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A BILL TO BE ENTITLED
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AN ACT
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relating to establishing caseload standards for certain care |
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coordinators under the Medicaid managed care 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 533.00292 to read as follows: |
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Sec. 533.00292. CARE COORDINATOR CASELOAD STANDARDS. (a) |
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In this section: |
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(1) "Care coordination" means assisting recipients to |
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develop a plan of care, including a service plan, that meets the |
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recipient's needs and coordinating the provision of Medicaid |
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benefits in a manner that is consistent with the plan of care. The |
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term is synonymous with "case management," "service coordination," |
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and "service management." |
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(2) "Care coordinator" means a person, including a |
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case manager, engaged by a managed care organization to provide |
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care coordination benefits. |
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(b) The executive commissioner by rule shall establish |
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caseload standards for care coordinators providing care |
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coordination under the STAR+PLUS home and community-based services |
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supports (HCBS) program. |
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(c) The executive commissioner by rule may, if the executive |
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commissioner determines it appropriate, establish caseload |
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standards for care coordinators providing care coordination under |
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Medicaid programs other than the STAR+PLUS home and community-based |
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services supports (HCBS) program. |
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(d) In determining whether to establish caseload standards |
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for a Medicaid program under Subsection (c), the executive |
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commissioner shall consider whether implementing the standards |
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would improve: |
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(1) contract compliance by managed care organizations |
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that contract with the commission under this chapter to provide |
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health care services to recipients; |
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(2) the quality and consistency of care coordination |
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provided under the program; and |
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(3) transparency regarding the availability of care |
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coordination benefits to recipients and interested stakeholders. |
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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, 2019. |