Texas 2019 - 86th Regular

Texas House Bill HB2353 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R13482 LED-D
2	2	By: Muñoz, Jr. H.B. No. 2353
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to administrative and other expenditures by Medicaid
8	8	managed care organizations.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter A, Chapter 533, Government Code, is
11	11	amended by adding Section 533.036 to read as follows:
12	12	Sec. 533.036. ADMINISTRATIVE AND OTHER EXPENDITURES. (a)
13	13	The legislature, after consulting with the commission, may set in
14	14	the General Appropriations Act an upper limit on the percentage or
15	15	amount of Medicaid capitated or other premium payments that a
16	16	managed care organization offering a Medicaid managed care plan may
17	17	spend on administrative, overhead, and marketing costs in each year
18	18	of the state fiscal biennium.
19	19	(b) Not later than December 1 of each year, a managed care
20	20	organization offering a Medicaid managed care plan shall report to
21	21	the legislature and the commission for the preceding state fiscal
22	22	year:
23	23	(1) the total amount of premium payments and other
24	24	state money received by the managed care organization, including a
25	25	list of the amount and date of each premium payment and the amount,
26	26	date, and source of each receipt of state money; and
27	27	(2) the amount and percentage of premium payments and
28	28	other state money that the managed care organization:
29	29	(A) spent on administrative, overhead, and
30	30	marketing costs;
31	31	(B) spent on clinical or pharmaceutical
32	32	reimbursement for medical and pharmaceutical services provided to
33	33	enrollees;
34	34	(C) paid to subcontractors, including a list of
35	35	the identity of and the amount paid to each subcontractor; and
36	36	(D) retained as profit.
37	37	(c) If a managed care organization contracts with a
38	38	subcontractor, the report must include a list of the amount of each
39	39	payment the subcontractor paid directly to a health care provider,
40	40	categorized by provider type.
41	41	(d) A managed care organization shall report the
42	42	information required by this section in an aggregate form that may
43	43	be organized by premium payments and other state money, service
44	44	delivery area, and provider type.
45	45	(e) A managed care organization may include in the report
46	46	the amount and percentage of premium payments and other state money
47	47	that the managed care organization spent on activities that improve
48	48	health care quality for enrollees and all other activities for
49	49	those enrollees but may not include that amount and percentage in
50	50	the amount and percentage reported under Subsection (b)(2)(B).
51	51	SECTION 2. If before implementing any provision of this Act
52	52	a state agency determines that a waiver or authorization from a
53	53	federal agency is necessary for implementation of that provision,
54	54	the agency affected by the provision shall request the waiver or
55	55	authorization and may delay implementing that provision until the
56	56	waiver or authorization is granted.
57	57	SECTION 3. This Act takes effect immediately if it receives
58	58	a vote of two-thirds of all the members elected to each house, as
59	59	provided by Section 39, Article III, Texas Constitution. If this
60	60	Act does not receive the vote necessary for immediate effect, this
61	61	Act takes effect September 1, 2019.