commission had |
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enrolled newborn infants in Medicaid managed care plans and |
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intended that the commission would continue to enroll newborn |
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infants in Medicaid managed care plans. In particular, the |
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Legislature intended that, under the express terms of Subdivision |
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(4), the commission would expedite the enrollment of newborn |
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infants whose Medicaid eligibility is known at the time of birth |
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into managed care plans to ensure access to care and to avoid delays |
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in payment for services. The Legislature has appropriated state |
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and federal funds to the commission for the payment of capitated |
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rates to managed care organizations that have contracted with the |
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commission to provide such coverage to newborn infants. |
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(e) Subdivision (6) of Section 533.0075 was intended to |
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address delays in payment that health care providers in Medicaid |
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managed care pilot areas experienced at the time of its enactment |
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for services provided to a newborn infant who was ultimately |
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enrolled in Medicaid but whose Medicaid eligibility was not |
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determined at the time of birth. The Legislature, in enacting |
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Subdivision (6), did not intend to nullify or supersede |
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Subdivisions (4) and (5) and prohibit enrollment of newborn infants |
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in a Medicaid managed care plan. Rather, the Legislature intended |
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to ensure that a newborn whose Medicaid eligibility was not known or |
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not determined at birth would receive medically necessary care |
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after its birth but before completion of the Medicaid eligibility |
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determination process and that providers who perform such care |
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receive reimbursement for such services. |
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(f) The Legislature understands that the delays in payment |
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that prompted the enactment of Subdivision (6) have largely been |
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resolved by more efficient and timely enrollment processes and that |
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providers who supply services to newborn infants do not experience |
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delays or denials of payment solely because of a delay in Medicaid |
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eligibility determination. Accordingly, the Legislature finds |
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that the purposes of Subdivision (6) have been fulfilled and its |
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requirements are no longer necessary to ensure appropriate payment |
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of providers of services to newborn infants. |
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SECTION 2. CLARIFYING AMENDMENT. Section 533.0075(6), |
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Government Code, is repealed. |
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SECTION 3. VALIDATION OF ACTS OR DECISIONS BY HEALTH AND |
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HUMAN SERVICES COMMISSION. (a) A governmental act taken or |
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decision made by the Health and Human Services Commission, to |
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enroll a newborn infant in a managed care organization under the |
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terms of a contract for managed care services authorized by Section |
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533.0075, Government Code, is conclusively presumed, as of the date |
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it occurred, to be valid and to have occurred in accordance with all |
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applicable law. |
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(b) This section does not apply to: |
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(1) an act or decision that was void at the time it |
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occurred; |
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(2) an act or decision that violates the terms of |
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federal law or a federal waiver; or |
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(2) an act or decision that, under a statute of this |
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state or the United States, was a misdemeanor or felony at the time |
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the act or decision occurred. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |