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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision under the medical assistance program of |
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certain medications to children younger than five years of age. |
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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 533.0162 to read as follows: |
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Sec. 533.0162. PRIOR AUTHORIZATION FOR CERTAIN MEDICATIONS |
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FOR CHILDREN. To the extent allowed by federal law, the commission |
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shall ensure that a managed care organization providing |
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prescription drug benefits under the Medicaid program requires |
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prior authorization for the provision of an antipsychotic or |
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neuroleptic medication to a child who is younger than five years of |
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age. In determining whether to grant prior authorization for the |
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provision of the medication, the managed care organization shall |
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consider: |
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(1) the child's diagnosis; |
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(2) approval by the United States Food and Drug |
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Administration for use by a person of the child's age; |
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(3) whether the child has successfully taken the |
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medication in the past; and |
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(4) any other relevant factor specified by rule. |
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SECTION 2. Section 32.024, Human Resources Code, is amended |
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by adding Subsection (hh) to read as follows: |
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(hh) To the extent allowed by federal law, the department |
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may not provide medical assistance through the vendor drug program |
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for the provision of an antipsychotic or neuroleptic medication to |
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a child who is younger than five years of age unless the department |
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authorizes the provision of that medication in advance. In |
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determining whether to authorize the medication, the department |
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shall consider: |
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(1) the child's diagnosis; |
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(2) approval by the United States Food and Drug |
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Administration for use by a person of the child's age; |
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(3) whether the child has successfully taken the |
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medication in the past; and |
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(4) any other factor the department considers |
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relevant. |
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SECTION 3. (a) The Health and Human Services Commission |
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shall, in a contract for the provision of prescription drug |
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benefits between the commission and a managed care organization |
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under Chapter 533, Government Code, that is entered into or renewed |
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on or after the effective date of this Act, require that the managed |
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care organization comply with Section 533.0162, Government Code, as |
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added by this Act. |
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(b) The Health and Human Services Commission shall seek to |
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amend contracts for the provision of prescription drug benefits |
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entered into with managed care organizations under Chapter 533, |
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Government Code, before the effective date of this Act to require |
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those managed care organizations to comply with Section 533.0162, |
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Government Code, as added by this Act. To the extent of a conflict |
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between that section and a provision of a contract with a managed |
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care organization entered into before the effective date of this |
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Act, the contract provision prevails. |
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SECTION 4. Not later than January 1, 2014, the Health and |
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Human Services Commission shall adopt protocols to implement the |
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changes in law made by this Act while ameliorating the effects those |
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changes in law may have on children receiving medication as a |
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covered benefit through the medical assistance program under |
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Chapter 32, Human Resources Code. |
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SECTION 5. 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 6. This Act takes effect September 1, 2013. |