85R12082 KKR-F
 
  By: Paddie H.B. No. 3675
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the provision of eye health care by certain
  professionals and institutions as providers in the Medicaid managed
  care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 32.072(a), Human Resources Code, is
  amended to read as follows:
         (a)  Notwithstanding any other law, a recipient of medical
  assistance is entitled to:
               (1)  select an ophthalmologist or therapeutic
  optometrist who is a medical assistance provider to provide eye
  health care services, other than surgery, that are within the scope
  of:
                     (A)  services provided under the medical
  assistance program; and
                     (B)  the professional specialty practice for
  which the ophthalmologist or therapeutic optometrist is licensed
  [and credentialed]; and
               (2)  have direct access to the selected ophthalmologist
  or therapeutic optometrist for the provision of the nonsurgical
  services without any requirement that the patient or
  ophthalmologist or therapeutic optometrist [to] obtain:
                     (A)  a referral from a primary care physician or
  other gatekeeper or health care coordinator; or
                     (B)  any other prior authorization or
  precertification.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.021191 to read as follows:
         Sec. 531.021191.  MEDICAID ENROLLMENT OF CERTAIN EYE HEALTH
  CARE PROVIDERS. (a)  This section applies only to:
               (1)  an optometrist who is licensed by the Texas
  Optometry Board;
               (2)  a therapeutic optometrist who is licensed by the
  Texas Optometry Board;
               (3)  an ophthalmologist who is licensed by the Texas
  Medical Board; and
               (4)  an institution of higher education that provides
  an accredited program for:
                     (A)  training as a Doctor of Optometry or an
  optometrist residency; or
                     (B)  training as an ophthalmologist or an
  ophthalmologist residency.
         (b)  The commission may not prevent a provider to whom this
  section applies from enrolling as a Medicaid provider if the
  provider:
               (1)  either:
                     (A)  joins an established practice of a health
  care provider or provider group that has a contract with a managed
  care organization to provide health care services to recipients
  under Chapter 533; or
                     (B)  is employed by or otherwise compensated for
  providing training at an institution of higher education described
  by Subsection (a)(4);
               (2)  applies to be an enrolled provider under the
  Medicaid program;
               (3)  if applicable, complies with the requirements of
  the contract between the provider or the provider's group and the
  applicable managed care organization; and
               (4)  complies with all other applicable requirements
  related to being a Medicaid provider.
         (c)  The commission may not prevent an institution of higher
  education from enrolling as a Medicaid provider if the institution:
               (1)  has a contract with a managed care organization to
  provide health care services to recipients under Chapter 533;
               (2)  applies to be an enrolled provider under the
  Medicaid program;
               (3)  complies with the requirements of the contract
  between the provider and the applicable managed care organization;
  and
               (4)  complies with all other applicable requirements
  related to being a Medicaid provider.
         SECTION 3.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0067 to read as follows:
         Sec. 533.0067.  EYE HEALTH CARE SERVICE PROVIDERS. Subject
  to Section 32.047, Human Resources Code, but notwithstanding any
  other law, the commission shall require that each managed care
  organization that contracts with the commission under any Medicaid
  managed care model or arrangement to provide health care services
  to recipients in a region include in the organization's provider
  network each optometrist, therapeutic optometrist, and
  ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
  and an institution of higher education described by Section
  531.021191(a)(4) in the region who:
               (1)  agrees to comply with the terms and conditions of
  the organization;
               (2)  agrees to accept the prevailing provider contract
  rate of the organization; and
               (3)  agrees to abide by the standards of care required
  by the organization.
         SECTION 4.  (a) The Health and Human Services Commission
  shall, in a contract between the commission and a Medicaid managed
  care organization under Chapter 533, Government Code, that is
  entered into or renewed on or after the effective date of this Act,
  require that the managed care organization comply with Section
  533.0067, Government Code, as added by this Act.
         (b)  The Health and Human Services Commission shall seek to
  amend each contract entered into with a Medicaid managed care
  organization under Chapter 533, Government Code, before the
  effective date of this Act to require those managed care
  organizations to comply with Section 533.0067, Government Code, as
  added by this Act. To the extent of a conflict between Section
  533.0067, Government Code, as added by this Act, and a provision of
  a contract with a managed care organization entered into before the
  effective date of this Act, the contract provision prevails.
         SECTION 5.  This Act may not be construed as authorizing or
  requiring implementation of Medicaid managed care delivery models
  in regions in this state in which those models are not used on the
  effective date of this Act for the delivery of Medicaid services.
         SECTION 6.  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 7.  This Act takes effect September 1, 2017.