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Relating to the provision of certain benefits under Medicaid, including the coordination of private health benefits, and to reimbursement for some of those benefits.
The fiscal implications of the bill cannot be determined at this time because it in unknown how many Medicaid recipients with complex medical needs who do not have primary health benefit plan coverage would receive services from an out-of-network specialty provider.
The Health and Human Services Commission is required to implement a provision of this Act only if the legislature appropriate money 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 the Act using other appropriations available for that purpose.
SB 1648 would ensure that Medicaid coverage meets the complex medical needs of patients and ensures that continuity of care applies regardless of whether or not they have a primary health benefit plan coverage in addition to Medicaid coverage.
SB 1648 would also require a managed care organization to negotiate a single-case agreement with a specialty provider for a recipient who has complex medical needs and who does not have primary health benefit plan coverage wants to continue to receive care from a specialty provider that is not in the provider network of the Medicaid managed care organization. Until the Medicaid managed care organization and the specialty provider enter into an agreement, the specialty provider would have to be reimbursed in accordance with the applicable reimbursement methodology.
SB 1648 would consider single-case agreements not to be accessing an out-of-network provider for the purposes of Medicaid managed care organization network adequacy requirements.
Texas Action is neutral toward SB 1648.