88R7303 BDP-F
By: LaMantia S.B. No. 1239
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement rates for eye health care services
providers participating in the Medicaid managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.005, Government Code, is amended by
adding Subsection (i) to read as follows:
(i) In addition to the requirements specified by Subsection
(a), a contract described by that subsection must contain a
requirement that a managed care organization, including any
subcontracted administrator, contractor, vision plan, or other
entity the organization contracts with, owns, or otherwise engages
to provide or arrange for the provision of eye health care services
under a managed care plan, reimburse an eye health care services
provider who provides services to a recipient under the
organization's managed care plan at a rate that is at least equal to
the Medicaid fee-for-service rate for the provision of the same or
similar services.
SECTION 2. Section 533.0067, Government Code, is amended to
read as follows:
Sec. 533.0067. EYE HEALTH CARE SERVICE PROVIDERS. Subject
to Section 32.047, Human Resources Code, but notwithstanding any
other law, the commission shall require that each managed care
organization that contracts with the commission under any Medicaid
managed care model or arrangement to provide health care services
to recipients in a region include in the organization's provider
network each optometrist, therapeutic optometrist, and
ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
and an institution of higher education described by Section
531.021191(a)(4) in the region who:
(1) agrees to comply with the terms and conditions of
the organization;
(2) [agrees to accept the prevailing provider contract
rate of the organization;
[(3)] agrees to abide by the standards of care
required by the organization; and
(3) [(4)] is an enrolled provider under Medicaid.
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(i),
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(i), Government Code, as added by this Act. To the extent of
a conflict between Section 533.005(i), 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, 2023.