Bill Text: TX HB473 | 2013-2014 | 83rd Legislature | Introduced

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Bill Title: Relating to the provision under the medical assistance program of certain medications to children younger than five years of age.

Spectrum: Slight Partisan Bill (Democrat 2-1)

Status: (Introduced - Dead) 2013-05-04 - Considered in Calendars [HB473 Detail]

Download: Texas-2013-HB473-Introduced.html

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83R2790 JSL-F
By: Turner of Harris H.B. No. 473

A BILL TO BE ENTITLED
AN ACT
relating to the provision under the medical assistance program of
certain medications to children younger than five years of age.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0162 to read as follows:
Sec. 533.0162. PRIOR AUTHORIZATION FOR CERTAIN MEDICATIONS
FOR CHILDREN. To the extent allowed by federal law, the commission
shall ensure that a managed care organization providing
prescription drug benefits under the Medicaid program requires
prior authorization for the provision of an antipsychotic or
neuroleptic medication to a child who is younger than five years of
age. In determining whether to grant prior authorization for the
provision of the medication, the managed care organization shall
consider:
(1) the child's diagnosis;
(2) approval by the United States Food and Drug
Administration for use by a person of the child's age;
(3) whether the child has successfully taken the
medication in the past; and
(4) any other relevant factor specified by rule.
SECTION 2. Section 32.024, Human Resources Code, is amended
by adding Subsection (hh) to read as follows:
(hh) To the extent allowed by federal law, the department
may not provide medical assistance through the vendor drug program
for the provision of an antipsychotic or neuroleptic medication to
a child who is younger than five years of age unless the department
authorizes the provision of that medication in advance. In
determining whether to authorize the medication, the department
shall consider:
(1) the child's diagnosis;
(2) approval by the United States Food and Drug
Administration for use by a person of the child's age;
(3) whether the child has successfully taken the
medication in the past; and
(4) any other factor the department considers
relevant.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract for the provision of prescription drug
benefits 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 533.0162, Government Code, as
added by this Act.
(b) The Health and Human Services Commission shall seek to
amend contracts for the provision of prescription drug benefits
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 533.0162,
Government Code, as added 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 4. Not later than January 1, 2014, the Health and
Human Services Commission shall adopt protocols to implement the
changes in law made by this Act while ameliorating the effects those
changes in law may have on children receiving medication as a
covered benefit through the medical assistance program under
Chapter 32, Human Resources Code.
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, 2013.