Texas 2019 - 86th Regular

Texas Senate Bill SB2039 Compare Versions

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

Old	New	Differences
1	1	86R11130 KLA-D
2	2	By: Rodríguez S.B. No. 2039
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the inclusion of certain health care providers in the
8	8	provider network of a Medicaid managed care organization.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 533.006, Government Code, is amended by
11	11	amending Subsection (a) and adding Subsection (c) to read as
12	12	follows:
13	13	(a) The commission shall require that each managed care
14	14	organization that contracts with the commission to provide health
15	15	care services to recipients in a region:
16	16	(1) seek participation in the organization's provider
17	17	network from:
18	18	(A) each health care provider in the region who
19	19	has traditionally provided care to recipients;
20	20	(B) each hospital in the region that has been
21	21	designated as a disproportionate share hospital under Medicaid; and
22	22	(C) each specialized pediatric laboratory in the
23	23	region, including those laboratories located in children's
24	24	hospitals; [and]
25	25	(2) include in its provider network for not less than
26	26	three years[:
27	27	[(A)] each health care provider in the region
28	28	who:
29	29	(A) [(i)] previously provided care to Medicaid
30	30	and charity care recipients at a significant level as prescribed by
31	31	the commission;
32	32	(B) [(ii)] agrees to accept the prevailing
33	33	provider contract rate of the managed care organization; and
34	34	(C) [(iii)] has the credentials required by the
35	35	managed care organization, provided that lack of board
36	36	certification or accreditation by The Joint Commission may not be
37	37	the sole ground for exclusion from the provider network; and
38	38	(3) include in its provider network each of the
39	39	following that desires to be included:
40	40	(A) [(B)] each accredited primary care residency
41	41	program in the region; [and]
42	42	(B) [(C)] each disproportionate share hospital
43	43	in the region; and
44	44	(C) each community center established in the
45	45	region under Chapter 534, Health and Safety Code [designated by the
46	46	commission as a statewide significant traditional provider].
47	47	(c) To the extent allowed by federal law and notwithstanding
48	48	any state law, the commission shall require that the terms included
49	49	in a provider contract between a managed care organization
50	50	described by Subsection (a) and a provider described by Subsection
51	51	(a)(3) be at least as favorable as the terms the contract would
52	52	include if the provider were a significant traditional provider in
53	53	the region in which the organization provides health care services
54	54	to recipients.
55	55	SECTION 2. If before implementing any provision of this Act
56	56	a state agency determines that a waiver or authorization from a
57	57	federal agency is necessary for implementation of that provision,
58	58	the agency affected by the provision shall request the waiver or
59	59	authorization and may delay implementing that provision until the
60	60	waiver or authorization is granted.
61	61	SECTION 3. This Act takes effect September 1, 2019.