Texas 2025 - 89th Regular

Texas House Bill HB3538 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	By: Geren H.B. No. 3538
2	2
3	3
4	4
5	5
6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to the Managed Care Consumer Choice Program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter A, Chapter 533, Government Code, is
11	11	amended by adding Section 533.0021 and 533.0022 to read as follows:
12	12	Sec. 533.0021. MANAGED CARE CONSUMER CHOICE PROGRAM. (a)
13	13	The commission may periodically issue a request for applications to
14	14	enter into a contract with the commission to provide health care
15	15	services to recipients.
16	16	(b) The commission shall not enter into a contract under
17	17	this section with a managed care organization until the commission
18	18	has:
19	19	(1) Certified the managed care organization under
20	20	Section 533.0035 for any service delivery area for which the
21	21	managed care organization will provide services to recipients under
22	22	the contract;
23	23	(2) Determined in writing the managed care
24	24	organization has provided satisfactory assurances regarding its
25	25	financial solvency; and
26	26	(3) Determined in writing the managed care
27	27	organization complies with the performance measures outlined in
28	28	Section 533.0036.
29	29	(c) Any contract entered under this section shall contain
30	30	the required contract provisions in Section 533.005 and all other
31	31	provisions required to be included in a contract between a managed
32	32	care organization and the commission under this chapter.
33	33	(d) The managed care organization shall not provide any
34	34	services to recipients, and the commission shall not make any
35	35	payments, under any contract entered into under this section until
36	36	the managed care organization completes readiness review as
37	37	required by federal law.
38	38	(e) The commission shall offer to contract with any managed
39	39	care organization that submits an application in response to a
40	40	request for applications under Section 533.011 and meets the
41	41	requirements of Subsection (a) of this section for the programs and
42	42	service delivery areas for which the managed care organization will
43	43	provide services under the contract.
44	44	(f) The programs to which this section applies include STAR,
45	45	CHIP, STAR Kids, and STAR + PLUS. This section does not apply to the
46	46	STAR Health program.
47	47	(g) The commission shall ensure that a recipient may select
48	48	any managed care plan offered by a managed care organization in good
49	49	standing that has entered into a contract with the commission under
50	50	this section to provide services in the recipient’s service
51	51	delivery area for the program under which the recipient is eligible
52	52	for services.
53	53	(h) If a managed care organization that has contracted with
54	54	the commission under this section fails to comply with a material
55	55	requirement of this section or its contract with the commission, or
56	56	does not comply with the performance measures defined in Section
57	57	533.0036, the commission may pursue any or all of the following
58	58	remedies in addition to any remedies available to the commission
59	59	under the contract:
60	60	(1) require submission of and compliance with a
61	61	corrective action plan;
62	62	(2) seek recovery of actual damages or liquidated
63	63	damages specified in the contract;
64	64	(3) suspend automatic enrollment process of
65	65	recipients to the managed care organization in one or more service
66	66	delivery areas; or
67	67	(4) terminate the contract for cause.
68	68	Sec. 533.0022. MINIMUM SELECTION CRITERIA. (a) The
69	69	commission shall publish criteria by which managed care
70	70	organizations will be measured prior to participation in the
71	71	managed care program consistent with the performance measures in
72	72	Section 533.0036.
73	73	(b) An applicant managed care organization is responsible
74	74	for providing the necessary data for analysis to determine
75	75	performance on the minimum selection criteria published by the
76	76	commission under subsection (a). The commission shall allow the
77	77	applicant managed care organization an adequate opportunity to cure
78	78	any deficiency identified by the commission related to the minimum
79	79	selection criteria.
80	80	SECTION 2. Subchapter A, Chapter 533, Government Code, is
81	81	amended by adding Section 533.0036 fto read as follows:
82	82	Sec. 533.0036. PERFORMANCE MEASURES. (a) The commission
83	83	shall establish quality and performance measures to evaluate
84	84	managed care organizations participating in the Managed Care
85	85	Consumer Choice Program under Section 533.0021 based on experience
86	86	in the Texas Medicaid and CHIP market.
