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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 Medicaid managed care |
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provider networks providing services in the Texas-Mexico border |
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region and other regions of the state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. EXPANSION OF PROVIDER NETWORKS OF MANAGED CARE |
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ORGANIZATIONS IN TEXAS-MEXICO BORDER REGION AND OTHER AREAS OF |
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STATE. Subchapter A, Chapter 533, Government Code, is amended by |
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adding Section 533.0065 to read as follows: |
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Sec. 533.0065. EYE HEALTH CARE SERVICE PROVIDERS. (a) In |
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this section, "Texas-Mexico border region" has the meaning assigned |
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by Section 2056.002. |
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(b) Subject to Section 32.047, Human Resources Code, but |
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notwithstanding any other law, the commission shall require that |
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each managed care organization that contracts with the commission |
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under any Medicaid managed care model or arrangement to provide |
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health care services to recipients in a region, including a region |
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consisting of all or part of the Texas-Mexico border region, |
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include in the organization's provider network each optometrist, |
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therapeutic optometrist, and 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. STUDY IN TEXAS-MEXICO BORDER REGION. (a) The |
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Health and Human Services Commission shall conduct a study of the |
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fiscal impact on this state of requiring each Medicaid managed care |
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organization that contracts with the commission under any Medicaid |
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managed care model or arrangement implemented under Chapter 533, |
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Government Code, to include in the organization's health care |
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provider network providing services in all or part of the |
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Texas-Mexico border region, as defined by Section 2056.002, |
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Government Code, each optometrist, therapeutic optometrist, and |
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ophthalmologist who meets the requirements under Section 533.0065, |
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Government Code, as 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. CONTRACTS. (a) The Health and Human Services |
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Commission shall, in a contract between the commission and a |
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Medicaid managed care organization under Chapter 533, Government |
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Code, that is entered into or renewed on or after the effective date |
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of this Act, require that the managed care organization comply with |
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Section 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. WAIVER. If before implementing any provision of |
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this Act a state agency determines that a waiver or authorization |
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from a federal agency is necessary for implementation of that |
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provision, the agency affected by the provision shall request the |
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waiver or authorization and may delay implementing that provision |
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until the waiver or authorization is granted. |
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SECTION 5. EFFECTIVE DATE. This Act takes effect September |
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1, 2011. |