87R8329 MM-F
By: Walle H.B. No. 4035
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid reimbursement rates.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.028, Human Resources Code, is amended
by adding Subsection (o) to read as follows:
(o) Notwithstanding any other provision of this section or
other law, the executive commissioner shall ensure that the rules
governing the determination of rates paid to a medical assistance
provider are at least equal to the rates paid under Medicare for the
provision of the same or substantially similar services.
SECTION 2. Section 533.005, Government Code, is amended by
adding Subsection (f) to read as follows:
(f) In addition to the requirements specified by Subsection
(a) and notwithstanding any other law, a contract described by that
subsection must require the managed care organization to reimburse
a provider who is in the organization's provider network and who
provides health care services to a recipient at a rate that is at
least equal to the rate paid under Medicare for the provision of the
same or substantially similar service.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this Act, require
that the managed care organization comply with Section 533.005(f),
Government Code, as added by this Act.
(b) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations under
Chapter 533, Government Code, before the effective date of this Act
to require those managed care organizations to comply with Section
533.005(f), Government Code, as added by this Act. To the extent of
a conflict between Section 533.005(f), Government Code, as added by
this Act, and a provision of a contract with a managed care
organization entered into before the effective date of this Act,
the contract provision prevails.
SECTION 4. 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 5. This Act takes effect September 1, 2021.