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A BILL TO BE ENTITLED
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AN ACT
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relating to the delivery of Medicaid benefits to certain medically |
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dependent children with private health benefits coverage. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.0025(b), Government Code, is amended |
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to read as follows: |
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(b) Except as otherwise provided by this section and Section |
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32.042421, Human Resources Code, and notwithstanding any other law, |
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the commission shall provide Medicaid acute care services through |
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the most cost-effective model of Medicaid capitated managed care as |
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determined by the commission. The commission shall require |
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mandatory participation in a Medicaid capitated managed care |
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program for all persons eligible for Medicaid acute care benefits, |
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but may implement alternative models or arrangements, including a |
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traditional fee-for-service arrangement, if the commission |
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determines the alternative would be more cost-effective or |
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efficient. |
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SECTION 2. Sections 533.00253(b) and (d), Government Code, |
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are amended to read as follows: |
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(b) Except as provided by Section 32.042421, Human |
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Resources Code, and subject [Subject] to Section 533.0025, the |
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commission shall operate [, in consultation with the Children's
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Policy Council established under Section 22.035, Human Resources
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Code, establish] a mandatory STAR Kids capitated managed care |
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program tailored to provide Medicaid benefits to children with |
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disabilities. The managed care program [developed] under this |
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section must: |
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(1) provide Medicaid benefits that are customized to |
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meet the health care needs of recipients under the program through a |
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defined system of care; |
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(2) better coordinate care of recipients under the |
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program; |
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(3) improve the health outcomes of recipients; |
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(4) improve recipients' access to health care |
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services; |
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(5) achieve cost containment and cost efficiency; |
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(6) reduce the administrative complexity of |
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delivering Medicaid benefits; |
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(7) reduce the incidence of unnecessary |
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institutionalizations and potentially preventable events by |
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ensuring the availability of appropriate services and care |
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management; |
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(8) require a health home; and |
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(9) coordinate and collaborate with long-term care |
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service providers and long-term care management providers, if |
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recipients are receiving long-term services and supports outside of |
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the managed care organization. |
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(d) The commission shall provide Medicaid benefits through |
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the STAR Kids managed care program operated [established] under |
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this section to children who are receiving benefits under the |
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medically dependent children (MDCP) waiver program, except that the |
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parent or guardian of a medically dependent child may opt the child |
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out of receiving benefits through the STAR Kids managed care |
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program and instead have the child receive benefits in accordance |
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with Section 32.042421, Human Resources Code. The commission shall |
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ensure that the STAR Kids managed care program provides all of the |
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benefits provided under the medically dependent children (MDCP) |
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waiver program to the extent necessary to implement this |
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subsection. |
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SECTION 3. Section 32.0212, Human Resources Code, is |
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amended to read as follows: |
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Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE. Except as |
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provided by Section 32.042421 and notwithstanding |
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[Notwithstanding] any other law [and subject to Section 533.0025,
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Government Code], the commission shall provide medical assistance |
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for acute care services through the Medicaid managed care system in |
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accordance with [implemented under] Chapter 533, Government Code, |
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or another Medicaid capitated managed care program. |
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SECTION 4. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.042421 to read as follows: |
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Sec. 32.042421. DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN |
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MEDICALLY DEPENDENT CHILDREN WITH PRIVATE HEALTH BENEFITS |
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COVERAGE. (a) The commission shall establish a program to provide |
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medical assistance benefits under a fee-for-service delivery model |
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to a recipient who: |
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(1) has private health benefits coverage, including a |
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recipient participating in the health insurance premium payment |
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program under Section 32.0422; and |
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(2) is a child receiving benefits under the medically |
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dependent children (MDCP) waiver program. |
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(b) In establishing a program under this section, the |
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commission shall ensure that the medical assistance program is the |
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secondary payor for covered benefits after application of the |
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private health benefits coverage. |
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(c) The executive commissioner shall adopt rules necessary |
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to implement this section. |
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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. |