86R31958 LED-D
 
  By: Perry, et al. S.B. No. 1207
 
  (Krause, Parker, Leach, Davis of Harris)
 
  Substitute the following for S.B. No. 1207:  No.
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the operation and administration of Medicaid, including
  the Medicaid managed care program and the medically dependent
  children (MDCP) waiver program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.001, Government Code, is amended by
  adding Subdivision (4-c) to read as follows:
               (4-c)  "Medicaid managed care organization" means a
  managed care organization as defined by Section 533.001 that
  contracts with the commission under Chapter 533 to provide health
  care services to Medicaid recipients.
         SECTION 2.  Section 531.02444, Government Code, is amended
  by amending Subsection (a) and adding Subsections (d) and (e) to
  read as follows:
         (a)  The executive commissioner shall develop and implement:
               (1)  a Medicaid buy-in program for persons with
  disabilities as authorized by the Ticket to Work and Work
  Incentives Improvement Act of 1999 (Pub. L. No. 106-170) or the
  Balanced Budget Act of 1997 (Pub. L. No. 105-33); and
               (2)  subject to Subsection (d) as authorized by the
  Deficit Reduction Act of 2005 (Pub. L. No. 109-171), a Medicaid
  buy-in program for children with disabilities that are [is]
  described by 42 U.S.C. Section 1396a(cc)(1) and whose family
  incomes do not exceed 300 percent of the applicable federal poverty
  level.
         (d)  The executive commissioner by rule shall increase the
  maximum family income prescribed by Subsection (a)(2) for
  determining eligibility of children with disabilities for the
  buy-in program under that subdivision to the maximum family income
  amount for which federal matching funds are available, considering
  available appropriations for that purpose.
         (e)  The commission shall, at the request of a child's
  legally authorized representative, conduct a disability
  determination assessment of the child to determine the child's
  eligibility for the buy-in program under Subsection (a)(2).  The
  commission shall directly conduct the disability determination
  assessment and may not contract with a Medicaid managed care
  organization or other entity to conduct the assessment.
         SECTION 3.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.024162, 531.024163, 531.024164,
  531.0601, 531.0602, and 531.06021 to read as follows:
         Sec. 531.024162.  NOTICE REQUIREMENTS REGARDING MEDICAID
  COVERAGE OR PRIOR AUTHORIZATION DENIAL AND INCOMPLETE REQUESTS.
  (a)  The commission shall ensure that notice sent by the commission
  or a Medicaid managed care organization to a Medicaid recipient or
  provider regarding the denial of coverage or prior authorization
  for a service includes:
               (1)  information required by federal and state law and
  applicable regulations;
               (2)  for the recipient, a clear and easy-to-understand
  explanation of the reason for the denial; and
               (3)  for the provider, a thorough and detailed clinical
  explanation of the reason for the denial, including, as applicable,
  information required under Subsection (b).
         (b)  The commission or a Medicaid managed care organization
  that receives from a provider a coverage or prior authorization
  request that contains insufficient or inadequate documentation to
  approve the request shall issue a notice to the provider and the
  Medicaid recipient on whose behalf the request was submitted.  The
  notice issued under this subsection must:
               (1)  include a section specifically for the provider
  that contains:
                     (A)  a clear and specific list and description of
  the documentation necessary for the commission or organization to
  make a final determination on the request;
                     (B)  the applicable timeline, based on the
  requested service, for the provider to submit the documentation and
  a description of the reconsideration process described by Section
  533.00284, if applicable; and
                     (C)  information on the manner through which a
  provider may contact a Medicaid managed care organization or other
  entity as required by Section 531.024163; and
               (2)  be sent to the provider:
                     (A)  using the provider's preferred method of
  contact most recently provided to the commission or the Medicaid
  managed care organization and using any alternative and known
  methods of contact; and
                     (B)  as applicable, through an electronic
  notification on an Internet portal.
