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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicaid managed care pilot programs for contracts with |
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provider-directed managed care organizations, including |
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organizations that delegate to health care collaboratives, and to |
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the establishment of those collaboratives. |
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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 533.0045 to read as follows: |
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Sec. 533.0045. PILOT PROGRAMS FOR CONTRACTS WITH |
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PROVIDER-DIRECTED MANAGED CARE ORGANIZATIONS. (a) In this section: |
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(1) "Delegation agreement" has the meaning assigned by |
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Section 1272.001, Insurance Code. |
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(2) "Health care collaborative" has the meaning |
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assigned by Section 848.001, Insurance Code, and includes an entity |
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described by Section 316.001, Health and Safety Code. |
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(3) "Medical assistance" has the meaning assigned by |
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Section 32.003, Human Resources Code. |
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(b) If cost-effective and feasible, the commission shall |
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develop and implement pilot programs under which the commission |
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contracts with provider-directed managed care organizations for |
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purposes of: |
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(1) promoting the efficient utilization of medical |
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assistance services by recipients; and |
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(2) determining the ability of the organizations to |
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improve patient outcomes and contain costs associated with |
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providing medical assistance to recipients within each |
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organization's service delivery area. |
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(c) The commission may develop and implement pilot programs |
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under this section to test one or more service delivery models |
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designed to provide medical assistance for acute care through a |
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health maintenance organization that executes a delegation |
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agreement with a health care collaborative, provided that: |
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(1) the delegation agreement between the health care |
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collaborative and the health maintenance organization is subject to |
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the requirements of Chapter 1272, Insurance Code, and other |
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applicable state and federal law; and |
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(2) at least one of the pilot programs established as |
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provided by this subsection is conducted with a provider-managed |
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health maintenance organization that is owned by a not-for-profit |
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pediatric facility. |
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(d) If the commission implements pilot programs under this |
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section, the commission shall: |
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(1) implement those programs not later than September |
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1, 2015; |
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(2) operate each program for at least 36 months and be |
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permitted to extend the period if the commission determines an |
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extension is appropriate; and |
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(3) establish each program only in a service delivery |
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area that: |
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(A) has more than 400,000 individuals who, in the |
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aggregate, are eligible for benefits under the STAR + PLUS Medicaid |
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managed care program or the child health plan program; |
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(B) is served by three or fewer managed care |
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organizations; and |
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(C) is served by a managed care organization that |
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provides services to more than 40 percent of recipients in the |
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service delivery area under the STAR + PLUS Medicaid managed |
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program or enrollees in the service delivery area under the child |
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health plan program. |
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(e) On the conclusion of a pilot program, the commission: |
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(1) shall evaluate the strengths and weaknesses of the |
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program and determine, based on the commission's evaluation, the |
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feasibility of expanding the program or implementing elements of |
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the program statewide; and |
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(2) if the commission determines it feasible and |
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likely to result in the effective provision of medical assistance |
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to recipients statewide, shall, not later than December 31, 2018, |
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submit a report to the governor and the legislature that makes |
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recommendations regarding improved policies and procedures with |
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statewide applicability. |
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(f) This section expires September 1, 2019. |
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SECTION 2. Section 316.001, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 316.001. AUTHORITY TO ESTABLISH HEALTH CARE |
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COLLABORATIVE. A public hospital created under Subtitle C or D, a |
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facility that is owned or operated by a public or not-for-profit |
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hospital and that includes an academic health center, or a hospital |
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district created under general or special law may form and sponsor a |
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nonprofit health care collaborative that is certified under Chapter |
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848, Insurance Code, or is otherwise exempt from obtaining a |
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certificate of authority or determination of approval under Section |
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848.002, Insurance Code. |
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SECTION 3. 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 4. This Act takes effect September 1, 2013. |