Bill Text: TX HB3695 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to providing access to local health departments and certain health service regional offices under the Medicaid managed care program.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-19 - Referred to Human Services [HB3695 Detail]
Download: Texas-2019-HB3695-Introduced.html
86R10863 KFF-F | ||
By: Miller | H.B. No. 3695 |
|
||
|
||
relating to providing access to local health departments and | ||
certain health service regional offices under the Medicaid managed | ||
care program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 533.001, Government Code, is amended by | ||
adding Subdivisions (3-a) and (3-b) to read as follows: | ||
(3-a) "Health service regional office" means an office | ||
located in a public health region and administered by a regional | ||
director under Section 121.007, Health and Safety Code. | ||
(3-b) "Local health department" means a local health | ||
department established under Subchapter D, Chapter 121, Health and | ||
Safety Code. | ||
SECTION 2. Section 533.006(a), Government Code, is amended | ||
to read as follows: | ||
(a) The commission shall require that each managed care | ||
organization that contracts with the commission to provide health | ||
care services to recipients in a region: | ||
(1) seek participation in the organization's provider | ||
network from: | ||
(A) each health care provider in the region who | ||
has traditionally provided care to recipients; | ||
(B) each hospital in the region that has been | ||
designated as a disproportionate share hospital under Medicaid; | ||
[ |
||
(C) each specialized pediatric laboratory in the | ||
region, including those laboratories located in children's | ||
hospitals; and | ||
(D) each local health department in the region | ||
and each health service regional office acting in the capacity of a | ||
local health department in the region; and | ||
(2) include in its provider network for not less than | ||
three years: | ||
(A) each health care provider in the region who: | ||
(i) previously provided care to Medicaid | ||
and charity care recipients at a significant level as prescribed by | ||
the commission; | ||
(ii) agrees to accept the prevailing | ||
provider contract rate of the managed care organization; and | ||
(iii) has the credentials required by the | ||
managed care organization, provided that lack of board | ||
certification or accreditation by The Joint Commission may not be | ||
the sole ground for exclusion from the provider network; | ||
(B) each accredited primary care residency | ||
program in the region; [ |
||
(C) each disproportionate share hospital | ||
designated by the commission as a statewide significant traditional | ||
provider; and | ||
(D) each local health department in the region | ||
and each health service regional office acting in the capacity of a | ||
local health department in the region. | ||
SECTION 3. Section 533.0061(a), Government Code, is amended | ||
to read as follows: | ||
(a) The commission shall establish minimum provider access | ||
standards for the provider network of a managed care organization | ||
that contracts with the commission to provide health care services | ||
to recipients. The access standards must ensure that a managed | ||
care organization provides recipients sufficient access to: | ||
(1) preventive care; | ||
(2) primary care; | ||
(3) specialty care; | ||
(4) after-hours urgent care; | ||
(5) chronic care; | ||
(6) long-term services and supports; | ||
(7) nursing services; | ||
(8) therapy services, including services provided in a | ||
clinical setting or in a home or community-based setting; [ |
||
(9) services provided by each local health department | ||
in the region and each health service regional office acting in the | ||
capacity of a local health department in the region; and | ||
(10) any other services identified by the commission. | ||
SECTION 4. (a) The Health and Human Services Commission | ||
shall, in a contract between the commission and a managed care | ||
organization under Chapter 533, Government Code, that is entered | ||
into or renewed on or after the effective date of this Act, require | ||
that the managed care organization comply with Section 533.006, | ||
Government Code, as amended by this Act. | ||
(b) The Health and Human Services Commission shall seek to | ||
amend contracts entered into with managed care organizations under | ||
Chapter 533, Government Code, before the effective date of this Act | ||
to require those managed care organizations to comply with Section | ||
533.006, Government Code, as amended by this Act. To the extent of | ||
a conflict between that section and a provision of a contract with a | ||
managed care organization entered into before the effective date of | ||
this Act, the contract provision prevails. | ||
SECTION 5. 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 6. This Act takes effect September 1, 2019. |