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A BILL TO BE ENTITLED
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AN ACT
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relating to care coordination under the Medicaid managed care |
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program. |
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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 533.00291 to read as follows: |
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Sec. 533.00291. CARE COORDINATION BENEFITS. (a) In this |
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section, "care coordination" means assisting recipients to develop |
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a plan of care, including a service plan, that meets the recipient's |
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needs and coordinating the provision of Medicaid benefits in a |
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manner that is consistent with the plan of care. The term is |
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synonymous with "case management," "service coordination," and |
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"service management." |
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(b) The commission shall streamline and clarify the |
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provision of care coordination benefits across Medicaid programs |
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and services for recipients receiving benefits under a managed care |
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delivery model. In streamlining and clarifying the provision of |
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care coordination benefits under this section, the commission |
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shall, at a minimum, include requirements in Medicaid managed care |
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contracts that are designed to: |
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(1) subject to Subsection (c), establish a process for |
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determining and designating a single entity as the primary entity |
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responsible for a recipient's care coordination; |
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(2) evaluate and eliminate duplicative services |
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intended to achieve recipient care coordination, including care |
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coordination or related benefits provided: |
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(A) by a Medicaid managed care organization; |
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(B) by a recipient's medical or health home; |
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(C) through a disease management program |
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provided by a Medicaid managed care organization; |
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(D) by a provider of targeted case management and |
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psychiatric rehabilitation services; and |
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(E) through a program of case management for |
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high-risk pregnant women and high-risk children established under |
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Section 22.0031, Human Resources Code; |
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(3) evaluate and, if the commission determines it |
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appropriate, modify the capitation rate paid to Medicaid managed |
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care organizations to account for the provision of care |
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coordination benefits by a person not affiliated with the |
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organization; and |
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(4) establish and use a consistent set of terms for |
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care coordination provided under a managed care delivery model. |
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(c) In establishing a process under Subsection (b)(1), the |
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commission shall ensure that: |
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(1) for a recipient who receives targeted case |
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management and psychiatric rehabilitation services through a local |
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mental health authority, the default entity to act as the primary |
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entity responsible for the recipient's care coordination under |
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Subsection (b)(1) is the local mental health authority; and |
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(2) for recipients other than those described by |
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Subdivision (1), the process includes an evaluation process |
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designed to identify the provider that would best and most |
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cost-effectively meet the care coordination needs of a recipient. |
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SECTION 2. 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 3. 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, 2017. |