Texas 2025 - 89th Regular

Texas House Bill HB5184 Compare Versions

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1	1		By: Frank H.B. No. 5184
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4	6		A BILL TO BE ENTITLED
5	7		AN ACT
6	8		relating to the Managed Care Consumer Choice Program.
7	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	10		SECTION 1. Subchapter A, Chapter 533, Government Code, is
9	11		amended by adding Section 533.0021 and 533.0022 to read as follows:
10	12		Sec. 533.0021. MANAGED CARE CONSUMER CHOICE PROGRAM. (a)
11	13		The commission may periodically issue a request for applications to
12	14		enter into a contract with the commission to provide health care
13	15		services to recipients.
14	16		(b) The commission shall not enter into a contract under
15	17		this section with a managed care organization until the commission
16	18		has:
17	19		(1) Certified the managed care organization under
18	20		Section 533.0035 for any service delivery area for which the
19	21		managed care organization will provide services to recipients under
20	22		the contract;
21	23		(2) Determined in writing the managed care
22	24		organization has provided satisfactory assurances regarding its
23	25		financial solvency; and
24	26		(3) Determined in writing the managed care
25	27		organization complies with the performance measures outlined in
26	28		Section 533.0036.
27	29		(c) Any contract entered under this section shall contain
28	30		the required contract provisions in Section 533.005 and all other
29	31		provisions required to be included in a contract between a managed
30	32		care organization and the commission under this chapter.
31	33		(d) The managed care organization shall not provide any
32	34		services to recipients, and the commission shall not make any
33	35		payments, under any contract entered into under this section until
34	36		the managed care organization completes readiness review as
35	37		required by federal law.
36	38		(e) The commission shall offer to contract with any managed
37	39		care organization that submits an application in response to a
38	40		request for applications under Section 533.011 and meets the
39	41		requirements of Subsection (a) of this section for the programs and
40	42		service delivery areas for which the managed care organization will
41	43		provide services under the contract.
42	44		(f) The programs to which this section applies include STAR,
43	45		CHIP, STAR Kids, and STAR + PLUS. This section does not apply to the
44	46		STAR Health program.
45	47		(g) The commission shall ensure that a recipient may select
46	48		any managed care plan offered by a managed care organization in good
47	49		standing that has entered into a contract with the commission under
48	50		this section to provide services in the recipient's service
49	51		delivery area for the program under which the recipient is eligible
50	52		for services.
51	53		(h) If a managed care organization that has contracted with
52	54		the commission under this section fails to comply with a material
53	55		requirement of this section or its contract with the commission, or
54	56		does not comply with the performance measures defined in Section
55	57		533.0036, the commission may pursue any or all of the following
56	58		remedies in addition to any remedies available to the commission
57	59		under the contract:
58	60		(1) require submission of and compliance with a
59	61		corrective action plan;
60	62		(2) seek recovery of actual damages or liquidated
61	63		damages specified in the contract;
62	64		(3) suspend automatic enrollment process of
63	65		recipients to the managed care organization in one or more service
64	66		delivery areas; or
65	67		(4) terminate the contract for cause.
66	68		Sec. 533.0022. MINIMUM SELECTION CRITERIA. (a) The
67	69		commission shall publish criteria by which managed care
68	70		organizations will be measured prior to participation in the
69	71		managed care program consistent with the performance measures in
70	72		Section 533.0036.
71	73		(b) An applicant managed care organization is responsible
72	74		for providing the necessary data for analysis to determine
73	75		performance on the minimum selection criteria published by the
74	76		commission under subsection (a). The commission shall allow the
75	77		applicant managed care organization an adequate opportunity to cure
76	78		any deficiency identified by the commission related to the minimum
77	79		selection criteria.
78	80		SECTION 2. Subchapter A, Chapter 533, Government Code, is
79	81		amended by adding Section 533.0036 fto read as follows:
80	82		Sec. 533.0036. PERFORMANCE MEASURES. (a) The commission
81	83		shall establish quality and performance measures to evaluate
82	84		managed care organizations participating in the Managed Care
83	85		Consumer Choice Program under Section 533.0021 based on experience
84	86		in the Texas Medicaid and CHIP market.
