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A BILL TO BE ENTITLED
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AN ACT
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relating to changes to and the setting of fees, charges, and rates |
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under the Medicaid and child health plan programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02112 to read as follows: |
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Sec. 531.02112. PROCEDURE FOR IMPLEMENTING CHANGES TO |
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PAYMENT RATES UNDER MEDICAID AND CHILD HEALTH PLAN PROGRAM. (a) In |
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adopting rules and standards related to the determination of fees, |
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charges, and rates for payments under Medicaid and the child health |
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plan program, the executive commissioner, in consultation with the |
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advisory committee established under Subsection (b), shall adopt |
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rules to ensure that changes to the fees, charges, and rates are |
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implemented in accordance with this section and in a way that |
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minimizes administrative complexity and financial uncertainty. |
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(b) The executive commissioner shall establish an advisory |
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committee of nine members to provide input for the adoption of rules |
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and standards that comply with this section. The advisory |
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committee is composed of representatives from managed care |
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organizations and providers, including physicians, under Medicaid |
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and the child health plan program. The advisory committee is |
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abolished on the date the rules that comply with this section are |
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adopted. This subsection expires September 1, 2021. |
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(c) Before implementing a change to the fees, charges, and |
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rates for payments under Medicaid or the child health plan program, |
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the commission shall: |
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(1) before or at the time notice of the proposed change |
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is published under Subdivision (2), notify managed care |
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organizations and the entity serving as the state's Medicaid claims |
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administrator under the Medicaid fee-for-service delivery model of |
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the proposed change; |
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(2) publish notice of the proposed change: |
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(A) for public comment in the Texas Register for |
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a period of not less than 30 days; and |
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(B) on the commission's and state Medicaid claims |
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administrator's Internet websites during the period specified |
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under Paragraph (A); |
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(3) publish notice of a final determination to make |
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the proposed change: |
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(A) in the Texas Register for a period of not less |
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than 30 days before the change becomes effective; and |
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(B) on the commission's and state Medicaid claims |
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administrator's Internet websites during the period specified |
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under Paragraph (A); and |
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(4) provide managed care organizations and the entity |
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serving as the state's Medicaid claims administrator under the |
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Medicaid fee-for-service delivery model with a period of not less |
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than 30 days before the effective date of the final change to make |
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any necessary administrative or systems adjustments to implement |
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the change. |
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(d) If changes to the fees, charges, or rates for payments |
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under Medicaid or the child health plan program are mandated by the |
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legislature or federal government on a date that does not fall |
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within the time frame for the implementation of those changes |
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described by this section, the commission shall: |
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(1) prorate the amount of the change over the fee, |
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charge, or rate period; and |
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(2) publish the proration schedule described by |
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Subdivision (1) in the Texas Register along with the notice |
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provided under Subsection (c)(3). |
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(e) This section does not apply to changes to the fees, |
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charges, or rates for payments made to a nursing facility. |
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SECTION 2. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0059 to read as follows: |
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Sec. 533.0059. RESTRICTIONS ON CERTAIN REIMBURSEMENT RATE |
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REDUCTIONS. (a) In this section, "across-the-board provider |
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reimbursement rate reduction" means a provider reimbursement rate |
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reduction proposed by a managed care organization that the |
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commission determines is likely to affect more than 50 percent of a |
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particular type of provider participating in the organization's |
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provider network during the 12-month period following |
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implementation of the proposed reduction, regardless of whether: |
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(1) the organization limits the proposed reduction to |
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specific service areas or provider types; or |
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(2) the affected providers are likely to experience |
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differing percentages of rate reductions or amounts of lost revenue |
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as a result of the proposed reduction. |
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(b) Except as provided by Subsection (e), a managed care |
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organization that contracts with the commission to provide health |
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care services to recipients may not implement a significant, as |
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determined by the commission, across-the-board provider |
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reimbursement rate reduction unless the organization: |
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(1) at least 90 days before the proposed rate |
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reduction is to take effect: |
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(A) provides the commission and affected |
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providers with written notice of the proposed rate reduction; and |
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(B) makes a good faith effort to negotiate the |
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reduction with the affected providers; and |
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(2) receives prior approval from the commission, |
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subject to Subsection (c). |
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(c) An across-the-board provider reimbursement rate |
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reduction is considered to have received the commission's prior |
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approval for purposes of Subsection (b)(2) unless the commission |
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issues a written statement of disapproval not later than the 45th |
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day after the date the commission receives notice of the proposed |
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rate reduction from the managed care organization under Subsection |
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(b)(1)(A). |
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(d) If a managed care organization proposes an |
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across-the-board provider reimbursement rate reduction in |
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accordance with this section and subsequently rejects alternative |
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rate reductions suggested by an affected provider, the organization |
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must provide the provider with written notice of that rejection, |
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including an explanation of the grounds for the rejection, before |
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implementing any rate reduction. |
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(e) This section does not apply to rate reductions that are |
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implemented because of reductions to the Medicaid fee schedule or |
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cost containment initiatives that are specifically directed by the |
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legislature and implemented by the commission. |
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SECTION 3. Section 2, Chapter 1117 (H.B. 3523), Acts of the |
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84th Legislature, Regular Session, 2015, which amended Section |
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533.00251(c), Government Code, effective September 1, 2021, is |
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repealed. |
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SECTION 4. Not later than December 31, 2019, the executive |
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commissioner of the Health and Human Services Commission shall |
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establish the advisory committee as required by Section |
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531.02112(b), Government Code, as added by this Act. |
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SECTION 5. (a) Not later than December 31, 2020, the |
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executive commissioner of the Health and Human Services Commission |
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shall adopt the rules required to implement Section 531.02112, |
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Government Code, as added by this Act. |
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(b) The procedure for implementing changes to payment rates |
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required by Section 531.02112, Government Code, as added by this |
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Act, applies only to a change to a fee, charge, or rate that takes |
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effect on or after January 1, 2021. |
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SECTION 6. 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 7. This Act takes effect September 1, 2019. |