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A BILL TO BE ENTITLED
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AN ACT
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relating to providing access to local health departments and |
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certain health service regional offices under the Medicaid managed |
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care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.001, Government Code, is amended by |
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adding Subdivisions (3-a) and (3-b) to read as follows: |
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(3-a) "Health service regional office" means an office |
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located in a public health region and administered by a regional |
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director under Section 121.007, Health and Safety Code. |
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(3-b) "Local health department" means a local health |
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department established under Subchapter D, Chapter 121, Health and |
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Safety Code. |
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SECTION 2. Section 533.006(a), Government Code, is amended |
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to read as follows: |
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(a) The commission shall require that each managed care |
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organization that contracts with the commission to provide health |
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care services to recipients in a region: |
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(1) seek participation in the organization's provider |
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network from: |
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(A) each health care provider in the region who |
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has traditionally provided care to recipients; |
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(B) each hospital in the region that has been |
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designated as a disproportionate share hospital under Medicaid; |
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[and] |
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(C) each specialized pediatric laboratory in the |
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region, including those laboratories located in children's |
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hospitals; and |
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(D) each local health department in the region |
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and each health service regional office acting in the capacity of a |
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local health department in the region; and |
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(2) include in its provider network for not less than |
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three years: |
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(A) each health care provider in the region who: |
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(i) previously provided care to Medicaid |
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and charity care recipients at a significant level as prescribed by |
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the commission; |
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(ii) agrees to accept the prevailing |
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provider contract rate of the managed care organization; and |
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(iii) has the credentials required by the |
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managed care organization, provided that lack of board |
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certification or accreditation by The Joint Commission may not be |
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the sole ground for exclusion from the provider network; |
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(B) each accredited primary care residency |
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program in the region; [and] |
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(C) each disproportionate share hospital |
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designated by the commission as a statewide significant traditional |
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provider; and |
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(D) each local health department in the region |
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and each health service regional office acting in the capacity of a |
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local health department in the region. |
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SECTION 3. Section 533.0061(a), Government Code, is amended |
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to read as follows: |
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(a) The commission shall establish minimum provider access |
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standards for the provider network of a managed care organization |
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that contracts with the commission to provide health care services |
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to recipients. The access standards must ensure that a managed |
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care organization provides recipients sufficient access to: |
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(1) preventive care; |
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(2) primary care; |
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(3) specialty care; |
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(4) after-hours urgent care; |
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(5) chronic care; |
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(6) long-term services and supports; |
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(7) nursing services; |
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(8) therapy services, including services provided in a |
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clinical setting or in a home or community-based setting; [and] |
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(9) services provided by each local health department |
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in the region and each health service regional office acting in the |
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capacity of a local health department in the region; and |
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(10) any other services identified by the commission. |
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SECTION 4. (a) The Health and Human Services Commission |
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shall, in a contract between the commission and a managed care |
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organization under Chapter 533, Government Code, that is entered |
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into or renewed on or after the effective date of this Act, require |
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that the managed care organization comply with Section 533.006, |
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Government Code, as amended by this Act. |
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(b) The Health and Human Services Commission shall seek to |
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amend contracts entered into with managed care organizations under |
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Chapter 533, Government Code, before the effective date of this Act |
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to require those managed care organizations to comply with Section |
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533.006, Government Code, as amended by this Act. To the extent of |
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a conflict between that section and a provision of a contract with a |
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managed care organization entered into before the effective date of |
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this Act, the contract provision prevails. |
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SECTION 5. 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 6. This Act takes effect September 1, 2019. |