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A BILL TO BE ENTITLED
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AN ACT
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relating to the accreditation of and a recipient's enrollment in a |
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Medicaid managed care plan. |
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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 533.0031 to read as follows: |
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Sec. 533.0031. MEDICAID MANAGED CARE PLAN ACCREDITATION. |
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Notwithstanding Section 533.004 or any other law requiring the |
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commission to contract with a managed care organization to provide |
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health care services to recipients, the commission may contract |
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with a managed care organization to provide those services only if |
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the managed care plan offered by the organization is accredited by a |
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nationally recognized accrediting entity. |
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SECTION 2. Section 533.0075, Government Code, is amended to |
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read as follows: |
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Sec. 533.0075. RECIPIENT ENROLLMENT. (a) The commission |
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shall: |
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(1) encourage recipients to choose appropriate |
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managed care plans and primary health care providers by: |
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(A) providing initial information to recipients |
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and providers in a region about the need for recipients to choose |
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plans and providers not later than the 90th day before the date on |
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which a managed care organization plans to begin to provide health |
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care services to recipients in that region through managed care; |
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(B) providing follow-up information before |
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assignment of plans and providers and after assignment, if |
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necessary, to recipients who delay in choosing plans and providers |
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after receiving the initial information under Paragraph (A); and |
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(C) allowing plans and providers to provide |
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information to recipients or engage in marketing activities under |
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marketing guidelines established by the commission under Section |
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533.008 after the commission approves the information or |
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activities; |
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(2) consider the following factors in assigning |
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managed care plans and primary health care providers to recipients |
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who fail to choose plans and providers: |
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(A) the importance of maintaining existing |
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provider-patient and physician-patient relationships, including |
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relationships with specialists, public health clinics, and |
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community health centers; |
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(B) to the extent possible, the need to assign |
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family members to the same providers and plans; and |
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(C) geographic convenience of plans and |
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providers for recipients; |
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(3) retain responsibility for enrollment and |
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disenrollment of recipients in managed care plans, except that the |
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commission may delegate the responsibility to an independent |
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contractor who receives no form of payment from, and has no |
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financial ties to, any managed care organization; |
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(4) develop and implement an expedited process for |
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determining eligibility for and enrolling pregnant women and |
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newborn infants in managed care plans; and |
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(5) ensure immediate access to prenatal services and |
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newborn care for pregnant women and newborn infants enrolled in |
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managed care plans, including ensuring that a pregnant woman may |
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obtain an appointment with an obstetrical care provider for an |
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initial maternity evaluation not later than the 30th day after the |
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date the woman applies for Medicaid. |
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(b) The commission shall, notwithstanding any other law, |
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implement an automatic enrollment process under which an applicant |
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determined eligible to receive Medicaid benefits through managed |
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care is automatically enrolled, at the time the applicant is |
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determined eligible for those benefits, in a Medicaid managed care |
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plan chosen by the applicant or, if the applicant fails to choose a |
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plan, by the commission. |
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SECTION 3. Section 533.0076(c), Government Code, is amended |
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to read as follows: |
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(c) The commission shall allow a recipient who is enrolled |
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in a managed care plan under this chapter to disenroll from that |
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plan and enroll in another managed care plan[:
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[(1)] at any time for cause in accordance with federal |
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law[; and
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[(2)
once for any reason after the periods described
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by Subsections (a) and (b)]. |
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SECTION 4. Section 533.0025(h), Government Code, is |
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repealed. |
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SECTION 5. Section 533.0031, Government Code, as added by |
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this Act, applies to a contract entered into or renewed on or after |
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the effective date of this Act. A contract entered into or renewed |
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before that date is governed by the law in effect immediately before |
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the effective date of this Act, and that law is continued in effect |
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for that purpose. |
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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. |