         Sec. 531.024163.  ACCESSIBILITY OF INFORMATION REGARDING
  MEDICAID PRIOR AUTHORIZATION REQUIREMENTS. (a) The executive
  commissioner by rule shall require each Medicaid managed care
  organization or other entity responsible for authorizing coverage
  for health care services under Medicaid to ensure that the
  organization or entity maintains on the organization's or entity's
  Internet website in an easily searchable and accessible format:
               (1)  the applicable timelines for prior authorization
  requirements, including:
                     (A)  the time within which the organization or
  entity must make a determination on a prior authorization request;
                     (B)  a description of the notice the organization
  or entity provides to a provider and Medicaid recipient on whose
  behalf the request was submitted regarding the documentation
  required to complete a determination on a prior authorization
  request; and
                     (C)  the deadline by which the organization or
  entity is required to submit the notice described by Paragraph (B);
  and
               (2)  an accurate and up-to-date catalogue of coverage
  criteria and prior authorization requirements, including:
                     (A)  for a prior authorization requirement first
  imposed on or after September 1, 2019, the effective date of the
  requirement;
                     (B)  a list or description of any supporting or
  other documentation necessary to obtain prior authorization for a
  specified service; and
                     (C)  the date and results of each review of the
  prior authorization requirement conducted under Section 533.00283,
  if applicable.
         (b)  The executive commissioner by rule shall require each
  Medicaid managed care organization or other entity responsible for
  authorizing coverage for health care services under Medicaid to:
               (1)  adopt and maintain a process for a provider or
  Medicaid recipient to contact the organization or entity to clarify
  prior authorization requirements or to assist the provider in
  submitting a prior authorization request; and
               (2)  ensure that the process described by Subdivision
  (1) is not arduous or overly burdensome to a provider or recipient.
         Sec. 531.024164.  EXTERNAL MEDICAL REVIEW. (a) In this
  section, "external medical reviewer" and "reviewer" mean a
  third-party medical review organization that provides objective,
  unbiased medical necessity determinations conducted by clinical
  staff with education and practice in the same or similar practice
  area as the procedure for which an independent determination of
  medical necessity is sought in accordance with applicable state law
  and rules.
         (b)  The commission shall contract with an independent
  external medical reviewer to conduct external medical reviews and
  review:
               (1)  the resolution of a Medicaid recipient appeal
  related to a reduction in or denial of services on the basis of
  medical necessity in the Medicaid managed care program; or
               (2)  a denial by the commission of eligibility for a
  Medicaid program in which eligibility is based on a Medicaid
  recipient's medical and functional needs.
         (c)  A Medicaid managed care organization may not have a
  financial relationship with or ownership interest in the external
  medical reviewer with which the commission contracts.
         (d)  The external medical reviewer with which the commission
  contracts must:
               (1)  be overseen by a medical director who is a
  physician licensed in this state; and
               (2)  employ or be able to consult with staff with
  experience in providing private duty nursing services and long-term
  services and supports.
         (e)  The commission shall establish a common procedure for
  reviews. Medical necessity under the procedure must be based on
  publicly available, up-to-date, evidence-based, and peer-reviewed
  clinical criteria. The reviewer shall conduct the review within a
  period specified by the commission. The commission shall also
  establish a procedure for expedited reviews that allows the
  reviewer to identify an appeal that requires an expedited
  resolution.
         (f)  An external medical review described by Subsection
  (b)(1) occurs after the internal Medicaid managed care organization
  appeal and before the Medicaid fair hearing and is granted when a
  Medicaid recipient contests the internal appeal decision of the
  Medicaid managed care organization. An external medical review
  described by Subsection (b)(2) occurs after the eligibility denial
  and before the Medicaid fair hearing. The Medicaid recipient or
  applicant, or the recipient's or applicant's parent or legally
  authorized representative, must affirmatively opt out of the
  external medical review to proceed to a Medicaid fair hearing
  without first participating in the external medical review.
         (g)  The external medical reviewer's determination of
  medical necessity establishes the minimum level of services a
  Medicaid recipient must receive, except that the level of services
  may not exceed the level identified as medically necessary by the
  ordering health care provider.
         (h)  The external medical reviewer shall require a Medicaid
  managed care organization, in an external medical review relating
  to a reduction in services, to submit a detailed reason for the
  reduction and supporting documents.
         Sec. 531.0601.  LONG-TERM CARE SERVICES WAIVER PROGRAM
  INTEREST LISTS.  (a)  This section applies only to a child who is
  enrolled in the medically dependent children (MDCP) waiver program 
  but becomes ineligible for services under the program because the
  child no longer meets:
               (1)  the level of care criteria for medical necessity
  for nursing facility care; or
               (2)  the age requirement for the program.
         (b)  A legally authorized representative of a child who is
  notified by the commission that the child is no longer eligible for
  the medically dependent children (MDCP) waiver program following a
  Medicaid fair hearing, or without a Medicaid fair hearing if the
  representative opted in writing to forego the hearing, may request
  that the commission:
               (1)  return the child to the interest list for the
  program unless the child is ineligible due to the child's age; or
               (2)  place the child on the interest list for another
  Section 1915(c) waiver program.
