Bill Text: TX HB3677 | 2021-2022 | 87th Legislature | Introduced

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Bill Title: Relating to the coordination of Medicaid and private health benefits for Medicaid recipients with complex medical needs.

Spectrum: Partisan Bill (Republican 3-0)

Status: (Introduced - Dead) 2021-03-22 - Referred to Human Services [HB3677 Detail]

Download: Texas-2021-HB3677-Introduced.html

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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.