87	87	(b) In adopting the measures under Subsection (a), the
88	88	commission shall consider:
89	89	(1) cost efficiency, quality of care, experience of
90	90	care, member and provider satisfaction;
91	91	(2) the quality of a managed care organization’s
92	92	provider network; and
93	93	(3) provider experience with the managed care
94	94	organization.
95	95	(c) The commission shall:
96	96	(1) annually evaluate a managed care organization’s
97	97	performance and quality by service delivery area; and
98	98	(2) post on its Internet website the results of the
99	99	annual performance evaluations conducted under this section in a
100	100	format that is readily accessible to and understandable by a member
101	101	of the public.
102	102	SECTION 3. Section 62.155(a), Health and Safety Code, is
103	103	amended to read as follows:
104	104	Sec. 62.155 HEALTH PLAN PROVIDERS. (a) Beginning with
105	105	services provided on or after September 1, 2027, the commission
106	106	shall contract with [select the] health plan providers under the
107	107	program through the Managed Care Consumer Choice Program in Section
108	108	533.0021[a competitive procurement process]. A health plan
109	109	provider, other than a state administered primary care case
110	110	management network, must hold a certificate of authority or other
111	111	appropriate license issued by the Texas Department of Insurance
112	112	that authorizes the health plan provider to provide the type of
113	113	child health plan offered and must satisfy, except as provided by
114	114	this chapter, any applicable requirement of the Insurance Code or
115	115	another insurance law of this state.
116	116	SECTION 4. As soon as practicable after the effective date
117	117	of this act, but not later than September 1, 2026, the Health and
118	118	Human Services Commission shall begin requesting applications for
119	119	the Managed Care Consumer Choice Program, and begin entering into
120	120	contracts with managed care organizations under Section 533.0021,
121	121	Government Code.
122	122	SECTION 5. (a) The Health and Human Services Commission
123	123	shall extend contracts that were in effect as of January 1, 2025
124	124	with managed care organizations for the STAR, CHIP, STAR Kids, and
125	125	STAR + PLUS programs until new contracts are entered under
126	126	Subsections (b) or (c). The commission shall cancel all
127	127	procurements for the STAR, CHIP, or STAR Kids programs that were
128	128	pending as of January 1, 2025.
129	129	(b) The commission shall enter into contracts with managed
130	130	care organizations under the Managed Care Consumer Choice Program,
131	131	Section 533.0021, Government Code, for the STAR and CHIP programs
132	132	with services to recipients under such contracts no later than
133	133	September 1, 2027.
134	134	(c) The commission shall enter into contracts with managed
135	135	care organizations under the Managed Care Consumer Choice Program,
136	136	Section 533.0021, Government Code, for the STAR Kids and STAR + PLUS
137	137	program with services to recipients under such contracts on
138	138	September 1, 2030.
139	139	(d) The Managed Care Consumer Choice Program, Section
140	140	533.0021, Government Code, shall be the exclusive means by which
141	141	the commission may enter into new contracts with managed care
142	142	organizations for the STAR, CHIP, STAR Kids, and STAR + PLUS
143	143	programs after the effective date of this Act.
144	144	(e) A recipient enrolled in a managed care plan prior to the
145	145	date services are provided under a contract entered into under
146	146	Subsections (b) or (c) shall, until such time as the recipient
147	147	chooses to be enrolled in a different managed care plan or is no
148	148	longer eligible for services continue enrollment in the same
149	149	managed care plan if the managed care organization contracts to
150	150	provide services in the recipient’s service delivery area under
151	151	Section 533.0021.
152	152	SECTION 6. If before implementing any provision of this Act
153	153	a state agency determines that a waiver or authorization from a
154	154	federal agency is necessary for implementation of that provision,
155	155	the agency affected by the provision shall request the waiver or
156	156	authorization and may delay implementing that provision until the
157	157	waiver or authorization is granted.
158	158	SECTION 7. This Act takes effect immediately if it receives
159	159	a vote of two-thirds of all the members elected to each house, as
160	160	provided by Section 39, Article III, Texas Constitution. If this
161	161	Act does not receive the vote necessary for immediate effect, this
162	162	Act takes effect September 1, 2025.