         (c)  At the time a child's legally authorized representative
  makes a request under Subsection (b), the commission shall:
               (1)  for a child who becomes ineligible for the reason
  described by Subsection (a)(1), place the child:
                     (A)  on the interest list for the medically
  dependent children (MDCP) waiver program in the first position on
  the list; or
                     (B)  except as provided by Subdivision (3), on the
  interest list for another Section 1915(c) waiver program in a
  position relative to other persons on the list that is based on the
  date the child was initially placed on the interest list for the
  medically dependent children (MDCP) waiver program;
               (2)  except as provided by Subdivision (3), for a child
  who becomes ineligible for the reason described by Subsection
  (a)(2), place the child on the interest list for another Section
  1915(c) waiver program in a position relative to other persons on
  the list that is based on the date the child was initially placed on
  the interest list for the medically dependent children (MDCP)
  waiver program; or
               (3)  for a child who becomes ineligible for a reason
  described by Subsection (a) and who is already on an interest list
  for another Section 1915(c) waiver program, move the child to a
  position on the interest list relative to other persons on the list
  that is based on the date the child was initially placed on the
  interest list for the medically dependent children (MDCP) waiver
  program, if that date is earlier than the date the child was
  initially placed on the interest list for the other waiver program.
         (d)  At the time the commission provides notice to a legally
  authorized representative that a child is no longer eligible for
  the medically dependent children (MDCP) waiver program following a
  Medicaid fair hearing, or without a Medicaid fair hearing if the
  representative opted in writing to forego the hearing, the
  commission shall inform the representative in writing about the
  options under this section for placing the child on an interest
  list.
         Sec. 531.0602.  MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
  PROGRAM REASSESSMENTS.  (a)  The commission shall ensure that the
  care coordinator for a Medicaid managed care organization under the
  STAR Kids managed care program provides the results of the annual
  medical necessity determination reassessment to the parent or
  legally authorized representative of a recipient receiving
  benefits under the medically dependent children (MDCP) waiver
  program for review.  The commission shall ensure the provision of
  the results does not delay the determination of the services to be
  provided to the recipient or the ability to authorize and initiate
  services.
         (b)  The commission shall require the parent's or
  representative's signature to verify the parent or representative
  received the results of the reassessment from the care coordinator
  under Subsection (a).  A Medicaid managed care organization may not
  delay the delivery of care pending the signature.
         (c)  The commission shall provide a parent or representative
  who disagrees with the results of the reassessment an opportunity
  to dispute the reassessment with the Medicaid managed care
  organization through a peer-to-peer review with the treating
  physician of choice.
         (d)  This section does not affect any rights of a recipient
  to appeal a reassessment determination through the Medicaid managed
  care organization's internal appeal process or through the Medicaid
  fair hearing process.
         Sec. 531.06021.  MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
  PROGRAM QUALITY MONITORING; REPORT.  (a)  The commission, through
  the state's external quality review organization, shall:
               (1)  conduct annual surveys of Medicaid recipients
  receiving benefits under the medically dependent children (MDCP)
  waiver program, or their representatives, using the Consumer
  Assessment of Healthcare Providers and Systems;
               (2)  conduct annual focus groups with recipients
  described by Subdivision (1) or their representatives on issues
  identified through:
                     (A)  the Consumer Assessment of Healthcare
  Providers and Systems;
                     (B)  other external quality review organization
  activities; or
                     (C)  stakeholders, including the STAR Kids
  Managed Care Advisory Committee described by Section 533.00254; and
               (3)  as frequently as feasible but not less frequently
  than annually, calculate Medicaid managed care organizations' 
  performance on performance measures using available data sources
  such as the STAR Kids Screening and Assessment Instrument or the
  National Committee for Quality Assurance's Healthcare
  Effectiveness Data and Information Set (HEDIS) measures.
         (b)  Not later than the 30th day after the last day of each
  state fiscal quarter, the commission shall submit to the governor,
  the lieutenant governor, the speaker of the house of
  representatives, the Legislative Budget Board, and each standing
  legislative committee with primary jurisdiction over Medicaid a
  report containing, for the most recent state fiscal quarter, the
  following information and data related to access to care for
  Medicaid recipients receiving benefits under the medically
  dependent children (MDCP) waiver program:
               (1)  enrollment in the Medicaid buy-in for children
  program implemented under Section 531.02444;
               (2)  requests relating to interest list placements
  under Section 531.0601;
               (3)  use of the Medicaid escalation help line
  established under Section 533.00253; 
               (4)  use, requests to opt out, and outcomes of the
  external medical review procedure established under Section
  531.024164; and
               (5)  complaints relating to the medically dependent
  children (MDCP) waiver program, categorized by disposition.
