85R9831 KFF-D

By: Muñoz, Jr. H.B. No. 1770

A BILL TO BE ENTITLED

AN ACT

relating to establishing caseload standards for certain care coordinators under the Medicaid managed care program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter A, Chapter 533, Government Code, is amended by adding Section 533.00292 to read as follows:

Sec. 533.00292. CARE COORDINATOR CASELOAD STANDARDS. (a) In this section:

(1) "Care coordination" means assisting recipients to develop a plan of care, including a service plan, that meets the recipient's needs and coordinating the provision of Medicaid benefits in a manner that is consistent with the plan of care. The term is synonymous with "case management," "service coordination," and "service management."

(2) "Care coordinator" means a person, including a case manager, engaged by a Medicaid managed care organization to provide care coordination benefits.

(b) The executive commissioner by rule shall establish caseload standards for care coordinators providing care coordination under the STAR+PLUS home and community-based services supports (HCBS) program.

(c) The executive commissioner by rule may, if the executive commissioner determines it appropriate, establish caseload standards for care coordinators providing care coordination under Medicaid programs other than the STAR+PLUS home and community-based services supports (HCBS) program.

(d) In determining whether to establish caseload standards for a Medicaid program under Subsection (c), the executive commissioner shall consider whether implementing the standards would improve:

(1) Medicaid managed care organization contract compliance;

(2) the quality and consistency of care coordination provided under the program; and

(3) transparency regarding the availability of care coordination benefits to recipients and interested stakeholders.

SECTION 2. 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 3. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2017.