| 1 | 1 | | 88R13511 JG-D |
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| 2 | 2 | | By: Guerra H.B. No. 5023 |
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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 requiring Medicaid managed care organizations to |
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| 8 | 8 | | provide an annual bonus payment to certain Medicaid providers. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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| 11 | 11 | | amended by adding Section 533.01317 to read as follows: |
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| 12 | 12 | | Sec. 533.01317. ANNUAL BONUS PAYMENT FOR CERTAIN PROVIDERS. |
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| 13 | 13 | | (a) Notwithstanding any other law, the executive commissioner by |
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| 14 | 14 | | rule shall, in accordance with this section, require each Medicaid |
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| 15 | 15 | | managed care organization to provide an annual bonus payment to |
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| 16 | 16 | | certain providers in the organization's provider network. The rule |
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| 17 | 17 | | must require that a Medicaid managed care organization provide a |
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| 18 | 18 | | bonus payment to a provider in the organization's provider network |
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| 19 | 19 | | if: |
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| 20 | 20 | | (1) during the immediately preceding fiscal year, the |
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| 21 | 21 | | provider: |
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| 22 | 22 | | (A) was an enrolled Medicaid provider who |
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| 23 | 23 | | provided health care services to recipients throughout the entire |
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| 24 | 24 | | fiscal year; and |
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| 25 | 25 | | (B) provided health care services to recipients |
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| 26 | 26 | | not later than an average of: |
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| 27 | 27 | | (i) 48 hours from the time a request for |
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| 28 | 28 | | services was made for recipients with an acute health care |
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| 29 | 29 | | condition; and |
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| 30 | 30 | | (ii) three weeks from the date a request for |
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| 31 | 31 | | services was made for recipients with a chronic health care |
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| 32 | 32 | | condition; and |
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| 33 | 33 | | (2) the provider is in good standing with the |
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| 34 | 34 | | provider's applicable licensing or regulatory authority. |
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| 35 | 35 | | (b) The bonus payment provided to a health care provider by |
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| 36 | 36 | | a Medicaid managed care organization under this section must be in |
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| 37 | 37 | | an amount equal to 25 percent of the profits the organization made |
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| 38 | 38 | | during the immediately preceding fiscal year on health care |
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| 39 | 39 | | services provided by the provider to recipients enrolled in the |
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| 40 | 40 | | organization's managed care plan. |
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| 41 | 41 | | (c) The executive commissioner shall ensure rules adopted |
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| 42 | 42 | | under this section prescribe a deadline by which a Medicaid managed |
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| 43 | 43 | | care organization must provide a bonus payment under this section. |
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| 44 | 44 | | SECTION 2. If before implementing any provision of this Act |
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| 45 | 45 | | a state agency determines that a waiver or authorization from a |
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| 46 | 46 | | federal agency is necessary for implementation of that provision, |
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| 47 | 47 | | the agency affected by the provision shall request the waiver or |
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| 48 | 48 | | authorization and may delay implementing that provision until the |
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| 49 | 49 | | waiver or authorization is granted. |
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| 50 | 50 | | SECTION 3. This Act takes effect September 1, 2023. |
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