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AN ACT
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relating to the administration and operation of Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.021135 to read as follows: |
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Sec. 531.021135. COMMISSION'S AUTHORITY TO RETAIN CERTAIN |
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MONEY TO ADMINISTER CERTAIN MEDICAID PROGRAMS; REPORT REQUIRED. |
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(a) In this section, "directed payment program" means a delivery |
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system and provider patient initiative implemented by this state |
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under 42 C.F.R. Section 438.6(c). |
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(b) This section applies only to money the commission |
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receives from a source other than the general revenue fund to |
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operate a waiver program established under Section 1115 of the |
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federal Social Security Act (42 U.S.C. Section 1315) or a directed |
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payment program or successor program as determined by the |
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commission. |
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(c) Subject to Subsection (e), the commission may retain |
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from money to which this section applies an amount equal to the |
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estimated costs necessary to administer the program for which the |
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money is received, but not to exceed $8 million for a state fiscal |
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year. |
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(d) The commission shall spend money retained under this |
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section to assist in paying the costs necessary to administer the |
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program for which the money is received, except that the commission |
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may not use the money to pay any type of administrative cost that, |
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before June 1, 2019, was funded with general revenue. |
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(e) If the commission determines that the commission needs |
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additional money to administer a program described by Subsection |
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(b), the commission may retain an additional amount with the |
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approval of the governor and the Legislative Budget Board, but not |
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to exceed a total retained amount equal to 0.25 percent of the total |
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amount estimated to be received for the program. |
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(f) The commission shall submit an annual report to the |
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governor and the Legislative Budget Board that: |
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(1) details the amount of money retained and spent by |
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the commission under this section during the preceding state fiscal |
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year, including a separate detail of any increase in the amount of |
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money retained for a program under Subsection (e); |
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(2) contains a transparent description of how the |
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commission used the money described by Subdivision (1); and |
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(3) assesses the extent to which the money retained by |
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the commission under this section covered the estimated costs to |
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administer the applicable program and states whether, based on that |
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assessment, the commission adjusted or considered adjustments to |
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the amount retained. |
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(g) The executive commissioner shall adopt rules necessary |
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to implement this section. |
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SECTION 2. Section 531.1023, Government Code, is amended to |
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read as follows: |
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Sec. 531.1023. COMPLIANCE WITH FEDERAL CODING GUIDELINES. |
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(a) The commission's office of inspector general, including |
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office staff and any third party with which the office contracts to |
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perform coding services, and the commission's medical and |
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utilization review appeals unit shall comply with federal coding |
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guidelines, including guidelines for diagnosis-related group (DRG) |
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validation and related audits. |
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(b) In this section, "federal coding guidelines" means the |
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code sets and guidelines adopted by the United States Department of |
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Health and Human Services in accordance with the Health Insurance |
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Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d |
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et seq.). |
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SECTION 3. 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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(a) A managed care plan offered by a Medicaid managed care |
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organization must be accredited by a nationally recognized |
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accreditation organization. The commission may choose whether to |
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require all managed care plans offered by Medicaid managed care |
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organizations to be accredited by the same organization or to allow |
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for accreditation by different organizations. |
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(b) The commission may use the data, scoring, and other |
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information provided to or received from an accreditation |
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organization in the commission's contract oversight processes. |
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SECTION 4. The Health and Human Services Commission shall |
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require that a managed care plan offered by a Medicaid managed care |
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organization with which the commission enters into or renews a |
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contract under Chapter 533, Government Code, on or after the |
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effective date of this Act complies with Section 533.0031, |
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Government Code, as added by this Act, not later than September 1, |
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2022. |
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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 immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 2138 passed the Senate on |
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April 29, 2019, by the following vote: Yeas 30, Nays 1; |
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May 23, 2019, Senate refused to concur in House amendments and |
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requested appointment of Conference Committee; May 23, 2019, House |
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granted request of the Senate; May 26, 2019, Senate adopted |
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Conference Committee Report by the following vote: Yeas 31, |
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Nays 0. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 2138 passed the House, with |
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amendments, on May 22, 2019, by the following vote: Yeas 131, |
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Nays 13, two present not voting; May 23, 2019, House granted |
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request of the Senate for appointment of Conference Committee; |
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May 26, 2019, House adopted Conference Committee Report by the |
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following vote: Yeas 125, Nays 21, one present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |