86R11130 KLA-D
By: RodrÃguez S.B. No. 2039
A BILL TO BE ENTITLED
AN ACT
relating to the inclusion of certain health care providers in the
provider network of a Medicaid managed care organization.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.006, Government Code, is amended by
amending Subsection (a) and adding Subsection (c) to read as
follows:
(a) The commission shall require that each managed care
organization that contracts with the commission to provide health
care services to recipients in a region:
(1) seek participation in the organization's provider
network from:
(A) each health care provider in the region who
has traditionally provided care to recipients;
(B) each hospital in the region that has been
designated as a disproportionate share hospital under Medicaid; and
(C) each specialized pediatric laboratory in the
region, including those laboratories located in children's
hospitals; [and]
(2) include in its provider network for not less than
three years[:
[(A)] each health care provider in the region
who:
(A) [(i)] previously provided care to Medicaid
and charity care recipients at a significant level as prescribed by
the commission;
(B) [(ii)] agrees to accept the prevailing
provider contract rate of the managed care organization; and
(C) [(iii)] has the credentials required by the
managed care organization, provided that lack of board
certification or accreditation by The Joint Commission may not be
the sole ground for exclusion from the provider network; and
(3) include in its provider network each of the
following that desires to be included:
(A) [(B)] each accredited primary care residency
program in the region; [and]
(B) [(C)] each disproportionate share hospital
in the region; and
(C) each community center established in the
region under Chapter 534, Health and Safety Code [designated by the
commission as a statewide significant traditional provider].
(c) To the extent allowed by federal law and notwithstanding
any state law, the commission shall require that the terms included
in a provider contract between a managed care organization
described by Subsection (a) and a provider described by Subsection
(a)(3) be at least as favorable as the terms the contract would
include if the provider were a significant traditional provider in
the region in which the organization provides health care services
to recipients.
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 September 1, 2019.