86R9846 KFF-D
 
  By: Perry S.B. No. 1094
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the delivery of Medicaid benefits to certain medically
  dependent children with private health benefits coverage.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.0025(b), Government Code, is amended
  to read as follows:
         (b)  Except as otherwise provided by this section and Section
  32.042421, Human Resources Code, and notwithstanding any other law,
  the commission shall provide Medicaid acute care services through
  the most cost-effective model of Medicaid capitated managed care as
  determined by the commission.  The commission shall require
  mandatory participation in a Medicaid capitated managed care
  program for all persons eligible for Medicaid acute care benefits,
  but may implement alternative models or arrangements, including a
  traditional fee-for-service arrangement, if the commission
  determines the alternative would be more cost-effective or
  efficient.
         SECTION 2.  Sections 533.00253(b) and (d), Government Code,
  are amended to read as follows:
         (b)  Except as provided by Section 32.042421, Human
  Resources Code, and subject [Subject] to Section 533.0025, the
  commission shall operate [, in consultation with the Children's
  Policy Council established under Section 22.035, Human Resources
  Code, establish] a mandatory STAR Kids capitated managed care
  program tailored to provide Medicaid benefits to children with
  disabilities.  The managed care program [developed] under this
  section must:
               (1)  provide Medicaid benefits that are customized to
  meet the health care needs of recipients under the program through a
  defined system of care;
               (2)  better coordinate care of recipients under the
  program;
               (3)  improve the health outcomes of recipients;
               (4)  improve recipients' access to health care
  services;
               (5)  achieve cost containment and cost efficiency;
               (6)  reduce the administrative complexity of
  delivering Medicaid benefits;
               (7)  reduce the incidence of unnecessary
  institutionalizations and potentially preventable events by
  ensuring the availability of appropriate services and care
  management;
               (8)  require a health home; and
               (9)  coordinate and collaborate with long-term care
  service providers and long-term care management providers, if
  recipients are receiving long-term services and supports outside of
  the managed care organization.
         (d)  The commission shall provide Medicaid benefits through
  the STAR Kids managed care program operated [established] under
  this section to children who are receiving benefits under the
  medically dependent children (MDCP) waiver program, except that the
  parent or guardian of a medically dependent child may opt the child
  out of receiving benefits through the STAR Kids managed care
  program and instead have the child receive benefits in accordance
  with Section 32.042421, Human Resources Code.  The commission shall
  ensure that the STAR Kids managed care program provides all of the
  benefits provided under the medically dependent children (MDCP)
  waiver program to the extent necessary to implement this
  subsection.
         SECTION 3.  Section 32.0212, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0212.  DELIVERY OF MEDICAL ASSISTANCE. Except as
  provided by Section 32.042421 and notwithstanding
  [Notwithstanding] any other law [and subject to Section 533.0025,
  Government Code], the commission shall provide medical assistance
  for acute care services through the Medicaid managed care system in
  accordance with [implemented under] Chapter 533, Government Code,
  or another Medicaid capitated managed care program.
         SECTION 4.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.042421 to read as follows:
         Sec. 32.042421.  DELIVERY OF MEDICAL ASSISTANCE TO CERTAIN
  MEDICALLY DEPENDENT CHILDREN WITH PRIVATE HEALTH BENEFITS
  COVERAGE. (a)  The commission shall establish a program to provide
  medical assistance benefits under a fee-for-service delivery model
  to a recipient who:
               (1)  has private health benefits coverage, including a
  recipient participating in the health insurance premium payment
  program under Section 32.0422; and
               (2)  is a child receiving benefits under the medically
  dependent children (MDCP) waiver program.
         (b)  In establishing a program under this section, the
  commission shall ensure that the medical assistance program is the
  secondary payor for covered benefits after application of the
  private health benefits coverage.
         (c)  The executive commissioner shall adopt rules necessary
  to implement this section.
         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.