85	87		(b) In adopting the measures under Subsection (a), the
86	88		commission shall consider:
87	89		(1) cost efficiency, quality of care, experience of
88	90		care, member and provider satisfaction;
89	91		(2) the quality of a managed care organization's
90	92		provider network; and
91	93		(3) provider experience with the managed care
92	94		organization.
93	95		(c) The commission shall:
94	96		(1) annually evaluate a managed care organization's
95	97		performance and quality by service delivery area; and
96	98		(2) post on its Internet website the results of the
97	99		annual performance evaluations conducted under this section in a
98	100		format that is readily accessible to and understandable by a member
99	101		of the public.
100	102		SECTION 3. Section 62.155(a), Health and Safety Code, is
101	103		amended to read as follows:
102	104		Sec. 62.155 HEALTH PLAN PROVIDERS. (a) Beginning with
103	105		services provided on or after September 1, 2027, the commission
104	106		shall contract with [select the] health plan providers under the
105	107		program through the Managed Care Consumer Choice Program in Section
106	108		533.0021[a competitive procurement process]. A health plan
107	109		provider, other than a state administered primary care case
108	110		management network, must hold a certificate of authority or other
109	111		appropriate license issued by the Texas Department of Insurance
110	112		that authorizes the health plan provider to provide the type of
111	113		child health plan offered and must satisfy, except as provided by
112	114		this chapter, any applicable requirement of the Insurance Code or
113	115		another insurance law of this state.
114	116		SECTION 4. As soon as practicable after the effective date
115	117		of this act, but not later than September 1, 2026, the Health and
116	118		Human Services Commission shall begin requesting applications for
117	119		the Managed Care Consumer Choice Program, and begin entering into
118	120		contracts with managed care organizations under Section 533.0021,
119	121		Government Code.
120	122		SECTION 5. (a) The Health and Human Services Commission
121	123		shall extend contracts that were in effect as of January 1, 2025
122	124		with managed care organizations for the STAR, CHIP, STAR Kids, and
123	125		STAR + PLUS programs until new contracts are entered under
124	126		Subsections (b) or (c). The commission shall cancel all
125	127		procurements for the STAR, CHIP, or STAR Kids programs that were
126	128		pending as of January 1, 2025.
127	129		(b) The commission shall enter into contracts with managed
128	130		care organizations under the Managed Care Consumer Choice Program,
129	131		Section 533.0021, Government Code, for the STAR and CHIP programs
130	132		with services to recipients under such contracts no later than
131	133		September 1, 2027.
132	134		(c) The commission shall enter into contracts with managed
133	135		care organizations under the Managed Care Consumer Choice Program,
134	136		Section 533.0021, Government Code, for the STAR Kids and STAR + PLUS
135	137		program with services to recipients under such contracts on
136	138		September 1, 2030.
137	139		(d) The Managed Care Consumer Choice Program, Section
138	140		533.0021, Government Code, shall be the exclusive means by which
139	141		the commission may enter into new contracts with managed care
140	142		organizations for the STAR, CHIP, STAR Kids, and STAR + PLUS
141	143		programs after the effective date of this Act.
142	144		(e) A recipient enrolled in a managed care plan prior to the
143	145		date services are provided under a contract entered into under
144	146		Subsections (b) or (c) shall, until such time as the recipient
145	147		chooses to be enrolled in a different managed care plan or is no
146	148		longer eligible for services continue enrollment in the same
147	149		managed care plan if the managed care organization contracts to
148	150		provide services in the recipient's service delivery area under
149	151		Section 533.0021.
150	152		SECTION 6. If before implementing any provision of this Act
151	153		a state agency determines that a waiver or authorization from a
152	154		federal agency is necessary for implementation of that provision,
153	155		the agency affected by the provision shall request the waiver or
154	156		authorization and may delay implementing that provision until the
155	157		waiver or authorization is granted.
156	158		SECTION 7. This Act takes effect immediately if it receives
157	159		a vote of two-thirds of all the members elected to each house, as
158	160		provided by Section 39, Article III, Texas Constitution. If this
159	161		Act does not receive the vote necessary for immediate effect, this
160	162		Act takes effect September 1, 2025.