82R13806 EES-F
 
  By: Alonzo H.B. No. 3191
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the inclusion of optometrists, therapeutic
  optometrists, and ophthalmologists in Medicaid managed care
  provider networks providing services in the Texas-Mexico border
  region and other regions of the state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  EXPANSION OF PROVIDER NETWORKS OF MANAGED CARE
  ORGANIZATIONS IN TEXAS-MEXICO BORDER REGION AND OTHER AREAS OF
  STATE.  Subchapter A, Chapter 533, Government Code, is amended by
  adding Section 533.0065 to read as follows:
         Sec. 533.0065.  EYE HEALTH CARE SERVICE PROVIDERS. (a)  In
  this section, "Texas-Mexico border region" has the meaning assigned
  by Section 2056.002.
         (b)  Subject to Section 32.047, Human Resources Code, but
  notwithstanding any other law, the commission shall require that
  each managed care organization that contracts with the commission
  under any Medicaid managed care model or arrangement to provide
  health care services to recipients in a region, including a region
  consisting of all or part of the Texas-Mexico border region,
  include in the organization's provider network each optometrist,
  therapeutic optometrist, and ophthalmologist who:
               (1)  agrees to comply with the terms and conditions of
  the organization;
               (2)  agrees to accept the prevailing provider contract
  rate of the organization;
               (3)  agrees to abide by the standards of care required
  by the organization; and
               (4)  has the credentials required by the organization.
         SECTION 2.  STUDY IN TEXAS-MEXICO BORDER REGION.  (a)  The
  Health and Human Services Commission shall conduct a study of the
  fiscal impact on this state of requiring each Medicaid managed care
  organization that contracts with the commission under any Medicaid
  managed care model or arrangement implemented under Chapter 533,
  Government Code, to include in the organization's health care
  provider network providing services in all or part of the
  Texas-Mexico border region, as defined by Section 2056.002,
  Government Code, each optometrist, therapeutic optometrist, and
  ophthalmologist who meets the requirements under Section 533.0065,
  Government Code, as added by this Act.
         (b)  Not later than September 1, 2016, the Health and Human
  Services Commission shall submit to the legislature a written
  report containing the findings of the study conducted under
  Subsection (a) of this section and the commission's recommendations
  regarding the requirement addressed in the study.
         SECTION 3.  CONTRACTS.  (a)  The Health and Human Services
  Commission shall, in a contract between the commission and a
  Medicaid managed care organization under Chapter 533, Government
  Code, that is entered into or renewed on or after the effective date
  of this Act, require that the managed care organization comply with
  Section 533.0065, Government Code, as added by this Act.
         (b)  The Health and Human Services Commission shall seek to
  amend each contract entered into with a Medicaid managed care
  organization under Chapter 533, Government Code, before the
  effective date of this Act to require those managed care
  organizations to comply with Section 533.0065, Government Code, as
  added by this Act. To the extent of a conflict between Section
  533.0065, Government Code, as added by this Act, and a provision of
  a contract with a managed care organization entered into before the
  effective date of this Act, the contract provision prevails.
         SECTION 4.  WAIVER.  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 5.  EFFECTIVE DATE.  This Act takes effect September
  1, 2011.