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A BILL TO BE ENTITLED
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AN ACT
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relating to the delivery of certain Medicaid managed care benefits |
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and reimbursement rates for certain of those services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 533.00251(c) and (d), Government Code, |
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are amended to read as follows: |
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(c) Subject to Section 533.0025 and notwithstanding any |
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other law, the commission, in consultation with the advisory |
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committee, shall provide benefits under the medical assistance |
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program to recipients who reside in nursing facilities through the |
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STAR + PLUS Medicaid managed care program. In implementing this |
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subsection, the commission shall ensure: |
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(1) that, subject to Section 533.002511, the |
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commission is responsible for setting the minimum reimbursement |
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rate paid to a nursing facility under the managed care program, |
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including the staff rate enhancement paid to a nursing facility |
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that qualifies for the enhancement; |
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(2) that a nursing facility is paid not later than the |
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10th day after the date the facility submits a clean claim; |
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(3) the appropriate utilization of services |
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consistent with criteria adopted by the commission; |
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(4) a reduction in the incidence of potentially |
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preventable events and unnecessary institutionalizations; |
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(5) that a managed care organization providing |
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services under the managed care program provides discharge |
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planning, transitional care, and other education programs to |
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physicians and hospitals regarding all available long-term care |
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settings; |
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(6) that a managed care organization providing |
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services under the managed care program: |
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(A) assists in collecting applied income from |
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recipients; and |
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(B) provides payment incentives to nursing |
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facility providers that reward reductions in preventable acute care |
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costs and encourage transformative efforts in the delivery of |
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nursing facility services, including efforts to promote a |
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resident-centered care culture through facility design and |
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services provided; |
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(7) the establishment of a portal that is in |
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compliance with state and federal regulations, including standard |
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coding requirements, through which nursing facility providers |
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participating in the STAR + PLUS Medicaid managed care program may |
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submit claims to any participating managed care organization; |
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(8) that rules and procedures relating to the |
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certification and decertification of nursing facility beds under |
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the medical assistance program are not affected; and |
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(9) that a managed care organization providing |
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services under the managed care program, to the greatest extent |
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possible, offers nursing facility providers access to: |
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(A) acute care professionals; and |
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(B) telemedicine, when feasible and in |
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accordance with state law, including rules adopted by the Texas |
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Medical Board. |
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(d) Subject to Subsection (e), the commission shall ensure |
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that a nursing facility provider authorized to provide services |
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under the medical assistance program on September 1, 2015 [2013], |
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is allowed to participate in the STAR + PLUS Medicaid managed care |
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program through August 31, 2019 [2017]. |
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SECTION 2. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.002511 to read as follows: |
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Sec. 533.002511. MINIMUM NURSING FACILITY REIMBURSEMENT |
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RATES FOR RECIPIENTS ALSO ELIGIBLE FOR MEDICARE. A contract |
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between a managed care organization and the commission for the |
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organization to provide health care services to recipients must |
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contain a requirement that the minimum reimbursement rate paid by |
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the organization to a nursing facility for services provided to a |
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recipient who is also eligible to receive services under the |
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Medicare program is the prevailing reimbursement rate for nursing |
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facilities under the Medicare program. |
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SECTION 3. Section 533.005(a-1), Government Code, is |
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amended to read as follows: |
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(a-1) The requirements imposed by Subsections (a)(23)(A), |
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(B), and (C) do not apply, and may not be enforced, on and after |
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August 31, 2019 [2018]. |
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SECTION 4. 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 5. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |