Bill Text: TX HB1159 | 2013-2014 | 83rd Legislature | Comm Sub
Bill Title: Relating to a utilization review process for managed care organizations participating in the STAR + PLUS Medicaid managed care program.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2013-05-06 - Laid on the table subject to call [HB1159 Detail]
Download: Texas-2013-HB1159-Comm_Sub.html
83R19626 ADM-F | |||
By: Kolkhorst | H.B. No. 1159 | ||
Substitute the following for H.B. No. 1159: | |||
By: Naishtat | C.S.H.B. No. 1159 |
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relating to a utilization review process for managed care | ||
organizations participating in the STAR + PLUS Medicaid managed | ||
care program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Section 533.00281 to read as follows: | ||
Sec. 533.00281. UTILIZATION REVIEW FOR STAR + PLUS MEDICAID | ||
MANAGED CARE ORGANIZATIONS. (a) The commission's office of | ||
contract management shall establish an annual utilization review | ||
process for managed care organizations participating in the STAR + | ||
PLUS Medicaid managed care program. The commission shall determine | ||
the topics to be examined in the review process, except that the | ||
review process must include a thorough investigation of each | ||
managed care organization's procedures for determining whether a | ||
recipient should be enrolled in the STAR + PLUS home and | ||
community-based services and supports (HCBS) program, including | ||
the conduct of functional assessments for that purpose and records | ||
relating to those assessments. | ||
(b) The office of contract management shall use the | ||
utilization review process to review each fiscal year: | ||
(1) every managed care organization participating in | ||
the STAR + PLUS Medicaid managed care program; or | ||
(2) only the managed care organizations that, using a | ||
risk-based assessment process, the office determines have a higher | ||
likelihood of inappropriate client placement in the STAR + PLUS | ||
home and community-based services and supports (HCBS) program. | ||
(c) Notwithstanding Subsection (b), during the state fiscal | ||
biennium ending August 31, 2015, the office of contract management | ||
shall use the utilization review process to review every managed | ||
care organization participating in the STAR + PLUS Medicaid managed | ||
care program. This subsection expires September 1, 2016. | ||
(d) In conjunction with the commission's office of contract | ||
management, the commission shall provide a report to the standing | ||
committees of the senate and house of representatives with | ||
jurisdiction over the Medicaid program not later than December 1 of | ||
each year. The report must: | ||
(1) summarize the results of the utilization reviews | ||
conducted under this section during the preceding fiscal year; | ||
(2) provide analysis of errors committed by each | ||
reviewed managed care organization; and | ||
(3) extrapolate those findings and make | ||
recommendations for improving the efficiency of the program. | ||
(e) If a utilization review conducted under this section | ||
results in a determination to recoup money from a managed care | ||
organization, a service provider who contracts with the managed | ||
care organization may not be held liable for the good faith | ||
provision of services based on an authorization from the managed | ||
care organization. | ||
SECTION 2. The Health and Human Services Commission shall | ||
provide the first report required by Section 533.00281(d), | ||
Government Code, as added by this Act, not later than December 1, | ||
2014. | ||
SECTION 3. 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 4. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2013. |