Texas House Bill HB939

Texas 2021 - 87th Regular

Caption

Relating to required access to care and provider network provisions in a contract between the Health and Human Services Commission and a Medicaid managed care organization.

Impact

The bill is likely to have a significant impact on state laws governing Medicaid managed care. It addresses various aspects of provider networks, notably mandating that managed care organizations include adequate numbers of primary care providers, including advanced practice registered nurses and physician assistants, thus broadening the scope of accessible healthcare coverage. This change is meant to improve accessibility for Medicaid recipients, particularly in under-served areas. Furthermore, the provisions requiring timely claims payment are expected to enhance provider participation within the Medicaid program and improve healthcare service delivery to recipients.

Summary

House Bill 939 is focused on enhancing the access to care and improving the contract provisions between the Health and Human Services Commission (HHSC) and Medicaid managed care organizations. The bill outlines new requirements for managed care organizations to ensure accountability in the provision of health care services to Medicaid recipients. It aims to streamline processes related to claims payment, provider access, and patient assistance, thereby enhancing the overall quality of care delivered under the Medicaid managed care system. The legislation emphasizes timely payment to healthcare providers and ensures that patients are informed of their rights and the services available to them.

Contention

Discussion surrounding HB 939 may center on the balance between regulatory oversight and the operational flexibility of managed care organizations. While proponents argue that these enhanced provisions will significantly improve patient outcomes and provider relationships, critics may express concern over potential increased costs for managed care organizations and the implications for financial sustainability within the Medicaid framework. Additionally, there may be debates over the adequacy of existing provider networks to meet the expanded requirements set forth by the bill, especially in rural and underserved areas.