S.B. No. 1648

	AN ACT
	relating to the provision of benefits under the Medicaid program,
	including to recipients with complex medical needs.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subchapter B, Chapter 531, Government Code, is
	amended by adding Section 531.024165 to read as follows:
	Sec. 531.024165.  MEDICAL REVIEW OF MEDICAID SERVICE DENIALS
	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
	system:
	(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
	programs;
	(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:
	Sec. 531.0501.  MEDICAID WAIVER PROGRAMS: INTEREST LIST
	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.
	Sec. 531.0512.  NOTIFICATION REGARDING CONSUMER DIRECTION
	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.
	Sec. 531.0605.  ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT
	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:
	Sec. 533.038.  COORDINATION OF BENEFITS; CONTINUITY OF
	SPECIALTY CARE FOR CERTAIN RECIPIENTS.
	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
	requirements.
	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
	repealed.
	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
	Approved:
	______________________________
	Date
	______________________________
	Governor