By: Kolkhorst  S.B. No. 1927          (In the Senate - Filed March 10, 2017; March 27, 2017, read   first time and referred to Committee on Health & Human Services;   April 24, 2017, reported adversely, with favorable Committee   Substitute by the following vote:  Yeas 9, Nays 0; April 24, 2017,   sent to printer.)Click here to see the committee vote    COMMITTEE SUBSTITUTE FOR S.B. No. 1927 By:  Kolkhorst     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.     * * * * *