| 1 | 1 | | 86R13478 KLA-F |
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| 2 | 2 | | By: Miller H.B. No. 3245 |
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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 considerations in awarding contracts under the Medicaid |
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| 8 | 8 | | 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. Section 533.001, Government Code, is amended by |
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| 11 | 11 | | adding Subdivision (6-a) to read as follows: |
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| 12 | 12 | | (6-a) "Social determinants of health" means the |
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| 13 | 13 | | environmental conditions in which a person is born, lives, learns, |
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| 14 | 14 | | works, plays, worships, and ages that affect a range of health, |
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| 15 | 15 | | functional, and quality of life outcomes and risks. |
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| 16 | 16 | | SECTION 2. Section 533.003(a), Government Code, is amended |
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| 17 | 17 | | to read as follows: |
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| 18 | 18 | | (a) In awarding contracts to managed care organizations, |
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| 19 | 19 | | the commission shall: |
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| 20 | 20 | | (1) give preference to organizations that have |
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| 21 | 21 | | significant participation in the organization's provider network |
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| 22 | 22 | | from each health care provider in the region who has traditionally |
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| 23 | 23 | | provided care to Medicaid and charity care patients; |
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| 24 | 24 | | (2) give extra consideration to organizations that |
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| 25 | 25 | | agree to assure continuity of care for at least three months beyond |
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| 26 | 26 | | the period of Medicaid eligibility for recipients; |
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| 27 | 27 | | (3) consider the need to use different managed care |
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| 28 | 28 | | plans to meet the needs of different populations; |
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| 29 | 29 | | (4) consider the ability of organizations to process |
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| 30 | 30 | | Medicaid claims electronically; and |
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| 31 | 31 | | (5) give extra consideration to organizations that use |
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| 32 | 32 | | enriched data sets incorporating social determinants of health to |
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| 33 | 33 | | manage socially complex populations in a manner that achieves: |
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| 34 | 34 | | (A) cost savings through implementation of |
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| 35 | 35 | | appropriate interventions for those populations; and |
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| 36 | 36 | | (B) favorable health outcomes for those |
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| 37 | 37 | | populations by reducing preventable emergency room visits, |
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| 38 | 38 | | hospitalizations, and institutionalizations [in the initial |
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| 39 | 39 | | implementation of managed care in the South Texas service region, |
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| 40 | 40 | | give extra consideration to an organization that either: |
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| 41 | 41 | | [(A) is locally owned, managed, and operated, if |
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| 42 | 42 | | one exists; or |
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| 43 | 43 | | [(B) is in compliance with the requirements of |
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| 44 | 44 | | Section 533.004]. |
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| 45 | 45 | | SECTION 3. This Act takes effect immediately if it receives |
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| 46 | 46 | | a vote of two-thirds of all the members elected to each house, as |
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| 47 | 47 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 48 | 48 | | Act does not receive the vote necessary for immediate effect, this |
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| 49 | 49 | | Act takes effect September 1, 2019. |
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