| 1 | 1 | | 85R14946 JG-D |
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| 2 | 2 | | By: Muñoz, Jr. H.B. No. 3884 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the establishment of a schedule for the payment of |
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| 8 | 8 | | reimbursable claims under the Medicaid managed care program. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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| 11 | 11 | | amended by adding Section 533.0067 to read as follows: |
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| 12 | 12 | | Sec. 533.0067. REQUIRED CONTRACT PROVISIONS; SCHEDULE FOR |
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| 13 | 13 | | PAYMENT OF REIMBURSABLE CLAIMS. (a) A managed care organization |
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| 14 | 14 | | that contracts with the commission to provide health care services |
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| 15 | 15 | | to recipients shall establish a schedule for the payment of |
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| 16 | 16 | | reimbursable claims that complies with Sections 533.005(a)(7) and |
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| 17 | 17 | | (7-a) and include the schedule in a contract between the managed |
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| 18 | 18 | | care organization and a health care provider in the managed care |
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| 19 | 19 | | organization's provider network. |
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| 20 | 20 | | (b) If a managed care organization to which this section |
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| 21 | 21 | | applies delegates the payment of reimbursable claims to a third |
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| 22 | 22 | | party through a subcontract or otherwise, the third party shall |
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| 23 | 23 | | also pay those claims according to the schedule described by |
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| 24 | 24 | | Subsection (a). |
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| 25 | 25 | | SECTION 2. If before implementing any provision of this Act |
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| 26 | 26 | | a state agency determines that a waiver or authorization from a |
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| 27 | 27 | | federal agency is necessary for implementation of that provision, |
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| 28 | 28 | | the agency affected by the provision shall request the waiver or |
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| 29 | 29 | | authorization and may delay implementing that provision until the |
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| 30 | 30 | | waiver or authorization is granted. |
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| 31 | 31 | | SECTION 3. The change in law made by this Act applies only |
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| 32 | 32 | | to a contract between a managed care organization and a health care |
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| 33 | 33 | | provider entered into or renewed on or after the effective date of |
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| 34 | 34 | | this Act. A contract between a managed care organization and a |
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| 35 | 35 | | health care provider entered into or renewed before the effective |
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| 36 | 36 | | date of this Act is governed by the law applicable to the contract |
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| 37 | 37 | | immediately before the effective date of this Act, and that law is |
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| 38 | 38 | | continued in effect for that purpose. |
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| 39 | 39 | | SECTION 4. This Act takes effect September 1, 2017. |
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