86R13482 LED-D
By: Muñoz, Jr. H.B. No. 2353
A BILL TO BE ENTITLED
AN ACT
relating to administrative and other expenditures by Medicaid
managed care organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.036 to read as follows:
Sec. 533.036. ADMINISTRATIVE AND OTHER EXPENDITURES. (a)
The legislature, after consulting with the commission, may set in
the General Appropriations Act an upper limit on the percentage or
amount of Medicaid capitated or other premium payments that a
managed care organization offering a Medicaid managed care plan may
spend on administrative, overhead, and marketing costs in each year
of the state fiscal biennium.
(b) Not later than December 1 of each year, a managed care
organization offering a Medicaid managed care plan shall report to
the legislature and the commission for the preceding state fiscal
year:
(1) the total amount of premium payments and other
state money received by the managed care organization, including a
list of the amount and date of each premium payment and the amount,
date, and source of each receipt of state money; and
(2) the amount and percentage of premium payments and
other state money that the managed care organization:
(A) spent on administrative, overhead, and
marketing costs;
(B) spent on clinical or pharmaceutical
reimbursement for medical and pharmaceutical services provided to
enrollees;
(C) paid to subcontractors, including a list of
the identity of and the amount paid to each subcontractor; and
(D) retained as profit.
(c) If a managed care organization contracts with a
subcontractor, the report must include a list of the amount of each
payment the subcontractor paid directly to a health care provider,
categorized by provider type.
(d) A managed care organization shall report the
information required by this section in an aggregate form that may
be organized by premium payments and other state money, service
delivery area, and provider type.
(e) A managed care organization may include in the report
the amount and percentage of premium payments and other state money
that the managed care organization spent on activities that improve
health care quality for enrollees and all other activities for
those enrollees but may not include that amount and percentage in
the amount and percentage reported under Subsection (b)(2)(B).
SECTION 2. 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 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2019.