86R3443 KKR-D

By: Guillen H.B. No. 4556

A BILL TO BE ENTITLED

AN ACT

relating to the delivery of certain transportation services under Medicaid and certain other health and human services programs.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 531.02414(a), Government Code, is amended by amending Subdivision (1) and adding Subdivisions (1-a) and (3) to read as follows:

(1) "Full-risk regional transportation broker" means a regional contracted broker that is paid a capitated rate for providing medical transportation program services to program participants.

(1-a) "Medical transportation program" means the program that provides nonemergency transportation services to and from covered health care services, based on medical necessity, to recipients under Medicaid, the children with special health care needs program, and the transportation for indigent cancer patients program, who have no other means of transportation.

(3) "Rural or urban transit district" means a transit district created under Chapter 458, Transportation Code.

SECTION 2. Section 531.02414, Government Code, is amended by amending Subsection (f) and adding Subsection (k) to read as follows:

(f) Except as provided by Subsection (k), the [The] commission shall require compliance with the rules adopted under Subsection (e) in any contract entered into with a regional contracted broker to provide nonemergency transportation services under the medical transportation program.

(k) A full-risk regional transportation broker may establish a preferred transportation provider network under which medical transportation program services are provided exclusively through a rural or urban transit district, subject to rules adopted under Subdivision (1). Rules adopted under Subsection (e) do not apply to providers under a preferred transportation provider network, and the commission may not regulate those providers. The executive commissioner shall adopt rules relating to the establishment of a preferred transportation provider network. The rules adopted under this subsection must provide that a full-risk regional transportation broker:

(1) may provide medical transportation program services through another provider with whom the broker contracts if a network provider is not able to provide the services to a person at a particular time; and

(2) may not regulate a transit district's motor vehicles or motor vehicle operators.

SECTION 3. Section 533.00257, Government Code, is amended by amending Subsections (d) and (g) and adding Subsections (m) and (n) to read as follows:

(d) A managed transportation organization that participates in the medical transportation program must attempt to contract with medical transportation providers that:

(1) are considered significant traditional providers, as defined by rule by the executive commissioner;

(2) except as provided by Subsections (m) and (n), meet the minimum quality and efficiency measures required under Subsection (g) and other requirements that may be imposed by the managed transportation organization; and

(3) agree to accept the prevailing contract rate of the managed transportation organization.

(g) Except as provided by Subsections (m) and (n), the [The] commission shall require that managed transportation organizations and providers participating in the medical transportation program meet minimum quality and efficiency measures as determined by the commission.

(m) A managed transportation organization other than an organization described by Subsection (a)(1)(A) may establish a preferred transportation provider network under which medical transportation program services are provided exclusively through a rural or urban transit district, subject to rules adopted under Subdivision (1). Minimum quality and efficiency measures under Subsection (g) do not apply to providers under a preferred transportation provider network, and the commission may not regulate those providers. The executive commissioner shall adopt rules relating to the establishment of a preferred transportation provider network. The rules adopted under this subsection must provide that a managed transportation organization:

(1) may provide medical transportation program services through another provider with whom the organization contracts if a network provider is not able to provide the services to a person at a particular time; and

(2) may not regulate a transit district's motor vehicles or motor vehicle operators.

(n) The commission may not impose minimum quality or efficiency measures on, or otherwise regulate, a managed transportation organization described by Subsection (a)(1)(A), provided that medical transportation program services are provided exclusively through the organization, subject to rules adopted under this section. The executive commissioner shall adopt rules that allow a managed transportation organization described by Subsection (a)(1)(A) to provide medical transportation program services through another provider with whom the organization contracts if the organization is not otherwise able to provide the services to a person at a particular time.

SECTION 4. As soon as practicable after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall adopt rules as necessary to implement the changes in law made by this Act.

SECTION 5. 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 6. This Act takes effect September 1, 2019.