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A BILL TO BE ENTITLED
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AN ACT
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relating to the transition of case management for children and |
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pregnant women program services and Healthy Texas Women program |
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services to a managed care program. |
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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 533.002555 to read as follows: |
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Sec. 533.002555. TRANSITION OF CASE MANAGEMENT FOR CHILDREN |
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AND PREGNANT WOMEN PROGRAM RECIPIENTS TO MANAGED CARE PROGRAM. (a) |
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In this section, "children and pregnant women program" means the |
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benefits program provided under Medicaid and administered by the |
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Department of State Health Services that provides case management |
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services to children who have a health condition or health risk and |
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pregnant women who have a high-risk condition. |
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(b) The commission shall transition to a Medicaid managed |
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care model for case management services provided to recipients |
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under the children and pregnant women program. In transitioning |
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services under this section, the commission shall ensure a |
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recipient is provided case management services through the managed |
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care plan in which the recipient is enrolled. |
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(c) In implementing this section, the commission shall |
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ensure: |
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(1) a seamless transition in case management for |
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recipients receiving benefits under the children and pregnant women |
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program; and |
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(2) case management services provided under the |
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program are not interrupted. |
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SECTION 2. Subchapter F, Chapter 32, Health and Safety |
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Code, is amended by amending Section 32.152 and adding Sections |
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32.156 and 32.157 to read as follows: |
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Sec. 32.152. [ASSESSING] PROVISION OF HEALTHY TEXAS WOMEN |
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PROGRAM SERVICES THROUGH MANAGED CARE. [(a)] The commission shall |
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contract [assess: |
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[(1) the feasibility and cost-effectiveness of |
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contracting] with Medicaid managed care organizations to provide |
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Healthy Texas Women program services [through managed care in one |
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or more health care service regions in this state if the Healthy |
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Texas Women Section 1115 Demonstration Waiver is approved; and |
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[(2) the potential impact of that delivery model on |
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women receiving services under the program]. |
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[(b) This section expires September 1, 2021.] |
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Sec. 32.156. INFORMATION ABOUT AVAILABILITY OF SUBSIDIZED |
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HEALTH INSURANCE COVERAGE. (a) The commission and each managed |
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care organization participating in the Healthy Texas Women program |
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shall provide a written notice containing information about |
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eligibility requirements for and enrollment in a health benefit |
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plan for which an enrollee receives a premium subsidy under the |
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Patient Protection and Affordable Care Act (Pub. L. No. 111-148), |
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based on family income, to a woman who: |
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(1) is enrolled in the Healthy Texas Women program; |
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and |
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(2) has a household income that is more than 100 |
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percent but not more than 200 percent of the federal poverty level. |
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(b) The commission, in consultation with the Texas |
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Department of Insurance, shall develop the form and content of the |
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notice required under this section. The notice must include: |
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(1) the latest information written in clear and easily |
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understood language on available options for obtaining a subsidized |
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health benefit plan described by Subsection (a); and |
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(2) resources for receiving assistance applying for |
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and enrolling in that health benefit plan. |
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Sec. 32.157. ASSESSING AUTOMATIC ENROLLMENT OF CERTAIN |
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WOMEN IN MANAGED CARE. (a) Not later than January 1, 2023, the |
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commission shall assess the feasibility, cost-effectiveness, and |
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benefits of automatically enrolling in managed care the women who |
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become pregnant while receiving services through the Healthy Texas |
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Women program. The assessment must examine whether automatically |
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enrolling those women leads to the delivery of prenatal care and |
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services earlier in the women's pregnancies. |
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(b) This section expires September 1, 2023. |
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SECTION 3. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission shall adopt rules necessary to implement the |
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changes in law made by this Act. |
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SECTION 4. 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 5. The Health and Human Services Commission is |
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required to implement a provision of this Act only if the |
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legislature appropriates money specifically for that purpose. If |
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the legislature does not appropriate money specifically for that |
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purpose, the Health and Human Services Commission may, but is not |
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required to, implement a provision of this Act using other |
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appropriations available for that purpose. |
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SECTION 6. This Act takes effect September 1, 2021. |