         SECTION 4.  Section 533.00253(a)(1), Government Code, is
  amended to read as follows:
               (1)  "Advisory committee" means the STAR Kids Managed
  Care Advisory Committee described by [established under] Section
  533.00254.
         SECTION 5.  Section 533.00253, Government Code, is amended
  by adding Subsections (c-1), (c-2), (f), (g), and (h) to read as
  follows:
         (c-1)  To improve the care needs assessment tool used for
  purposes of a care needs assessment provided as a component of care
  management services and to improve the initial assessment and
  reassessment processes, the commission in consultation and
  collaboration with the advisory committee shall consider changes
  that will:
               (1)  reduce the amount of time needed to complete the
  care needs assessment initially and at reassessment; and
               (2)  improve training and consistency in the completion
  of the care needs assessment using the tool and in the initial
  assessment and reassessment processes across different Medicaid
  managed care organizations and different service coordinators
  within the same Medicaid managed care organization.
         (c-2)  To the extent feasible and allowed by federal law, the
  commission shall streamline the STAR Kids managed care program
  annual care needs reassessment process for a child who has not had a
  significant change in function that may affect medical necessity.
         (f)  The commission shall operate a Medicaid escalation help
  line through which Medicaid recipients receiving benefits under the
  medically dependent children (MDCP) waiver program and their
  legally authorized representatives, parents, guardians, or other
  representatives have access to assistance.  The escalation help
  line must be:
               (1)  dedicated to assisting families of Medicaid
  recipients receiving benefits under the medically dependent
  children (MDCP) waiver program in navigating and resolving issues
  related to the STAR Kids managed care program; and
               (2)  operational at all times, including evenings,
  weekends, and holidays.
         (g)  The commission shall ensure staff operating the
  Medicaid escalation help line:
               (1)  return a telephone call not later than two hours
  after receiving the call during standard business hours; and
               (2)  return a telephone call not later than four hours
  after receiving the call during evenings, weekends, and holidays.
         (h)  The commission shall require a Medicaid managed care
  organization participating in the STAR Kids managed care program
  to:
               (1)  designate an individual as a single point of
  contact for the Medicaid escalation help line; and
               (2)  authorize that individual to take action to
  resolve escalated issues.
         SECTION 6.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Sections 533.00254, 533.00282, 533.00283,
  533.00284, and 533.038 to read as follows:
         Sec. 533.00254.  STAR KIDS MANAGED CARE ADVISORY COMMITTEE.
  (a)  The STAR Kids Managed Care Advisory Committee established by
  the executive commissioner under Section 531.012 shall:
               (1)  advise the commission on the operation of the STAR
  Kids managed care program under Section 533.00253; and
               (2)  make recommendations for improvements to that
  program.
         (b)  On September 1, 2023:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         Sec. 533.00282.  UTILIZATION REVIEW AND PRIOR AUTHORIZATION
  PROCEDURES.  (a)  Section 4201.304(a)(2), Insurance Code, does not
  apply to a Medicaid managed care organization or a utilization
  review agent who conducts utilization reviews for a Medicaid
  managed care organization.
         (b)  In addition to the requirements of Section 533.005, a
  contract between a Medicaid managed care organization and the
  commission must require that:
               (1)  before issuing an adverse determination on a prior
  authorization request, the organization provide the physician
  requesting the prior authorization with a reasonable opportunity to
  discuss the request with another physician who practices in the
  same or a similar specialty, but not necessarily the same
  subspecialty, and has experience in treating the same category of
  population as the recipient on whose behalf the request is
  submitted; and
               (2)  the organization review and issue determinations
  on prior authorization requests with respect to a recipient who is
  not hospitalized at the time of the request according to the
  following time frames:
                     (A)  within three business days after receiving
  the request; or
                     (B)  within the time frame and following the
  process established by the commission if the organization receives
  a request for prior authorization that does not include sufficient
  or adequate documentation.
