Texas SB 2225: Relating to early childhood intervention and rehabilitative and habilitative services.

Bill Text

By:AAZaffirini S.B.ANo.A2225
A BILL TO BE ENTITLED
AN ACT
relating to early childhood intervention and rehabilitative and
habilitative services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTIONA1.AASubchapter A, Chapter 533, Government Code, is
amended by adding Section 533.00521 to read as follows:
Sec.A533.00521.AAPRIOR AUTHORIZATION NOT REQUIRED FOR
CERTAIN EARLY CHILDHOOD INTERVENTION SERVICES. (a) A managed care
organization that contracts with the commission to provide health
care services to recipients under the STAR Health program or the
STAR Kids managed care program may not require prior authorization
for the provision of early childhood intervention program services
under Chapter 73, Human Resources Code, to a child eligible for the
program, including services specified in the child’s
individualized family service plan issued by the commission under
the program.
(b)AAA contract between a managed care organization and the
commission for the organization to provide health care services to
recipients under the STAR Health program or the STAR Kids managed
care program must contain a requirement that the organization:
(1)AAproactively review and monitor recipient access
and utilization of early childhood intervention services under
Chapter 73, Human Resources Code; and
(2)AAdemonstrate to the commission that the
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organization is in compliance with Subsection (a), including a
requirement that the organization submit quarterly reports to the
commission that verify that the organization did not include a
prior authorization request for early childhood intervention
services under Chapter 73, Human Resources Code, as part of a
medical necessity determination.
SECTIONA2.AASection 73.009(a), Human Resources Code, is
amended to read as follows:
(a)AAThe commission [department] shall develop and the
executive commissioner shall establish policies concerning
services described by this section. A child under three years of
age and the child’s parent, guardian, or other legally authorized
representative [family] may be referred for services described by
this section if the child is:
(1)AAidentified as having a developmental delay;
(2)AAsuspected of having a developmental delay; or
(3)AAconsidered at risk of developmental delay.
SECTIONA3.AAChapter 73, Human Resources Code, is amended by
adding Sections 73.0111 and 73.012 to read as follows:
Sec.A73.0111.AAPROVIDER OMBUDSMAN. (a) In this section,
"ombudsman" means the individual designated as the ombudsman for
providers of services authorized under this chapter.
(b)AAThe executive commissioner shall designate an ombudsman
for providers of services authorized under this chapter.
(c)AAThe ombudsman’s office is administratively attached to
the office of the ombudsman of the commission.
(d)AAThe commission may use an alternate title for the
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ombudsman in provider-directed materials if the commission
determines that the alternate title would benefit providers’
understanding of or access to ombudsman services.
(e)AAThe ombudsman serves as a neutral party to assist
providers of services authorized under this chapter in resolving
issues related to providing early childhood intervention services
under this chapter, including through the STAR Kids managed care
program.
(f)AAThe ombudsman shall:
(1)AAprovide dispute and complaint resolution
services;
(2)AAperform provider protection and advocacy
functions;
(3)AAcollect inquiry and complaint data; and
(4)AAat least annually, submit a report to the
commission relating to the inquiry and complaint data collected
under Subdivision (3) and make recommendations to the commission on
how to improve the provision of early childhood intervention
services under this chapter.
(g)AAThe executive commissioner by rule shall adopt and
ensure the use of procedures for the reporting, monitoring, and
resolution of disputes and complaints described by Subsection (f)
that are consistent with the procedures adopted and used under
Medicaid.
Sec.A73.012.AAGUIDANCE ON REIMBURSEMENT METHODOLOGY FOR CASE
MANAGEMENT SERVICES. (a) The executive commissioner shall request
clear direction and guidance from the federal Centers for Medicare
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and Medicaid Services on the reimbursement methodology that may be
used for the provision of case management services under this
chapter, including direction on allowable and unallowable costs.
(b)AAThis section expires September 1, 2021.
SECTIONA4.AASubtitle B, Title 3, Human Resources Code, is
amended by adding Chapter 74 to read as follows:
CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
Sec.A74.0001.AADEFINITIONS. In this chapter:
(1)AA"Commission" means the Health and Human Services
Commission.
(2)AA"Eligible child" means a child who is eligible for
early