Bill Text: TX SB1402 | 2015-2016 | 84th Legislature | Introduced
Bill Title: Relating to expedited credentialing for certain licensed clinical social workers under the Medicaid managed care program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2015-03-18 - Referred to Health & Human Services [SB1402 Detail]
Download: Texas-2015-SB1402-Introduced.html
84R8755 ADM-F | ||
By: Rodríguez | S.B. No. 1402 |
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relating to expedited credentialing for certain licensed clinical | ||
social workers under the Medicaid managed care program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 533, Government Code, is amended by | ||
adding Subchapter G to read as follows: | ||
SUBCHAPTER G. EXPEDITED CREDENTIALING PROCESS | ||
FOR CERTAIN LICENSED CLINICAL SOCIAL WORKERS | ||
Sec. 533.121. DEFINITIONS. In this subchapter: | ||
(1) "Applicant licensed clinical social worker" means | ||
a licensed clinical social worker applying for expedited | ||
credentialing under this subchapter. | ||
(2) "Licensed clinical social worker" means an | ||
individual licensed by the Texas State Board of Social Worker | ||
Examiners as a licensed clinical social worker. | ||
(3) "Social work medical group" means: | ||
(A) a single legal entity owned by two or more | ||
licensed clinical social workers; | ||
(B) a professional association composed of | ||
licensed clinical social workers; or | ||
(C) any other entity composed of licensed | ||
clinical social workers. | ||
Sec. 533.122. APPLICABILITY. This subchapter applies only | ||
to a licensed clinical social worker who joins an established | ||
social work medical group that has a current contract in force with | ||
a managed care organization. | ||
Sec. 533.123. ELIGIBILITY REQUIREMENTS. To qualify for | ||
expedited credentialing under this subchapter and payment under | ||
Section 533.124, an applicant licensed clinical social worker must: | ||
(1) be licensed in this state by, and in good standing | ||
with, the Texas State Board of Social Worker Examiners; | ||
(2) submit all necessary documentation and other | ||
information required by the managed care organization to enable the | ||
organization to begin the credentialing process required by the | ||
organization to include a licensed clinical social worker as a | ||
provider under the organization's provider network; and | ||
(3) agree to comply with the terms of the managed care | ||
organization's participating provider contract currently in force | ||
with the applicant licensed clinical social worker's established | ||
social work medical group. | ||
Sec. 533.124. PAYMENT OF APPLICANT LICENSED CLINICAL SOCIAL | ||
WORKER DURING CREDENTIALING PROCESS. On submission by the | ||
applicant licensed clinical social worker of the information | ||
required by the managed care organization under Section 533.123(2), | ||
and for payment purposes only, the organization shall treat the | ||
applicant licensed clinical social worker as if the licensed | ||
clinical social worker were a participating provider in the | ||
organization's provider network when the applicant licensed | ||
clinical social worker provides services to recipients under the | ||
managed care plan, including: | ||
(1) authorizing the applicant licensed clinical | ||
social worker to collect copayments from the recipients; and | ||
(2) making payments to the applicant licensed clinical | ||
social worker. | ||
Sec. 533.125. DIRECTORY ENTRIES. Pending the approval of | ||
an application submitted under Section 533.124, the managed care | ||
plan may exclude the applicant licensed clinical social worker from | ||
the managed care plan's directory of participating licensed | ||
clinical social workers, the managed care plan's website listing of | ||
participating licensed clinical social workers, or any other | ||
listing of participating licensed clinical social workers. | ||
Sec. 533.126. EFFECT OF FAILURE TO MEET CREDENTIALING | ||
REQUIREMENTS. If, on completion of the credentialing process, the | ||
managed care organization determines that the applicant licensed | ||
clinical social worker does not meet the organization's | ||
credentialing requirements: | ||
(1) the managed care organization may recover from the | ||
applicant licensed clinical social worker or the licensed clinical | ||
social worker's social work medical group an amount equal to the | ||
difference between payments for in-network benefits and | ||
out-of-network benefits; and | ||
(2) the applicant licensed clinical social worker or | ||
the licensed clinical social worker's social work medical group may | ||
retain any copayments collected or in the process of being | ||
collected as of the date of the organization's determination. | ||
Sec. 533.127. RECIPIENT HELD HARMLESS. A recipient under a | ||
managed care plan is not responsible and shall be held harmless for | ||
any portion of the licensed clinical social worker's fee that is not | ||
paid or reimbursed by the recipient's managed care plan other than | ||
any cost-sharing requirement imposed under the plan. | ||
Sec. 533.128. LIMITATION ON MANAGED CARE ORGANIZATION | ||
LIABILITY. A managed care organization that complies with this | ||
subchapter is not subject to liability for damages arising out of or | ||
in connection with, directly or indirectly, the payment by the | ||
organization of an applicant licensed clinical social worker as if | ||
the licensed clinical social worker were a participating provider | ||
in the organization's provider network. | ||
SECTION 2. The change in law made by this Act applies only | ||
to credentialing of a licensed clinical social worker under a | ||
contract entered into or renewed by a medical group and an issuer of | ||
a Medicaid managed care plan on or after the effective date of this | ||
Act. A contract entered into or renewed before the effective date | ||
of this Act is governed by the law in effect immediately before that | ||
date, and that law is continued in effect for that purpose. | ||
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, 2015. |