         (c)  The commission shall establish a process consistent
  with 42 C.F.R. Section 438.210 for use by a Medicaid managed care
  organization that receives a prior authorization request, with
  respect to a recipient who is not hospitalized at the time of the
  request, that does not include sufficient or adequate
  documentation.  The process must provide a time frame within which a
  provider may submit the necessary documentation.
         Sec. 533.00283.  ANNUAL REVIEW OF PRIOR AUTHORIZATION
  REQUIREMENTS. (a) Each Medicaid managed care organization shall
  develop and implement a process to conduct an annual review of the
  organization's prior authorization requirements, other than a
  prior authorization requirement prescribed by or implemented under
  Section 531.073 for the vendor drug program. In conducting a
  review, the organization must:
               (1)  solicit, receive, and consider input from
  providers in the organization's provider network; and
               (2)  ensure that each prior authorization requirement
  is based on accurate, up-to-date, evidence-based, and
  peer-reviewed clinical criteria that distinguish, as appropriate,
  between categories, including age, of recipients for whom prior
  authorization requests are submitted.
         (b)  A Medicaid managed care organization may not impose a
  prior authorization requirement, other than a prior authorization
  requirement prescribed by or implemented under Section 531.073 for
  the vendor drug program, unless the organization has reviewed the
  requirement during the most recent annual review required under
  this section.
         Sec. 533.00284.  RECONSIDERATION FOLLOWING ADVERSE
  DETERMINATIONS ON CERTAIN PRIOR AUTHORIZATION REQUESTS. (a) In
  addition to the requirements of Section 533.005, a contract between
  a Medicaid managed care organization and the commission must
  include a requirement that the organization establish a process for
  reconsidering an adverse determination on a prior authorization
  request that resulted solely from the submission of insufficient or
  inadequate documentation.
         (b)  The process for reconsidering an adverse determination
  on a prior authorization request under this section must:
               (1)  allow a provider to, not later than the seventh
  business day following the date of the determination, submit any
  documentation that was identified as insufficient or inadequate in
  the notice provided under Section 531.024162;
               (2)  allow the provider requesting the prior
  authorization to discuss the request with another provider who
  practices in the same or a similar specialty, but not necessarily
  the same subspecialty, and has experience in treating the same
  category of population as the recipient on whose behalf the request
  is submitted;
               (3)  require the Medicaid managed care organization to,
  not later than the first business day following the date the
  provider submits sufficient and adequate documentation under
  Subdivision (1), amend the determination on the prior authorization
  request as necessary, considering the additional documentation;
  and
               (4)  comply with 42 C.F.R. Section 438.210.
         (c)  An adverse determination on a prior authorization
  request is considered a denial of services in an evaluation of the
  Medicaid managed care organization only if the determination is not
  amended under Subsection (b)(3) to approve the request.
         (d)  The process for reconsidering an adverse determination
  on a prior authorization request under this section does not
  affect:
               (1)  any related timelines, including the timeline for
  an internal appeal, a Medicaid fair hearing, or a review conducted
  by an independent review organization; or
               (2)  any rights of a recipient to appeal a
  determination on a prior authorization request.
         Sec. 533.038.  COORDINATION OF BENEFITS. (a)  In this
  section, "Medicaid wrap-around benefit" means a Medicaid-covered
  service, including a pharmacy or medical benefit, that is provided
  to a recipient with both Medicaid and primary health benefit plan
  coverage when the recipient has exceeded the primary health benefit
  plan coverage limit or when the service is not covered by the
  primary health benefit plan issuer.
         (b)  The commission, in coordination with Medicaid managed
  care organizations, shall develop and adopt a clear policy for a
  Medicaid managed care organization to ensure the coordination and
  timely delivery of Medicaid wrap-around benefits for recipients
  with both primary health benefit plan coverage and Medicaid
  coverage.  In developing the policy, the commission shall consider
  requiring a Medicaid managed care organization to allow,
  notwithstanding Sections 531.073 and 533.005(a)(23) or any other
  law, a recipient using a prescription drug for which the
  recipient's primary health benefit plan issuer previously provided
  coverage to continue receiving the prescription drug without
  requiring additional prior authorization.
         (c)  To further assist with the coordination of benefits and
  to the extent allowed under federal requirements for third-party
  liability, the commission, in coordination with Medicaid managed
  care organizations, shall develop and maintain a list of services
  that are not traditionally covered by primary health benefit plan
  coverage that a Medicaid managed care organization may approve
  without having to coordinate with the primary health benefit plan
  issuer and that can be resolved through third-party liability
  resolution processes.  The commission shall periodically review and
  update the list.
