85R8360 LED-D
By: Muñoz, Jr. H.B. No. 1524
A BILL TO BE ENTITLED
AN ACT
relating to transparency in the rate-setting processes for the
Medicaid managed care and child health plan programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.01314 to read as follows:
Sec. 533.01314. TRANSPARENCY OF PREMIUM PAYMENT
RATE-SETTING PROCESS FOR MEDICAID MANAGED CARE PROGRAM. (a) The
commission shall ensure the transparency of the premium payment
rate-setting process for the Medicaid managed care program by
publishing actuarial reports:
(1) in a format that allows for tracing data and
formulas across attachments, exhibits, and examples; and
(2) that clearly identify and describe:
(A) the methodology by which the executive
commissioner set the payment rates;
(B) the data sources used;
(C) the components of the process that are
assumptions and how the assumptions are developed;
(D) multipliers and factors used throughout the
reports, including the source and purpose of the multipliers and
factors; and
(E) the methodology by which the executive
commissioner determined that the rates are actuarially sound for
the populations covered and the services provided.
(b) Notwithstanding Subsection (a), the commission is not
required to publish particular information in an actuarial report
if the commission determines the information is proprietary.
SECTION 2. Subchapter B, Chapter 62, Health and Safety
Code, is amended by adding Section 62.061 to read as follows:
Sec. 62.061. TRANSPARENCY OF PREMIUM PAYMENT RATE-SETTING
PROCESS. (a) The commission shall ensure the transparency of the
premium payment rate-setting process for the child health plan
program by publishing actuarial reports:
(1) in a format that allows for tracing data and
formulas across attachments, exhibits, and examples; and
(2) that clearly identify and describe:
(A) the methodology by which the executive
commissioner set the payment rates;
(B) the data sources used;
(C) the components of the process that are
assumptions and how the assumptions are developed;
(D) multipliers and factors used throughout the
reports, including the source and purpose of the multipliers and
factors; and
(E) the methodology by which the executive
commissioner determined that the rates are actuarially sound for
the populations covered and the services provided.
(b) Notwithstanding Subsection (a), the commission is not
required to publish particular information in an actuarial report
if the commission determines the information is proprietary.
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, 2017.