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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of initial health risk assessments for |
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Medicaid recipients. |
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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 533.002501 to read as follows: |
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Sec. 533.002501. INITIAL HEALTH RISK ASSESSMENTS OF CERTAIN |
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RECIPIENTS. (a) In this section, "assessing third-party entity" |
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means the third-party entity with which the commission is required |
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to contract under Subsection (c) to conduct health risk assessments |
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of recipients under this section. |
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(b) The commission shall, in accordance with this section, |
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conduct an initial health risk assessment of each recipient who is |
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to be enrolled in a managed care plan offered by a Medicaid managed |
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care organization. |
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(c) The commission shall contract with an independent, |
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third-party entity to provide the health risk assessment required |
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by this section. A third-party entity is eligible to contract with |
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the commission under this subsection only if: |
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(1) the entity is qualified under Sections 1902(d) and |
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1903(a)(3)(C) of the federal Social Security Act (42 U.S.C. |
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Sections 1396a(d) and 1396b(a)(3)(C)) to provide the service; |
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(2) the entity is independent of each: |
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(A) Medicaid managed care organization; and |
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(B) health care provider participating in a |
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managed care model or arrangement implemented under this chapter; |
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and |
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(3) a person who is an owner, employee, or consultant |
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of or who has another contract arrangement with the entity: |
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(A) does not have a direct or indirect financial |
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interest in a managed care organization or health care provider |
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described by Subdivision (2); and |
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(B) has not been excluded from participating in a |
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program established under Title XVIII or XIX of the federal Social |
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Security Act, debarred by a federal agency, or subject to a civil |
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money penalty under the federal Social Security Act. |
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(d) The health risk assessment required by this section |
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must: |
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(1) be completed by the assessing third-party entity |
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as soon as practicable and, if possible, before the recipient is |
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enrolled in a managed care plan; and |
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(2) subject to Subsection (e), be administered using a |
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standardized risk assessment instrument. |
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(e) For a recipient who is to be enrolled in the STAR+PLUS |
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Medicaid managed care program or the STAR Kids managed care |
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program, the assessing third-party entity shall complete a |
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functional needs assessment that uses a nationally recognized, |
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evidence-based instrument to conduct the assessment. |
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Notwithstanding any other law, the functional needs assessment |
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conducted under this section must be used: |
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(1) as the basis for determining the recipient's |
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eligibility for waiver services; and |
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(2) in the development of the recipient's individual |
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service plan. |
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(f) The assessing third-party entity shall retain the |
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results of the health risk assessments conducted under this section |
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and report the results of the assessments to the commission and the |
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appropriate managed care organization. If a recipient enrolls in |
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another managed care plan offered by another Medicaid managed care |
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organization, the managed care organization in which the recipient |
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is enrolled shall notify the commission and the commission shall |
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ensure that a copy of the recipient's health risk assessment is |
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provided to the managed care organization by the third-party entity |
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that assessed the recipient. |
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SECTION 2. (a) Not later than September 1, 2022, the Health |
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and Human Services Commission shall: |
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(1) contract with a third-party entity as required by |
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Section 533.002501(c), Government Code, as added by this Act; and |
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(2) subject to Subsection (b) of this section, |
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develop, in conjunction with each Medicaid managed care |
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organization with which the commission contracts to provide health |
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care services to Medicaid recipients under Chapter 533, Government |
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Code, a plan for phasing in the transition of responsibility for the |
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provision of health risk assessments of Medicaid recipients who are |
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to be enrolled in the Medicaid managed care plan from the managed |
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care organizations offering the managed care plans in which those |
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recipients are enrolled to the third-party entity with which the |
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commission contracts under Section 533.002501(c), Government Code, |
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as added by this Act. |
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(b) The plan for phasing in the transition of the provision |
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of health risk assessments required by Subsection (a) of this |
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section must begin with the transition of recipients who are to be |
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enrolled in the STAR Kids managed care program. |
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(c) Section 533.002501, Government Code, as added by this |
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Act, applies only to a Medicaid recipient who is initially enrolled |
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in a managed care plan offered by a Medicaid managed care |
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organization that contracts with the Health and Human Services |
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Commission under Chapter 533, Government Code, on or after the date |
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specified in the plan for phasing in the transition of the provision |
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of health risk assessments required by Subsection (a) of this |
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section. |
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SECTION 3. 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 4. This Act takes effect September 1, 2021. |