By: Parker H.B. No. 3677
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the coordination of Medicaid and private health
  benefits for Medicaid recipients with complex medical needs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.038, Government Code, is amended by
  amending Subsections (a) and (g) and adding Subsection (h) to read
  as follows:
         (a)  In this section:[,]
               (1)  "Durable medical equipment" means equipment,
  services, and supplies, including repair and replacement parts for
  the equipment, that:
                     (A)  is primarily and customarily used to serve a
  medical purpose as prescribed for medical necessity; and
                     (B)  includes, but is not limited to, ventilators,
  infusion pumps, medical devices, prostheses, complex
  rehabilitation technology (CRT), and such other medical equipment,
  supplies, and services as prescribed by the treating provider.
               (2)  "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.
               (3)  The guarantee of continuity of care is applicable
  to all Medicaid recipients regardless of:
                     (A)  whether the recipient is a Medicaid
  wrap-around beneficiary;
                     (B)  primary health benefit plan coverage;
                     (C)  date of enrollment of the recipient; or
                     (D)  network status of the provider.
                     (D-1)  In network specialty provider contract
  cancellation does not void the guarantee of continuity of care. The
  recipient retains the right to select their preferred specialty
  provider should contract cancellation occur.
               (4)  "Specialty provider" means a person who provides
  health-related goods or services to a recipient, including:
                     (A)  a physician licensed under Subtitle B, Title
  3, Occupations Code;
                     (B)  an audiologist licensed under Chapter 401,
  Occupations Code;
                     (C)  a chiropractor licensed under Chapter 201,
  Occupations Code;
                     (D)  a dietitian licensed under Chapter 701,
  Occupations Code;
                     (E)  an optometrist licensed under Chapter 351,
  Occupations Code;
                     (F)  a podiatrist licensed under Chapter 202,
  Occupations Code;
                     (G)  a pharmacist licensed under Subtitle J, Title
  3, Occupations Code;
                     (H)  a durable medical equipment provider; and
                     (I)  any other provider of health-related goods,
  including medication, therapy, equipment, and services to a person
  with complex medical needs.
         (g)  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 at any
  time with a specialty provider to receive care, including
  equipment, supplies, and services necessary to provide that care,
  from that provider. A Medicaid managed care organization shall
  provide a recipient with access to that care from that specialty
  provider. A Medicaid managed care organization shall provide
  reimbursement to the specialty provider as described by 1 T.A.C.
  Section 353.4(e)(2) and (e)(3).
         SECTION 2.  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 3.  This Act takes effect September 1, 2021.