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Amend CSSB 10 (House Committee Printing) by adding the
following appropriately numbered SECTION to the bill and
renumbering subsequent SECTIONS of the bill accordingly:
SECTION ____. (a) Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.072 to read as follows:
Sec. 32.072. DIRECT ACCESS TO EYE HEALTH CARE SERVICES. (a)
Notwithstanding any other law, a recipient of medical assistance is
entitled to:
(1) select an ophthalmologist or therapeutic
optometrist who is a medical assistance provider to provide eye
health care services that are within the scope of:
(A) services provided under the medical
assistance program; and
(B) the professional specialty practice for
which the ophthalmologist or therapeutic optometrist is licensed
and credentialed; and
(2) have direct access to the selected ophthalmologist
or therapeutic optometrist for the provision of the services
without any requirement to obtain:
(A) a referral from a primary care physician or
other gatekeeper or health care coordinator; or
(B) any other prior authorization or
precertification.
(b) The department may require an ophthalmologist or
therapeutic optometrist selected as provided by this section by a
recipient of medical assistance who is otherwise required to have a
primary care physician or other gatekeeper or health care
coordinator to forward to the recipient's physician, gatekeeper, or
health care coordinator information concerning the eye health care
services provided to the recipient.
(c) This section may not be construed to expand the scope of
eye health care services provided under the medical assistance
program.
(b) Subchapter A, Chapter 533, Government Code, is amended
by adding Section 533.0026 to read as follows:
Sec. 533.0026. DIRECT ACCESS TO EYE HEALTH CARE SERVICES
UNDER MEDICAID MANAGED CARE MODEL OR ARRANGEMENT. Notwithstanding
any other law, the commission shall ensure that a managed care plan
offered by a managed care organization that contracts with the
commission under this chapter and any other Medicaid managed care
model or arrangement implemented under this chapter allow a
Medicaid recipient who receives services through the plan or other
model or arrangement to, in the manner and to the extent required by
Section 32.072, Human Resources Code:
(1) select an ophthalmologist or therapeutic
optometrist to provide eye health care services; and
(2) have direct access to the selected ophthalmologist
or therapeutic optometrist for the provision of the services.
(c) The changes in law made by Section 533.0026, Government
Code, as added by this section, apply to a contract between the
Health and Human Services 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 section.