85R12082 KKR-F     By: Hinojosa S.B. No. 2228       A BILL TO BE ENTITLED   AN ACT   relating to the provision of eye health care by certain   professionals and institutions as providers in the Medicaid managed   care program.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 32.072(a), Human Resources Code, is   amended to read as follows:          (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, other than surgery, 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 nonsurgical   services without any requirement that the patient or   ophthalmologist or therapeutic optometrist [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.          SECTION 2.  Subchapter B, Chapter 531, Government Code, is   amended by adding Section 531.021191 to read as follows:          Sec. 531.021191.  MEDICAID ENROLLMENT OF CERTAIN EYE HEALTH   CARE PROVIDERS. (a)  This section applies only to:                (1)  an optometrist who is licensed by the Texas   Optometry Board;                (2)  a therapeutic optometrist who is licensed by the   Texas Optometry Board;                (3)  an ophthalmologist who is licensed by the Texas   Medical Board; and                (4)  an institution of higher education that provides   an accredited program for:                      (A)  training as a Doctor of Optometry or an   optometrist residency; or                      (B)  training as an ophthalmologist or an   ophthalmologist residency.          (b)  The commission may not prevent a provider to whom this   section applies from enrolling as a Medicaid provider if the   provider:                (1)  either:                      (A)  joins an established practice of a health   care provider or provider group that has a contract with a managed   care organization to provide health care services to recipients   under Chapter 533; or                      (B)  is employed by or otherwise compensated for   providing training at an institution of higher education described   by Subsection (a)(4);                (2)  applies to be an enrolled provider under the   Medicaid program;                (3)  if applicable, complies with the requirements of   the contract between the provider or the provider's group and the   applicable managed care organization; and                (4)  complies with all other applicable requirements   related to being a Medicaid provider.          (c)  The commission may not prevent an institution of higher   education from enrolling as a Medicaid provider if the institution:                (1)  has a contract with a managed care organization to   provide health care services to recipients under Chapter 533;                (2)  applies to be an enrolled provider under the   Medicaid program;                (3)  complies with the requirements of the contract   between the provider and the applicable managed care organization;   and                (4)  complies with all other applicable requirements   related to being a Medicaid provider.          SECTION 3.  Subchapter A, Chapter 533, Government Code, is   amended by adding Section 533.0067 to read as follows:          Sec. 533.0067.  EYE HEALTH CARE SERVICE PROVIDERS. Subject   to Section 32.047, Human Resources Code, but notwithstanding any   other law, the commission shall require that each managed care   organization that contracts with the commission under any Medicaid   managed care model or arrangement to provide health care services   to recipients in a region include in the organization's provider   network each optometrist, therapeutic optometrist, and   ophthalmologist described by Section 531.021191(b)(1)(A) or (B)   and an institution of higher education described by Section   531.021191(a)(4) in the region who:                (1)  agrees to comply with the terms and conditions of   the organization;                (2)  agrees to accept the prevailing provider contract   rate of the organization; and                (3)  agrees to abide by the standards of care required   by the organization.          SECTION 4.  (a) The Health and Human Services Commission   shall, in a contract between the commission and a Medicaid managed   care organization under Chapter 533, Government Code, that is   entered into or renewed on or after the effective date of this Act,   require that the managed care organization comply with Section   533.0067, Government Code, as added by this Act.          (b)  The Health and Human Services Commission shall seek to   amend each contract entered into with a Medicaid managed care   organization under Chapter 533, Government Code, before the   effective date of this Act to require those managed care   organizations to comply with Section 533.0067, Government Code, as   added by this Act. To the extent of a conflict between Section   533.0067, Government Code, as added by this Act, and a provision of   a contract with a managed care organization entered into before the   effective date of this Act, the contract provision prevails.          SECTION 5.  This Act may not be construed as authorizing or   requiring implementation of Medicaid managed care delivery models   in regions in this state in which those models are not used on the   effective date of this Act for the delivery of Medicaid services.          SECTION 6.  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 7.  This Act takes effect September 1, 2017.