S.B. No. 1648
  relating to the provision of benefits under the Medicaid program,
  including to recipients with complex medical needs.
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.024165 to read as follows:
  FOR FOSTER CARE YOUTH. (a) Using existing resources, the
  commission shall coordinate with the Department of Family and
  Protective Services to develop and implement a process to review a
  denial of services under the Medicaid managed care program on the
  basis of medical necessity for foster care youth.
         (b)  Not later than December 31, 2022, the commission and the
  Department of Family and Protective Services shall submit a report
  to the legislature that includes a summary of the process developed
  and implemented under Subsection (a).
         (c)  This section expires September 1, 2023.
         SECTION 2.  Section 531.024172(d), Government Code, is
  amended to read as follows:
         (d)  In implementing the electronic visit verification
               (1)  subject to Subsection (e), the executive
  commissioner shall adopt compliance standards for health care
  providers; and
               (2)  the commission shall ensure that:
                     (A)  the information required to be reported by
  health care providers is standardized across managed care
  organizations that contract with the commission to provide health
  care services to Medicaid recipients and across commission
                     (B)  processes required by managed care
  organizations to retrospectively correct data are standardized and
  publicly accessible to health care providers; [and]
                     (C)  standardized processes are established for
  addressing the failure of a managed care organization to provide a
  timely authorization for delivering services necessary to ensure
  continuity of care; and
                     (D)  a health care provider is allowed to enter a
  variable schedule into the electronic visit verification system.
         SECTION 3.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.0501, 531.0512, and 531.0605 to read
  as follows:
  MANAGEMENT. (a) The commission, in consultation with the
  Intellectual and Developmental Disability System Redesign Advisory
  Committee established under Section 534.053 and the STAR Kids
  Managed Care Advisory Committee, shall study the feasibility of
  creating an online portal for individuals to request to be placed
  and check the individual's placement on a Medicaid waiver program
  interest list. As part of the study, the commission shall determine
  the most appropriate and cost-effective automated method for
  determining the level of need of an individual seeking services
  through a Medicaid waiver program.
         (b)  Not later than January 1, 2023, the commission shall
  prepare and submit a report to the governor, the lieutenant
  governor, the speaker of the house of representatives, and the
  standing legislative committees with primary jurisdiction over
  health and human services that summarizes the commission's findings
  and conclusions from the study.
         (c)  Subsections (a) and (b) and this subsection expire
  September 1, 2023.
         (d)  The commission shall develop a protocol in the office of
  the ombudsman to improve the capture and updating of contact
  information for an individual who contacts the office of the
  ombudsman regarding Medicaid waiver programs or services.
  MODEL. The commission shall:
               (1)  develop a procedure to:
                     (A)  verify that a Medicaid recipient or the
  recipient's parent or legal guardian is informed regarding the
  consumer direction model and provided the option to choose to
  receive care under that model; and
                     (B)  if the individual declines to receive care
  under the consumer direction model, document the declination; and
               (2)  ensure that each Medicaid managed care
  organization implements the procedure.
  PROGRAM. (a) The commission shall collaborate with the STAR Kids
  Managed Care Advisory Committee, Medicaid recipients, family
  members of children with complex medical conditions, children's
  health care advocates, Medicaid managed care organizations, and
  other stakeholders to develop and implement a pilot program that is
  substantially similar to the program described by Section 3,
  Medicaid Services Investment and Accountability Act of 2019 (Pub.
  L. No. 116-16), to provide coordinated care through a health home
  to children with complex medical conditions.
         (b)  The commission shall seek guidance from the Centers for
  Medicare and Medicaid Services and the United States Department of
  Health and Human Services regarding the design of the program and,
  based on the guidance, may actively seek and apply for federal
  funding to implement the program.
         (c)  Not later than December 31, 2024, the commission shall
  prepare and submit a report to the legislature that includes:
               (1)  a summary of the commission's implementation of
  the pilot program; and
               (2)  if the pilot program has been operating for a
  period sufficient to obtain necessary data, a summary of the
  commission's evaluation of the effect of the pilot program on the
  coordination of care for children with complex medical conditions
  and a recommendation as to whether the pilot program should be
  continued, expanded, or terminated.
         (d)  The pilot program terminates and this section expires
  September 1, 2025.
         SECTION 4.  The heading to Section 533.038, Government Code,
  is amended to read as follows:
         SECTION 5.  Section 533.038, Government Code, is amended by
  amending Subsection (g) and adding Subsections (h) and (i) to read
  as follows:
         (g)  The commission shall develop a clear and easy process,
  to be implemented through a contract, that allows a recipient with
  complex medical needs who has established a relationship with a
  specialty provider to continue receiving care from that provider,
  regardless of whether the recipient has primary health benefit plan
  coverage in addition to Medicaid coverage.
         (h)  If a recipient who has complex medical needs wants to
  continue to receive care from a specialty provider that is not in
  the provider network of the Medicaid managed care organization
  offering the managed care plan in which the recipient is enrolled,
  the managed care organization shall develop a simple, timely, and
  efficient process to and shall make a good-faith effort to,
  negotiate a single-case agreement with the specialty provider.
  Until the Medicaid managed care organization and the specialty
  provider enter into the single-case agreement, the specialty
  provider shall be reimbursed in accordance with the applicable
  reimbursement methodology specified in commission rule, including
  1 T.A.C. Section 353.4.
         (i)  A single-case agreement entered into under this section
  is not considered accessing an out-of-network provider for the
  purposes of Medicaid managed care organization network adequacy
         SECTION 6.  Section 32.054, Human Resources Code, is amended
  by adding Subsection (f) to read as follows:
         (f)  To prevent serious medical conditions and reduce
  emergency room visits necessitated by complications resulting from
  a lack of access to dental care, the commission shall provide
  medical assistance reimbursement for preventive dental services,
  including reimbursement for one preventive dental care visit per
  year, for an adult recipient with a disability who is enrolled in
  the STAR+PLUS Medicaid managed care program. This subsection does
  not apply to an adult recipient who is enrolled in the STAR+PLUS
  home and community-based services (HCBS) waiver program. This
  subsection may not be construed to reduce dental services available
  to persons with disabilities that are otherwise reimbursable under
  the medical assistance program.
         SECTION 7.  Section 531.0601(f), Government Code, is
         SECTION 8.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money to the commission specifically for
  that purpose. If the legislature does not appropriate money
  specifically for that purpose, the commission may, but is not
  required to, implement a provision of this Act using other
  appropriations that are available for that purpose.
         SECTION 9.  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 10.  This Act takes effect September 1, 2021.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I hereby certify that S.B. No. 1648 passed the Senate on
  May 12, 2021, by the following vote:  Yeas 30, Nays 0;
  May 27, 2021, Senate refused to concur in House amendments and
  requested appointment of Conference Committee; May 28, 2021, House
  granted request of the Senate; May 30, 2021, Senate adopted
  Conference Committee Report by the following vote:  Yeas 31,
  Nays 0.
  Secretary of the Senate    
         I hereby certify that S.B. No. 1648 passed the House, with
  amendments, on May 24, 2021, by the following vote:  Yeas 141,
  Nays 1, one present not voting; May 28, 2021, House granted request
  of the Senate for appointment of Conference Committee;
  May 30, 2021, House adopted Conference Committee Report by the
  following vote:  Yeas 137, Nays 0, two present not voting.
  Chief Clerk of the House