Amend CSSB 1096 (senate committee report) as follows:
(1) In SECTION 1 of the bill, in added Section 533.005(a)(23)(L)(i), Government Code (page 5, lines 67-68), strike "imposed under the vendor drug program" and substitute "or a prior authorization imposed by the commission to minimize the opportunity for waste, fraud, or abuse".
(2) In SECTION 1 of the bill, in added Section 533.005(a) (23)(L)(i), Government Code (page 5, line 69), strike "medically fragile".
(3) In SECTION 1 of the bill, in added Section 533.005(a) (23)(L)(i), Government Code (page 5, line 69), between "child" and "for", insert "enrolled in the STAR Kids managed care program".
(4) Add the following appropriately numbered SECTION to the bill and renumber subsequent SECTIONS of the bill accordingly:
SECTION ____. Section 533.00253, Government Code, is amended by adding Subsection (i) to read as follows:
(i) The commission, at least once every two years, shall conduct a utilization review on a sample of cases for children enrolled in the STAR Kids managed care program to ensure that all imposed clinical prior authorizations are based on publicly available clinical criteria and are not being used to negatively impact a recipient's access to care.