84R8755 ADM-F
 
  By: Naishtat H.B. No. 3672
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to expedited credentialing for certain licensed clinical
  social workers under the Medicaid managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 533, Government Code, is amended by
  adding Subchapter G to read as follows:
  SUBCHAPTER G. EXPEDITED CREDENTIALING PROCESS
  FOR CERTAIN LICENSED CLINICAL SOCIAL WORKERS
         Sec. 533.121.  DEFINITIONS. In this subchapter:
               (1)  "Applicant licensed clinical social worker" means
  a licensed clinical social worker applying for expedited
  credentialing under this subchapter.
               (2)  "Licensed clinical social worker" means an
  individual licensed by the Texas State Board of Social Worker
  Examiners as a licensed clinical social worker.
               (3)  "Social work medical group" means:
                     (A)  a single legal entity owned by two or more
  licensed clinical social workers;
                     (B)  a professional association composed of
  licensed clinical social workers; or
                     (C)  any other entity composed of licensed
  clinical social workers.
         Sec. 533.122.  APPLICABILITY. This subchapter applies only
  to a licensed clinical social worker who joins an established
  social work medical group that has a current contract in force with
  a managed care organization.
         Sec. 533.123.  ELIGIBILITY REQUIREMENTS. To qualify for
  expedited credentialing under this subchapter and payment under
  Section 533.124, an applicant licensed clinical social worker must:
               (1)  be licensed in this state by, and in good standing
  with, the Texas State Board of Social Worker Examiners;
               (2)  submit all necessary documentation and other
  information required by the managed care organization to enable the
  organization to begin the credentialing process required by the
  organization to include a licensed clinical social worker as a
  provider under the organization's provider network; and
               (3)  agree to comply with the terms of the managed care
  organization's participating provider contract currently in force
  with the applicant licensed clinical social worker's established
  social work medical group.
         Sec. 533.124.  PAYMENT OF APPLICANT LICENSED CLINICAL SOCIAL
  WORKER DURING CREDENTIALING PROCESS. On submission by the
  applicant licensed clinical social worker of the information
  required by the managed care organization under Section 533.123(2),
  and for payment purposes only, the organization shall treat the
  applicant licensed clinical social worker as if the licensed
  clinical social worker were a participating provider in the
  organization's provider network when the applicant licensed
  clinical social worker provides services to recipients under the
  managed care plan, including:
               (1)  authorizing the applicant licensed clinical
  social worker to collect copayments from the recipients; and
               (2)  making payments to the applicant licensed clinical
  social worker.
         Sec. 533.125.  DIRECTORY ENTRIES.  Pending the approval of
  an application submitted under Section 533.124, the managed care
  plan may exclude the applicant licensed clinical social worker from
  the managed care plan's directory of participating licensed
  clinical social workers, the managed care plan's website listing of
  participating licensed clinical social workers, or any other
  listing of participating licensed clinical social workers.
         Sec. 533.126.  EFFECT OF FAILURE TO MEET CREDENTIALING
  REQUIREMENTS. If, on completion of the credentialing process, the
  managed care organization determines that the applicant licensed
  clinical social worker does not meet the organization's
  credentialing requirements:
               (1)  the managed care organization may recover from the
  applicant licensed clinical social worker or the licensed clinical
  social worker's social work medical group an amount equal to the
  difference between payments for in-network benefits and
  out-of-network benefits; and
               (2)  the applicant licensed clinical social worker or
  the licensed clinical social worker's social work medical group may
  retain any copayments collected or in the process of being
  collected as of the date of the organization's determination.
         Sec. 533.127.  RECIPIENT HELD HARMLESS. A recipient under a
  managed care plan is not responsible and shall be held harmless for
  any portion of the licensed clinical social worker's fee that is not
  paid or reimbursed by the recipient's managed care plan other than
  any cost-sharing requirement imposed under the plan.
         Sec.  533.128.  LIMITATION ON MANAGED CARE ORGANIZATION
  LIABILITY.  A managed care organization that complies with this
  subchapter is not subject to liability for damages arising out of or
  in connection with, directly or indirectly, the payment by the
  organization of an applicant licensed clinical social worker as if
  the licensed clinical social worker were a participating provider
  in the organization's provider network.
         SECTION 2.  The change in law made by this Act applies only
  to credentialing of a licensed clinical social worker under a
  contract entered into or renewed by a medical group and an issuer of
  a Medicaid managed care plan on or after the effective date of this
  Act. A contract entered into or renewed before the effective date
  of this Act is governed by the law in effect immediately before that
  date, and that law is continued in effect for that purpose.
         SECTION 3.  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 4.  This Act takes effect September 1, 2015.