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  H.B. No. 3231
 
 
 
 
AN ACT
  relating to clarification of legislative intent regarding
  enrollment of newborns in Medicaid managed care plans and
  validating related acts and decisions.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  CLARIFICATION OF INTENT OF LEGISLATION. (a) In
  1993, this state began the transition to managed care for certain
  recipients of Medicaid services with pilot programs in Travis
  County and the tri-county area of Jefferson, Chambers, and
  Galveston Counties. Since that time, Medicaid managed care has
  been implemented in six additional service areas consisting of
  territory in Bexar, Tarrant, Lubbock, Harris, Dallas, El Paso, and
  Nueces Counties.  Total enrollment in Medicaid managed care is
  currently more than 2.5 million.
         (b)  In 1999, the legislature enacted H.B. No. 2896 (Chapter
  1447, Acts of the 76th Legislature, Regular Session, 1999) and H.B.
  No. 2641 (Chapter 1460, Acts of the 76th Legislature, Regular
  Session, 1999). Both bills included identical amendments to
  Section 533.0075, Government Code, as originally enacted in 1997,
  and addressed enrollment of Medicaid recipients in managed care
  programs.
         (c)  The 1999 amendments added Subdivisions (4), (5), and (6)
  to Section 533.0075, Government Code. Subdivision (4) required the
  Health and Human Services Commission to develop and implement an
  expedited process for determining eligibility for and enrolling
  pregnant women and newborns in managed care plans. Subdivision (5)
  required the commission to ensure immediate access to prenatal
  services and newborn care for pregnant women and newborns enrolled
  in managed care plans. Subdivision (6) required the commission to
  temporarily assign newborns to the traditional fee-for-services
  component of Medicaid for a period not to exceed 60 days or the date
  on which the newborn's eligibility determination is completed.
         (d)  The legislature, in enacting Subdivisions (4), (5), and
  (6) of Section 533.0075, Government Code, understood that the
  Health and Human Services Commission had enrolled newborns in
  Medicaid managed care plans and intended that the commission would
  continue to enroll newborns in Medicaid managed care plans. In
  particular, the legislature intended that, under the express terms
  of Subdivision (4), the commission would expedite the enrollment of
  newborns whose Medicaid eligibility is known at the time of birth
  into managed care plans to ensure access to care and to avoid delays
  in payment for services. The legislature has appropriated state
  and federal funds to the commission for the payment of capitated
  rates to managed care organizations that have contracted with the
  commission to provide this coverage to newborns.
         (e)  Subdivision (6) of Section 533.0075, Government Code,
  was intended to address delays in payment that health care
  providers in Medicaid managed care pilot areas experienced at the
  time of the subdivision's enactment for services provided to a
  newborn who was ultimately enrolled in Medicaid but whose Medicaid
  eligibility was not determined at the time of birth. The
  legislature, in enacting Subdivision (6), did not intend to nullify
  or supersede Subdivisions (4) and (5) or prohibit enrollment of
  newborns in a Medicaid managed care plan. Rather, the legislature
  intended to ensure that a newborn whose Medicaid eligibility was
  not known or not determined at birth would receive medically
  necessary care after the newborn's birth but before completion of
  the Medicaid eligibility determination process, and that a provider
  who provides care for the newborn receives reimbursement for the
  provider's services.
         (f)  The legislature understands that the delays in payment
  that prompted the enactment of Subdivision (6) have largely been
  resolved by more efficient and timely enrollment processes and that
  providers who supply services to newborns do not experience delays
  or denials of payment solely because of a delay in Medicaid
  eligibility determination. Accordingly, the legislature finds
  that the purposes of Subdivision (6) have been fulfilled and the
  requirements of that provision are no longer necessary to ensure
  appropriate payment of providers of services to newborns.
         SECTION 2.  CLARIFYING AMENDMENT. Section 533.0075,
  Government Code, is amended to read as follows:
         Sec. 533.0075.  RECIPIENT ENROLLMENT.  The commission
  shall:
               (1)  encourage recipients to choose appropriate
  managed care plans and primary health care providers by:
                     (A)  providing initial information to recipients
  and providers in a region about the need for recipients to choose
  plans and providers not later than the 90th day before the date on
  which the commission plans to begin to provide health care services
  to recipients in that region through managed care;
                     (B)  providing follow-up information before
  assignment of plans and providers and after assignment, if
  necessary, to recipients who delay in choosing plans and providers;
  and
                     (C)  allowing plans and providers to provide
  information to recipients or engage in marketing activities under
  marketing guidelines established by the commission under Section
  533.008 after the commission approves the information or
  activities;
               (2)  consider the following factors in assigning
  managed care plans and primary health care providers to recipients
  who fail to choose plans and providers:
                     (A)  the importance of maintaining existing
  provider-patient and physician-patient relationships, including
  relationships with specialists, public health clinics, and
  community health centers;
                     (B)  to the extent possible, the need to assign
  family members to the same providers and plans; and
                     (C)  geographic convenience of plans and
  providers for recipients;
               (3)  retain responsibility for enrollment and
  disenrollment of recipients in managed care plans, except that the
  commission may delegate the responsibility to an independent
  contractor who receives no form of payment from, and has no
  financial ties to, any managed care organization;
               (4)  develop and implement an expedited process for
  determining eligibility for and enrolling pregnant women and
  newborn infants in managed care plans; and
               (5)  ensure immediate access to prenatal services and
  newborn care for pregnant women and newborn infants enrolled in
  managed care plans, including ensuring that a pregnant woman may
  obtain an appointment with an obstetrical care provider for an
  initial maternity evaluation not later than the 30th day after the
  date the woman applies for Medicaid[; and
               [(6)     temporarily assign Medicaid-eligible newborn
  infants to the traditional fee-for-service component of the state
  Medicaid program for a period not to exceed the earlier of:
                     [(A)  60 days; or
                     [(B)     the date on which the Texas Department of
  Human Services has completed the newborn's Medicaid eligibility
  determination, including assignment of the newborn's Medicaid
  eligibility number].
         SECTION 3.  VALIDATION OF ACTS OR DECISIONS BY HEALTH AND
  HUMAN SERVICES COMMISSION. (a) A governmental act taken or a
  decision made by the Health and Human Services Commission before
  the effective date of this Act to enroll a newborn infant in a
  managed care organization under the terms of a contract for managed
  care services authorized by Section 533.0075, Government Code, is
  conclusively presumed, as of the date the act or decision occurred,
  to be valid and to have occurred in accordance with all applicable
  law.
         (b)  This section does not apply to:
               (1)  an act or decision that was void at the time the
  act or decision occurred;
               (2)  an act or decision that violates the terms of
  federal law or a federal waiver; or
               (3)  an act or decision that, under a statute of this
  state or the United States, was a misdemeanor or felony at the time
  the act or decision occurred.
         SECTION 4.  EFFECTIVE DATE.  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, 2009.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 3231 was passed by the House on April
  28, 2009, by the following vote:  Yeas 149, Nays 0, 1 present, not
  voting.
 
  ______________________________
  Chief Clerk of the House   
 
 
         I certify that H.B. No. 3231 was passed by the Senate on May
  21, 2009, by the following vote:  Yeas 31, Nays 0.
 
  ______________________________
  Secretary of the Senate    
  APPROVED:  _____________________
                     Date          
   
            _____________________
                   Governor