| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to allowing the parents or guardians of certain medically |
|
|
dependent children to opt out of the STAR Kids managed care program |
|
|
under Medicaid. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 533.0025(b), Government Code, is amended |
|
|
to read as follows: |
|
|
(b) Except as otherwise provided by this section and Section |
|
|
533.002531 and notwithstanding any other law, the commission shall |
|
|
provide Medicaid acute care services through the most |
|
|
cost-effective model of Medicaid capitated managed care as |
|
|
determined by the commission. The commission shall require |
|
|
mandatory participation in a Medicaid capitated managed care |
|
|
program for all persons eligible for Medicaid acute care benefits, |
|
|
but may implement alternative models or arrangements, including a |
|
|
traditional fee-for-service arrangement, if the commission |
|
|
determines the alternative would be more cost-effective or |
|
|
efficient. |
|
|
SECTION 2. Sections 533.00253(b) and (d), Government Code, |
|
|
are amended to read as follows: |
|
|
(b) Except as provided by Section 533.002531 and subject |
|
|
[Subject] to Section 533.0025, the commission shall operate[, in
|
|
|
consultation with the Children's Policy Council established under
|
|
|
Section 22.035, Human Resources Code, establish] a mandatory STAR |
|
|
Kids capitated managed care program tailored to provide Medicaid |
|
|
benefits to children with disabilities. The managed care program |
|
|
[developed] under this section must: |
|
|
(1) provide Medicaid benefits that are customized to |
|
|
meet the health care needs of recipients under the program through a |
|
|
defined system of care; |
|
|
(2) better coordinate care of recipients under the |
|
|
program; |
|
|
(3) improve the health outcomes of recipients; |
|
|
(4) improve recipients' access to health care |
|
|
services; |
|
|
(5) achieve cost containment and cost efficiency; |
|
|
(6) reduce the administrative complexity of |
|
|
delivering Medicaid benefits; |
|
|
(7) reduce the incidence of unnecessary |
|
|
institutionalizations and potentially preventable events by |
|
|
ensuring the availability of appropriate services and care |
|
|
management; |
|
|
(8) require a health home; and |
|
|
(9) coordinate and collaborate with long-term care |
|
|
service providers and long-term care management providers, if |
|
|
recipients are receiving long-term services and supports outside of |
|
|
the managed care organization. |
|
|
(d) The commission shall provide Medicaid benefits through |
|
|
the STAR Kids managed care program operated [established] under |
|
|
this section to children who are receiving benefits under the |
|
|
medically dependent children (MDCP) waiver program, except that the |
|
|
parent or guardian of a medically dependent child may opt the child |
|
|
out of receiving benefits through the STAR Kids managed care |
|
|
program in accordance with Section 533.002531. The commission |
|
|
shall ensure that the STAR Kids managed care program provides all of |
|
|
the benefits provided under the medically dependent children (MDCP) |
|
|
waiver program to the extent necessary to implement this |
|
|
subsection. |
|
|
SECTION 3. Subchapter A, Chapter 533, Government Code, is |
|
|
amended by adding Section 533.002531 to read as follows: |
|
|
Sec. 533.002531. STAR KIDS MANAGED CARE PROGRAM: OPT-OUT |
|
|
ALTERNATIVE. (a) The commission shall provide a process by which |
|
|
the parent or guardian of a child receiving benefits under the |
|
|
medically dependent children (MDCP) waiver program may opt the |
|
|
medically dependent child out of receiving benefits through the |
|
|
STAR Kids managed care program operated under Section 533.00253 and |
|
|
elect instead to have the child receive benefits through a |
|
|
traditional fee-for-service arrangement. The commission shall |
|
|
ensure that any transition in the delivery of benefits to a child |
|
|
under this section is completed in a manner that protects |
|
|
continuity of care. |
|
|
(b) The parent or guardian of a medically dependent child |
|
|
who opts the child out of receiving benefits through the STAR Kids |
|
|
managed care program may not opt to return the child to receiving |
|
|
benefits through the STAR Kids managed care program or any other |
|
|
capitated managed care model for a period of at least two years. |
|
|
(c) If a parent or guardian of a medically dependent child |
|
|
opts the child out of receiving benefits through the STAR Kids |
|
|
managed care program, the commission shall monitor: |
|
|
(1) whether, after the child transitioned to the |
|
|
traditional fee-for-service arrangement, the child's: |
|
|
(A) utilization of benefits increased; and |
|
|
(B) wellness improved; and |
|
|
(2) the satisfaction of the child's parent or guardian |
|
|
with the provision of benefits under the fee-for-service |
|
|
arrangement. |
|
|
(d) To the same extent required under Section 533.00253(e), |
|
|
the commission shall ensure that there is a plan for transitioning |
|
|
the provision of Medicaid benefits to recipients 21 years of age or |
|
|
older from the fee-for-service arrangement provided under this |
|
|
section to the STAR + PLUS Medicaid managed care program that |
|
|
protects continuity of care. The plan must ensure that the |
|
|
coordination begins when the recipient reaches 18 years of age. |
|
|
SECTION 4. 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 5. This Act takes effect September 1, 2019. |