By: Kolkhorst S.B. No. 1927
 
  (Raymond)
 
   
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to requiring the Health and Human Services Commission to
  evaluate and implement changes to the Medicaid and child health
  plan programs to make the programs more cost-effective, increase
  competition among providers, and improve health outcomes for
  recipients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02142 to read as follows:
         Sec. 531.02142.  PUBLIC ACCESS TO CERTAIN MEDICAID DATA.
  (a)  To the extent permitted by federal law, the commission shall
  make available to the public on its Internet website in an
  easy-to-read format data relating to the quality of health care
  received by recipients and the health outcomes of recipients under
  Medicaid. Data made available to the public under this section must
  be made available in a manner that does not identify or allow for
  the identification of individual recipients.
         (b)  In performing its duties under this section, the
  commission may collaborate with an institution of higher education
  or another state agency with experience in analyzing and producing
  public use data.
         SECTION 2.  Section 531.1131, Government Code, is amended by
  amending Subsections (a), (b), and (c) and adding Subsections
  (c-1), (c-2), and (c-3) to read as follows:
         (a)  If a managed care organization [organization's special
  investigative unit under Section 531.113(a)(1)] or an [the] entity
  with which the managed care organization contracts under Section
  531.113(a)(2) discovers fraud or abuse in Medicaid or the child
  health plan program, the organization [unit] or entity shall:
               (1)  immediately submit written notice to [and
  contemporaneously notify] the commission's office of inspector
  general and the office of the attorney general in the form and
  manner prescribed by the office of inspector general and containing
  a detailed description of the fraud or abuse and each payment made
  to a provider as a result of the fraud or abuse;
               (2)  subject to Subsection (b), begin payment recovery
  efforts; and
               (3)  ensure that any payment recovery efforts in which
  the organization engages are in accordance with applicable rules
  adopted by the executive commissioner.
         (b)  If the amount sought to be recovered under Subsection
  (a)(2) exceeds $100,000, the managed care organization
  [organization's special investigative unit] or the contracted
  entity described by Subsection (a) may not engage in payment
  recovery efforts if, not later than the 10th business day after the
  date the organization [unit] or entity notified the commission's
  office of inspector general and the office of the attorney general
  under Subsection (a)(1), the organization [unit] or entity receives
  a notice from either office indicating that the organization [unit]
  or entity is not authorized to proceed with recovery efforts.
         (c)  A managed care organization may retain one-half of any
  money recovered under Subsection (a)(2) by the organization
  [organization's special investigative unit] or the contracted
  entity described by Subsection (a). The managed care organization
  shall remit the remaining amount of money recovered under
  Subsection (a)(2) to the commission's office of inspector general
  for deposit to the credit of the general revenue fund.
         (c-1)  If the commission's office of inspector general
  notifies a managed care organization under Subsection (b), proceeds
  with recovery efforts, and recovers all or part of the payments the
  organization identified as required by Subsection (a)(1), the
  organization is entitled to one-half of the amount recovered for
  each payment the organization identified after any applicable
  federal share is deducted. The organization may not receive more
  than one-half of the total amount of money recovered after any
  applicable federal share is deducted.
         (c-2)  Notwithstanding any provision of this section, if the
  commission's office of inspector general discovers fraud, waste, or
  abuse in Medicaid or the child health plan program in the
  performance of its duties, the office may recover payments made to a
  provider as a result of the fraud, waste, or abuse as otherwise
  provided by this subchapter.  All payments recovered by the office
  under this subsection shall be deposited to the credit of the
  general revenue fund.
         (c-3)  The commission's office of inspector general shall
  coordinate with appropriate managed care organizations to ensure
  that the office and an organization or an entity with which an
  organization contracts under Section 531.113(a)(2) do not both
  begin payment recovery efforts under this section for the same case
  of fraud, waste, or abuse.
         SECTION 3.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Sections 533.023 and 533.024 to read as follows:
         Sec. 533.023.  OPTIONS FOR ESTABLISHING COMPETITIVE
  PROCUREMENT PROCESS. Not later than December 1, 2018, the
  commission shall develop and analyze options, including the
  potential costs of and cost savings that may be achieved by the
  options, for establishing a range of rates within which a managed
  care organization must bid during a competitive procurement process
  to contract with the commission to arrange for or provide a managed
  care plan.  This section expires September 1, 2019.
         Sec. 533.024.  ASSESSMENT OF STATEWIDE MANAGED CARE PLANS.
  (a)  Not later than December 1, 2018, the commission shall assess
  the feasibility and cost-effectiveness of contracting with managed
  care organizations to arrange for or provide managed care plans to
  recipients throughout the state instead of on a regional basis.  In
  conducting the assessment, the commission shall consider:
               (1)  regional variations in the cost of and access to
  health care services;
               (2)  recipient access to and choice of providers;
               (3)  the potential impact on providers, including
  safety net providers; and
               (4)  public input.
