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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement rates for eye health care services |
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providers participating in the Medicaid managed care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.005, Government Code, is amended by |
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adding Subsection (i) to read as follows: |
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(i) In addition to the requirements specified by Subsection |
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(a), a contract described by that subsection must contain a |
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requirement that a managed care organization, including any |
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subcontracted administrator, contractor, vision plan, or other |
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entity the organization contracts with, owns, or otherwise engages |
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to provide or arrange for the provision of eye health care services |
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under a managed care plan, reimburse an eye health care services |
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provider who provides services to a recipient under the |
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organization's managed care plan at a rate that is at least equal to |
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the Medicaid fee-for-service rate for the provision of the same or |
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similar services. |
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SECTION 2. Section 533.0067, Government Code, is amended to |
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read as follows: |
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Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject |
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to Section 32.047, Human Resources Code, but notwithstanding any |
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other law, the commission shall require that each managed care |
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organization that contracts with the commission under any Medicaid |
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managed care model or arrangement to provide health care services |
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to recipients in a region include in the organization's provider |
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network each optometrist, therapeutic optometrist, and |
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ophthalmologist described by Section 531.021191(b)(1)(A) or (B) |
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and an institution of higher education described by Section |
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531.021191(a)(4) in the region who: |
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(1) agrees to comply with the terms and conditions of |
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the organization; |
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(2) [agrees to accept the prevailing provider contract |
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rate of the organization; |
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[(3)] agrees to abide by the standards of care |
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required by the organization; and |
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(3) [(4)] is an enrolled provider under Medicaid. |
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SECTION 3. (a) The Health and Human Services Commission |
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shall, in a contract between the commission and a managed care |
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organization under Chapter 533, Government Code, that is entered |
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into or renewed on or after the effective date of this Act, require |
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that the managed care organization comply with Section 533.005(i), |
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Government Code, as added by this Act. |
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(b) The Health and Human Services Commission shall seek to |
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amend contracts entered into with managed care organizations under |
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Chapter 533, Government Code, before the effective date of this Act |
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to require those managed care organizations to comply with Section |
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533.005(i), Government Code, as added by this Act. To the extent of |
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a conflict between Section 533.005(i), Government Code, as added by |
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this Act, and a provision of a contract with a managed care |
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organization entered into before the effective date of this Act, |
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the contract provision prevails. |
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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. This Act takes effect September 1, 2023. |