Bill Text: TX SB348 | 2013-2014 | 83rd Legislature | Enrolled
Bill Title: Relating to a utilization review process for managed care organizations participating in the STAR + PLUS Medicaid managed care program.
Sponsorship: Partisan Bill (Republican 3)
Status: (Passed) 2013-05-18 - Effective immediately [SB348 Detail]
Download: Texas-2013-SB348-Enrolled.html
| S.B. No. 348 | ||
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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 Subsection (d), Section | ||
| 533.00281, 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. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I hereby certify that S.B. No. 348 passed the Senate on | ||
| March 27, 2013, by the following vote: Yeas 30, Nays 0. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| I hereby certify that S.B. No. 348 passed the House on | ||
| May 7, 2013, by the following vote: Yeas 143, Nays 0, two present | ||
| not voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| Approved: | ||
| ______________________________ | ||
| Date | ||
| ______________________________ | ||
| Governor | ||