         (b)  This section expires September 1, 2019.
         SECTION 4.  (a)  Using existing resources, the Health and
  Human Services Commission shall:
               (1)  identify and evaluate barriers preventing
  Medicaid recipients enrolled in the STAR + PLUS Medicaid managed
  care program or a home and community-based services waiver program
  from choosing the consumer directed services option and develop
  recommendations for increasing the percentage of Medicaid
  recipients enrolled in those programs who choose the consumer
  directed services option; and
               (2)  study the feasibility of establishing a community
  attendant registry to assist Medicaid recipients enrolled in the
  community attendant services program in locating providers.
         (b)  Not later than December 1, 2018, the Health and Human
  Services Commission shall submit a report containing the
  commission's findings and recommendations under Subsection (a) of
  this section to the governor, the legislature, and the Legislative
  Budget Board.  The report required by this subsection may be
  combined with any other report required by this Act or other law.
         SECTION 5.  (a)  The Health and Human Services Commission
  shall conduct a study to evaluate the 30-day limitation on
  reimbursement for inpatient hospital care provided to Medicaid
  recipients enrolled in the STAR + PLUS Medicaid managed care
  program under 1 T.A.C. Section 354.1072(a)(1) and other applicable
  law. In evaluating the limitation and to the extent data is
  available on the subject, the commission shall consider:
               (1)  the number of Medicaid recipients affected by the
  limitation and their clinical outcomes;
               (2)  the types of providers providing health care
  services to Medicaid recipients who have been denied Medicaid
  coverage because of the limitation;
               (3)  the impact of the limitation on the providers
  described in Subdivision (2) of this subsection;
               (4)  the appropriateness of hospitals using money
  received under the uncompensated care payment program established
  under the Texas Health Care Transformation and Quality Improvement
  Program waiver issued under Section 1115 of the federal Social
  Security Act (42 U.S.C. Section 1315) to pay for health care
  services provided to Medicaid recipients who have been denied
  Medicaid coverage because of the limitation; and
               (5)  the impact of the limitation on reducing
  unnecessary Medicaid inpatient hospital days and any cost savings
  achieved by the limitation under Medicaid.
         (b)  Not later than December 1, 2018, the Health and Human
  Services Commission shall submit a report containing the results of
  the study conducted under Subsection (a) of this section to the
  governor, the legislature, and the Legislative Budget Board. The
  report required under this subsection may be combined with any
  other report required by this Act or other law.
         SECTION 6.  (a)  The Health and Human Services Commission
  shall conduct a study of the provision of dental services to adults
  with disabilities under the Medicaid program, including:
               (1)  the types of dental services provided, including
  preventive dental care, emergency dental services, and
  periodontal, restorative, and prosthodontic services;
               (2)  limits or caps on the types and costs of dental
  services provided;
               (3)  unique considerations in providing dental care to
  adults with disabilities, including additional services necessary
  for adults with particular disabilities; and
               (4)  the availability and accessibility of dentists who
  provide dental care to adults with disabilities, including the
  availability of dentists who provide additional services necessary
  for adults with particular disabilities.
         (b)  In conducting the study under Subsection (a) of this
  section, the Health and Human Services Commission shall:
               (1)  identify the number of adults with disabilities
  whose Medicaid benefits include limited or no dental services and
  who, as a result, have sought medically necessary dental services
  during an emergency room visit;
               (2)  if feasible, estimate the number of adults with
  disabilities who are receiving services under the Medicaid program
  and who have access to alternative sources of dental care,
  including pro bono dental services, faith-based dental services
  providers, and other public health care providers; and
               (3)  collect data on the receipt of dental services
  during emergency room visits by adults with disabilities who are
  receiving services under the Medicaid program, including the
  reasons for seeking dental services during an emergency room visit
  and the costs of providing the dental services during an emergency
  room visit, as compared to the cost of providing the dental services
  in the community.
         (c)  Not later than December 1, 2018, the Health and Human
  Services Commission shall submit a report containing the results of
  the study conducted under Subsection (a) of this section and the
  commission's recommendations for improving access to dental
  services in the community for and reducing the provision of dental
  services during emergency room visits to adults with disabilities
  receiving services under the Medicaid program to the governor, the
  legislature, and the Legislative Budget Board.  The report required
  by this subsection may be combined with any other report required by
  this Act or other law.
         SECTION 7.  Section 531.1131, Government Code, as amended by
  this Act, applies only to an amount of money recovered on or after
  the effective date of this Act. An amount of money recovered 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 8.  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 9.  This Act takes effect September 1, 2017.