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A BILL TO BE ENTITLED
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AN ACT
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relating to the inclusion of optometrists, therapeutic |
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optometrists, and ophthalmologists in the health care provider |
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networks of Medicaid managed care organizations. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0065 to read as follows: |
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Sec. 533.0065. EYE HEALTH CARE SERVICE PROVIDERS. Subject |
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to Section 32.047, Human Resources Code, but notwithstanding any |
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other law, the commission shall require that each managed care |
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organization that contracts with the commission under any Medicaid |
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managed care model or arrangement to provide health care services |
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to recipients in a region include in the organization's provider |
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network each optometrist, therapeutic optometrist, and |
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ophthalmologist who: |
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(1) agrees to comply with the terms and conditions of |
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the organization; |
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(2) agrees to accept the prevailing provider contract |
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rate of the organization; |
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(3) agrees to abide by the standards of care required |
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by the organization; and |
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(4) has the credentials required by the organization. |
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SECTION 2. (a) The Health and Human Services Commission |
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shall conduct a study of the fiscal impact on this state of |
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requiring each Medicaid managed care organization that contracts |
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with the commission under any Medicaid managed care model or |
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arrangement implemented under Chapter 533, Government Code, to |
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include in the organization's health care provider network each |
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optometrist, therapeutic optometrist, and ophthalmologist who |
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meets the requirements under Section 533.0065, Government Code, as |
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added by this Act. |
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(b) Not later than September 1, 2016, the Health and Human |
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Services Commission shall submit to the legislature a written |
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report containing the findings of the study conducted under |
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Subsection (a) of this section and the commission's recommendations |
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regarding the requirement addressed in the study. |
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SECTION 3. (a) The Health and Human Services Commission |
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shall, in a contract between the commission and a Medicaid managed |
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care organization under Chapter 533, Government Code, that is |
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entered into or renewed on or after the effective date of this Act, |
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require that the managed care organization comply with Section |
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533.0065, Government Code, as added by this Act. |
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(b) The Health and Human Services Commission shall seek to |
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amend each contract entered into with a Medicaid managed care |
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organization under Chapter 533, Government Code, before the |
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effective date of this Act to require those managed care |
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organizations to comply with Section 533.0065, Government Code, as |
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added by this Act. To the extent of a conflict between Section |
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533.0065, Government Code, as added by this Act, and a provision of |
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a contract with a managed care organization entered into before the |
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effective date of this Act, the contract provision prevails. |
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SECTION 4. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 5. This Act takes effect September 1, 2011. |