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Amend CSSB 23 (house committee printing) by striking SECTION 3(a) (page 7, line 12, through page 8, line 2) and substituting the following:
(a) Section 533.0025, Government Code, is amended by amending Subsection (e) and adding Subsection (f) to read as follows:
(e) In expanding the health maintenance organization model of the managed care program into the South Texas service delivery area, the executive commissioner shall determine and develop the most effective alignment of managed care service delivery areas for each managed care model through which services are provided in Duval, Hidalgo, Jim Hogg, Cameron, Maverick, McMullen, Starr, Webb, Willacy, and Zapata Counties. In developing the service delivery areas for each managed care model, the executive commissioner shall consider:
(1) the number of individuals impacted in each of the counties;
(2) the usual source of health care services for residents in each of the counties; and
(3) other factors relevant to the delivery of health care services in each of the counties [Notwithstanding Subsection (b)(1), the commission may not provide medical assistance using a health maintenance organization in Cameron County, Hidalgo County, or Maverick County].
(f) Each managed care organization that operates within the South Texas service delivery area must maintain a medical director within the service delivery area whose duties include overseeing and managing the managed care organization medical necessity determination process. The medical director:
(1) may be a managed care organization employee or be under contract with the managed care organization;
(2) must be available for peer-to-peer discussions about managed care organization medical necessity determinations and other managed care organization clinical policies; and
(3) may not be affiliated with any hospital, clinic, or other health care related institution or business that operates within the service delivery area.