88R13511 JG-D
By: Guerra H.B. No. 5023
A BILL TO BE ENTITLED
AN ACT
relating to requiring Medicaid managed care organizations to
provide an annual bonus payment to certain Medicaid providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.01317 to read as follows:
Sec. 533.01317. ANNUAL BONUS PAYMENT FOR CERTAIN PROVIDERS.
(a) Notwithstanding any other law, the executive commissioner by
rule shall, in accordance with this section, require each Medicaid
managed care organization to provide an annual bonus payment to
certain providers in the organization's provider network. The rule
must require that a Medicaid managed care organization provide a
bonus payment to a provider in the organization's provider network
if:
(1) during the immediately preceding fiscal year, the
provider:
(A) was an enrolled Medicaid provider who
provided health care services to recipients throughout the entire
fiscal year; and
(B) provided health care services to recipients
not later than an average of:
(i) 48 hours from the time a request for
services was made for recipients with an acute health care
condition; and
(ii) three weeks from the date a request for
services was made for recipients with a chronic health care
condition; and
(2) the provider is in good standing with the
provider's applicable licensing or regulatory authority.
(b) The bonus payment provided to a health care provider by
a Medicaid managed care organization under this section must be in
an amount equal to 25 percent of the profits the organization made
during the immediately preceding fiscal year on health care
services provided by the provider to recipients enrolled in the
organization's managed care plan.
(c) The executive commissioner shall ensure rules adopted
under this section prescribe a deadline by which a Medicaid managed
care organization must provide a bonus payment under this section.
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, 2023.