By: Zerwas H.B. No. 3158
A BILL TO BE ENTITLED
AN ACT
relating to certain contracts for Medicaid managed care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.01. Subchapter B, Chapter 32, Human Resources
Code is amended by adding Sec. 32.0491, and 32.492, to read as
follows:
Sec. 32.491. PILOT PROJECTS TO ENCOURAGE MANAGED CARE
CONTRACTING WITH HEALTH CARE COLLABORATIVES. (a) In this section,
"health care collaboratives" has the meaning assigned by Section
848.001, Insurance Code.
(b) In this section, a "delegation agreement" means a
contract that complies with Chapter 1272, Insurance Code.
(c) The department shall develop and implement a managed
care contracting pilot program that is consistent with federal law
to:
(1) promote efficient utilization of Medicaid
services by recipients; and
(2) demonstrate the ability of provider-owned managed
care organizations to improve patient outcomes and contain costs
for providing medical assistance to recipients within their service
delivery area.
(d) The department may develop and implement pilot programs
in accordance with this subchapter to test one or more service
delivery models that provide medical assistance for acute care
through a health maintenance organization that executes a
delegation agreement with a health care collaborative under Chapter
848, Insurance Code. The Commissioner may contract with such a
health maintenance organization to implement the pilot Medicaid
managed care program under this chapter, provided, however, that:
(1) the delegation agreement between the health care
collaborative and the health maintenance organization complies
with state and federal law; and
(2) at least one of the pilot programs established
under this subchapter is conducted with a provider-managed health
maintenance organization that is owned by a not-for-profit
pediatric facility.
Sec. 32.492. IMPLEMENTATION, LOCATION AND DURATION.
(a) The department shall implement the pilot programs established
under this subchapter not later than September 1, 2015.
(b) A pilot program established under this subchapter shall
be conducted in a service delivery area that has over 400,000
combined STAR and CHIP eligibles; maintains three or less managed
care organizations in that service delivery area; and has at least
one existing managed care organization with over 40 percent market
share in either STAR or CHIP programs.
(c) A pilot program established under this subchapter must
operate for not less than 36 months and may be extended as the
commissioner deems appropriate.
(d) If at the conclusion of the period specified by
subsection (c) the department evaluates the strengths and
weaknesses of each implemented pilot program and determines the
feasibility of expanding the pilot program statewide, the
department may adopt improved policies and procedures with
statewide applicability, as determined from the information
obtained in operating the pilot program, to ensure effective
provision of medical assistance to recipients statewide.
SECTION 2. Chapter 316, Health and Safety Code, is amended
as follows:
SECTION 2.01. Section 316.001, Health and Safety Code, is
amended to read as follows:
316.001. AUTHORITY TO ESTABLISH HEALTH CARE COLLABORATIVE.
A public hospital created under Subtitle C or D, a facility that is
owned or operated by a public or not-for-profit hospital and that
includes academic health center, or a hospital district created
under general or special law may form and sponsor a nonprofit health
care collaborative that is certified under Chapter 848, Insurance
Code, or otherwise exempt from certification under Section 848.002,
Insurance Code.
SECTION 3. This Act takes effect September 1, 2013.