         (d)  A Medicaid managed care organization that in good faith
  and following commission policies provides coverage for a Medicaid
  wrap-around benefit shall include the cost of providing the benefit
  in the organization's financial reports.  The commission shall
  include the reported costs in computing capitation rates for the
  managed care organization.
         (e)  If the commission determines that a recipient's primary
  health benefit plan issuer should have been the primary payor of a
  claim, the Medicaid managed care organization that paid the claim
  shall work with the commission on the recovery process and make
  every attempt to reduce health care provider and recipient
  abrasion.
         (f)  The executive commissioner may seek a waiver from the
  federal government as needed to:
               (1)  address federal policies related to coordination
  of benefits and third-party liability; and
               (2)  maximize federal financial participation for
  recipients with both primary health benefit plan coverage and
  Medicaid coverage.
         (g)  The commission may include in the Medicaid managed care
  eligibility files an indication of whether a recipient has primary
  health benefit plan coverage or is enrolled in a group health
  benefit plan for which the commission provides premium assistance
  under the health insurance premium payment program. For recipients
  with that coverage or for whom that premium assistance is provided,
  the files may include the following up-to-date, accurate
  information related to primary health benefit plan coverage to the
  extent the information is available to the commission:
               (1)  the health benefit plan issuer's name and address
  and the recipient's policy number;
               (2)  the primary health benefit plan coverage start and
  end dates; and
               (3)  the primary health benefit plan coverage benefits,
  limits, copayment, and coinsurance information.
         (h)  To the extent allowed by federal law, the commission
  shall maintain processes and policies to allow a health care
  provider who is primarily providing services to a recipient through
  primary health benefit plan coverage to receive Medicaid
  reimbursement for services ordered, referred, or prescribed,
  regardless of whether the provider is enrolled as a Medicaid
  provider. The commission shall allow a provider who is not enrolled
  as a Medicaid provider to order, refer, or prescribe services to a
  recipient based on the provider's national provider identifier
  number and may not require an additional state provider identifier
  number to receive reimbursement for the services. The commission
  may seek a waiver of Medicaid provider enrollment requirements for
  providers of recipients with primary health benefit plan coverage
  to implement this subsection.
         (i)  The commission shall develop a clear and easy process,
  to be implemented through a contract, that allows a recipient with
  complex medical needs who has established a relationship with a
  specialty provider to continue receiving care from that provider.
         SECTION 7.  (a) Section 531.02444(e), Government Code, as
  added by this Act, applies to a request for a disability
  determination assessment to determine eligibility for the Medicaid
  buy-in for children program made on or after the effective date of
  this Act.
         (b)  Section 531.0601, Government Code, as added by this Act,
  applies only to a child who becomes ineligible for the medically
  dependent children (MDCP) waiver program on or after December 1,
  2019.
         (c)  Section 531.0602, Government Code, as added by this Act,
  applies only to a reassessment of a child's eligibility for the
  medically dependent children (MDCP) waiver program made on or after
  December 1, 2019.
         (d)  Notwithstanding Section 531.06021, Government Code, as
  added by this Act, the Health and Human Services Commission shall
  submit the first report required by that section not later than
  September 30, 2020, for the state fiscal quarter ending August 31,
  2020.
         (e)  Not later than March 1, 2020, the Health and Human
  Services Commission shall:
               (1)  develop a plan to improve the care needs
  assessment tool and the initial assessment and reassessment
  processes as required by Sections 533.00253(c-1) and (c-2),
  Government Code, as added by this Act; and
               (2)  post the plan on the commission's Internet
  website.
         (f)  Sections 533.00282 and 533.00284, Government Code, as
  added by this Act, apply only to a contract between the Health and
  Human Services Commission and a Medicaid managed care organization
  under Chapter 533, Government Code, that is entered into or renewed
  on or after the effective date of this Act.
         (g)  The Health and Human Services Commission shall seek to
  amend contracts entered into with Medicaid managed care
  organizations under Chapter 533, Government Code, before the
  effective date of this Act to include the provisions required by
  Sections 533.00282 and 533.00284, Government Code, as added by this
  Act.
         SECTION 8.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules necessary to implement the
  changes in law made by this Act.
         SECTION 9.  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 10.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money specifically for that purpose. If
  the legislature does not appropriate money specifically for that
  purpose, the commission may, but is not required to, implement a
  provision of this Act using other appropriations available for that
  purpose.
         SECTION 11.  This Act takes effect September 1, 2019.