| 1 | 1 | | 87R8329 MM-F |
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| 2 | 2 | | By: Walle H.B. No. 4035 |
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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 Medicaid reimbursement rates. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Section 32.028, Human Resources Code, is amended |
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| 10 | 10 | | by adding Subsection (o) to read as follows: |
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| 11 | 11 | | (o) Notwithstanding any other provision of this section or |
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| 12 | 12 | | other law, the executive commissioner shall ensure that the rules |
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| 13 | 13 | | governing the determination of rates paid to a medical assistance |
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| 14 | 14 | | provider are at least equal to the rates paid under Medicare for the |
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| 15 | 15 | | provision of the same or substantially similar services. |
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| 16 | 16 | | SECTION 2. Section 533.005, Government Code, is amended by |
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| 17 | 17 | | adding Subsection (f) to read as follows: |
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| 18 | 18 | | (f) In addition to the requirements specified by Subsection |
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| 19 | 19 | | (a) and notwithstanding any other law, a contract described by that |
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| 20 | 20 | | subsection must require the managed care organization to reimburse |
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| 21 | 21 | | a provider who is in the organization's provider network and who |
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| 22 | 22 | | provides health care services to a recipient at a rate that is at |
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| 23 | 23 | | least equal to the rate paid under Medicare for the provision of the |
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| 24 | 24 | | same or substantially similar service. |
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| 25 | 25 | | SECTION 3. (a) The Health and Human Services Commission |
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| 26 | 26 | | shall, in a contract between the commission and a managed care |
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| 27 | 27 | | organization under Chapter 533, Government Code, that is entered |
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| 28 | 28 | | into or renewed on or after the effective date of this Act, require |
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| 29 | 29 | | that the managed care organization comply with Section 533.005(f), |
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| 30 | 30 | | Government Code, as added by this Act. |
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| 31 | 31 | | (b) The Health and Human Services Commission shall seek to |
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| 32 | 32 | | amend contracts entered into with managed care organizations under |
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| 33 | 33 | | Chapter 533, Government Code, before the effective date of this Act |
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| 34 | 34 | | to require those managed care organizations to comply with Section |
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| 35 | 35 | | 533.005(f), Government Code, as added by this Act. To the extent of |
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| 36 | 36 | | a conflict between Section 533.005(f), Government Code, as added by |
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| 37 | 37 | | this Act, and a provision of a contract with a managed care |
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| 38 | 38 | | organization entered into before the effective date of this Act, |
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| 39 | 39 | | the contract provision prevails. |
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| 40 | 40 | | SECTION 4. If before implementing any provision of this Act |
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| 41 | 41 | | a state agency determines that a waiver or authorization from a |
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| 42 | 42 | | federal agency is necessary for implementation of that provision, |
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| 43 | 43 | | the agency affected by the provision shall request the waiver or |
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| 44 | 44 | | authorization and may delay implementing that provision until the |
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| 45 | 45 | | waiver or authorization is granted. |
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| 46 | 46 | | SECTION 5. This Act takes effect September 1, 2021. |
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