Bill Text: TX SB1463 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to certain contracts for Medicaid managed care.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-03-18 - Referred to Health & Human Services [SB1463 Detail]
Download: Texas-2013-SB1463-Introduced.html
By: West | S.B. No. 1463 | |
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relating to certain contracts for Medicaid managed care. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1.01. Subchapter B, Chapter 32, Human Resources | ||
Code is amended by adding Sec. 32.0491, and 32.492, to read as | ||
follows: | ||
Sec. 32.491. PILOT PROJECTS TO ENCOURAGE MANAGED CARE | ||
CONTRACTING WITH HEALTH CARE COLLABORATIVES. (a) In this section, | ||
"health care collaboratives" has the meaning assigned by Section | ||
848.001, Insurance Code. | ||
(b) In this section, a "delegation agreement" means a | ||
contract that complies with Chapter 1272, Insurance Code. | ||
(c) The department shall develop and implement a managed | ||
care contracting pilot program that is consistent with federal law | ||
to: | ||
(1) promote efficient utilization of Medicaid | ||
services by recipients; and | ||
(2) demonstrate the ability of provider-owned managed | ||
care organizations to improve patient outcomes and contain costs | ||
for providing medical assistance to recipients within their service | ||
delivery area. | ||
(d) The department may develop and implement pilot programs | ||
in accordance with this subchapter to test one or more service | ||
delivery models that provide medical assistance for acute care | ||
through a health maintenance organization that executes a | ||
delegation agreement with a health care collaborative under Chapter | ||
848, Insurance Code. The Commissioner may contract with such a | ||
health maintenance organization to implement the pilot Medicaid | ||
managed care program under this chapter, provided, however, that: | ||
(1) the delegation agreement between the health care | ||
collaborative and the health maintenance organization complies | ||
with state and federal law; and | ||
(2) at least one of the pilot programs established | ||
under this subchapter is conducted with a provider-managed health | ||
maintenance organization that is owned by a not-for-profit | ||
pediatric facility. | ||
Sec. 32.492. IMPLEMENTATION, LOCATION AND DURATION. | ||
(a) The department shall implement the pilot programs established | ||
under this subchapter not later than September 1, 2015. | ||
(b) A pilot program established under this subchapter shall | ||
be conducted in a service delivery area that has over 400,000 | ||
combined STAR and CHIP eligibles; maintains three or less managed | ||
care organizations in that service delivery area; and has at least | ||
one existing managed care organization with over 40 percent market | ||
share in either STAR or CHIP programs. | ||
(c) A pilot program established under this subchapter must | ||
operate for not less than 36 months and may be extended as the | ||
commissioner deems appropriate. | ||
(d) If at the conclusion of the period specified by | ||
subsection (c) the department evaluates the strengths and | ||
weaknesses of each implemented pilot program and determines the | ||
feasibility of expanding the pilot program statewide, the | ||
department may adopt improved policies and procedures with | ||
statewide applicability, as determined from the information | ||
obtained in operating the pilot program, to ensure effective | ||
provision of medical assistance to recipients statewide. | ||
SECTION 2. Chapter 316, Health and Safety Code, is amended | ||
as follows: | ||
SECTION 2.01. Section 316.001, Health and Safety Code, is | ||
amended to read as follows: | ||
316.001. AUTHORITY TO ESTABLISH HEALTH CARE COLLABORATIVE. | ||
A public hospital created under Subtitle C or D, a facility that is | ||
owned or operated by a public or not-for-profit hospital and that | ||
includes academic health center, or a hospital district created | ||
under general or special law may form and sponsor a nonprofit health | ||
care collaborative that is certified under Chapter 848, Insurance | ||
Code, or otherwise exempt from certification under Section 848.002, | ||
Insurance Code. | ||
SECTION 3. This Act takes effect September 1, 2013. |