Bill Text: TX HB3944 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to the provision of initial health risk assessments for Medicaid recipients.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2021-04-20 - Left pending in committee [HB3944 Detail]
Download: Texas-2021-HB3944-Introduced.html
87R7411 KFF-F | ||
By: Klick | H.B. No. 3944 |
|
||
|
||
relating to the provision of initial health risk assessments for | ||
Medicaid recipients. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Section 533.002501 to read as follows: | ||
Sec. 533.002501. INITIAL HEALTH RISK ASSESSMENTS OF CERTAIN | ||
RECIPIENTS. (a) In this section, "assessing third-party entity" | ||
means the third-party entity with which the commission is required | ||
to contract under Subsection (c) to conduct health risk assessments | ||
of recipients under this section. | ||
(b) The commission shall, in accordance with this section, | ||
conduct an initial health risk assessment of each recipient who is | ||
to be enrolled in a managed care plan offered by a Medicaid managed | ||
care organization. | ||
(c) The commission shall contract with an independent, | ||
third-party entity to provide the health risk assessment required | ||
by this section. A third-party entity is eligible to contract with | ||
the commission under this subsection only if: | ||
(1) the entity is qualified under Sections 1902(d) and | ||
1903(a)(3)(C) of the federal Social Security Act (42 U.S.C. | ||
Sections 1396a(d) and 1396b(a)(3)(C)) to provide the service; | ||
(2) the entity is independent of each: | ||
(A) Medicaid managed care organization; and | ||
(B) health care provider participating in a | ||
managed care model or arrangement implemented under this chapter; | ||
and | ||
(3) a person who is an owner, employee, or consultant | ||
of or who has another contract arrangement with the entity: | ||
(A) does not have a direct or indirect financial | ||
interest in a managed care organization or health care provider | ||
described by Subdivision (2); and | ||
(B) has not been excluded from participating in a | ||
program established under Title XVIII or XIX of the federal Social | ||
Security Act, debarred by a federal agency, or subject to a civil | ||
money penalty under the federal Social Security Act. | ||
(d) The health risk assessment required by this section | ||
must: | ||
(1) be completed by the assessing third-party entity | ||
as soon as practicable and, if possible, before the recipient is | ||
enrolled in a managed care plan; and | ||
(2) subject to Subsection (e), be administered using a | ||
standardized risk assessment instrument. | ||
(e) For a recipient who is to be enrolled in the STAR+PLUS | ||
Medicaid managed care program or the STAR Kids managed care | ||
program, the assessing third-party entity shall complete a | ||
functional needs assessment that uses a nationally recognized, | ||
evidence-based instrument to conduct the assessment. | ||
Notwithstanding any other law, the functional needs assessment | ||
conducted under this section must be used: | ||
(1) as the basis for determining the recipient's | ||
eligibility for waiver services; and | ||
(2) in the development of the recipient's individual | ||
service plan. | ||
(f) The assessing third-party entity shall retain the | ||
results of the health risk assessments conducted under this section | ||
and report the results of the assessments to the commission and the | ||
appropriate managed care organization. If a recipient enrolls in | ||
another managed care plan offered by another Medicaid managed care | ||
organization, the managed care organization in which the recipient | ||
is enrolled shall notify the commission and the commission shall | ||
ensure that a copy of the recipient's health risk assessment is | ||
provided to the managed care organization by the third-party entity | ||
that assessed the recipient. | ||
SECTION 2. (a) Not later than September 1, 2022, the Health | ||
and Human Services Commission shall: | ||
(1) contract with a third-party entity as required by | ||
Section 533.002501(c), Government Code, as added by this Act; and | ||
(2) subject to Subsection (b) of this section, | ||
develop, in conjunction with each Medicaid managed care | ||
organization with which the commission contracts to provide health | ||
care services to Medicaid recipients under Chapter 533, Government | ||
Code, a plan for phasing in the transition of responsibility for the | ||
provision of health risk assessments of Medicaid recipients who are | ||
to be enrolled in the Medicaid managed care plan from the managed | ||
care organizations offering the managed care plans in which those | ||
recipients are enrolled to the third-party entity with which the | ||
commission contracts under Section 533.002501(c), Government Code, | ||
as added by this Act. | ||
(b) The plan for phasing in the transition of the provision | ||
of health risk assessments required by Subsection (a) of this | ||
section must begin with the transition of recipients who are to be | ||
enrolled in the STAR Kids managed care program. | ||
(c) Section 533.002501, Government Code, as added by this | ||
Act, applies only to a Medicaid recipient who is initially enrolled | ||
in a managed care plan offered by a Medicaid managed care | ||
organization that contracts with the Health and Human Services | ||
Commission under Chapter 533, Government Code, on or after the date | ||
specified in the plan for phasing in the transition of the provision | ||
of health risk assessments required by Subsection (a) of this | ||
section. | ||
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 September 1, 2021. |