foster medical consenters can pay for out-of-network care

The text as introduced · 536 words

89R6287 RAL-D

By: Sparks
S.B. No. 855

A BILL TO BE ENTITLED

AN ACT

relating to the authority of certain medical consenters to assume

financial responsibility for certain out-of-network medical care

provided to children in foster care.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 266, Family Code, is amended by adding

Section 266.0043 to read as follows:

Sec. 266.0043. ASSUMPTION OF FINANCIAL RESPONSIBILITY BY

MEDICAL CONSENTERS. (a) In this section:

(1) "Health care provider" means an individual who is

licensed, certified, or otherwise authorized to provide health care

services in this state.

(2) "Managed care plan" has the meaning assigned by

Section 540.0001, Government Code.

(3) "Medicaid" and "Medicaid managed care

organization" have the meanings assigned by Section 521.0001,

Government Code.

(4) "Medicaid managed care plan" means a managed care

plan offered by a Medicaid managed care organization.

(5) "Medical consenter" means a person authorized to

consent to medical care for a foster child under Section

266.004(b).

(6) "Out-of-network provider" means a health care

provider who is not included in the provider network of the Medicaid

managed care plan in which a foster child is enrolled.

(b) Notwithstanding any other law, a medical consenter

other than the department may assume financial responsibility for

medical care, including behavioral health services, provided to a

foster child by an out-of-network provider engaged by the medical

consenter on behalf of the child.

(c) The department is not liable for the cost of medical

care described by Subsection (b).

(d) This section may not be construed to limit or restrict a

foster child's access to Medicaid benefits, including in-network

benefits provided under the Medicaid managed care program.

(e) Not later than the 10th business day after the date

medical care for which a medical consenter assumes financial

responsibility under this section is provided, the medical

consenter shall notify, in the form and manner prescribed by the

department, the child's caseworker of the provision of that care.

The department shall ensure the child's health passport includes

records of the medical care provided under this section.

SECTION 2. Subchapter Q, Chapter 540, Government Code, as

effective April 1, 2025, is amended by adding Section 540.0807 to

read as follows:

Sec. 540.0807. ACCESS TO CARE PAID FOR BY CERTAIN MEDICAL

CONSENTERS. (a) A Medicaid managed care organization may not take

adverse action to prevent or discourage a recipient from accessing

health care and related services and benefits in accordance with

Section 266.0043, Family Code.

(b) A STAR Health program managed care contract between a

Medicaid managed care organization and the commission must require

that the organization comply with Subsection (a).

(c) This section may not be construed to confer liability on

a Medicaid managed care organization for the cost of health care and

related services and benefits described by Section 266.0043(b),

Family Code.

SECTION 3. 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 4. This Act takes effect September 1, 2025.