Texas 2025 - 89th Regular

Texas Senate Bill SB2450 Compare Versions

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

Old	New	Differences
1	1	89R16086 KKR-F
2	2	By: Hughes S.B. No. 2450
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the participation and reimbursement of and requirements
10	10	affecting certain providers, including providers of eye health care
11	11	and vision care services, under Medicaid.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subchapter D, Chapter 532, Government Code, as
14	14	effective April 1, 2025, is amended by adding Sections 532.01511
15	15	and 532.01512 to read as follows:
16	16	Sec. 532.01511. PROVIDER ENROLLMENT AND CREDENTIALING
17	17	PROCESSES: PROVIDER SUPPORT; COMPLAINTS. (a) The commission shall
18	18	ensure that providers have access to a dedicated support team for
19	19	the Internet portal established under Section 532.0151 that:
20	20	(1) assists current and prospective Medicaid
21	21	providers in completing the Medicaid provider enrollment and
22	22	credentialing processes; and
23	23	(2) reduces the administrative burdens associated
24	24	with those processes.
25	25	(b) The commission shall:
26	26	(1) annually evaluate the performance of the support
27	27	team described by Subsection (a), including the timeliness of
28	28	assistance the support team provides; and
29	29	(2) not later than September 1 of each year, post on
30	30	the commission's Internet website a report summarizing the results
31	31	of the evaluation conducted under Subdivision (1).
32	32	(c) For purposes of improving the commission's Medicaid
33	33	provider enrollment and credentialing processes, the commission
34	34	shall develop a procedure by which a provider may electronically
35	35	submit complaints and feedback about those processes and the
36	36	support provided by the support team described by Subsection (a).
37	37	Information about the procedure must:
38	38	(1) be prominently posted on the commission's or the
39	39	commission's designee's Internet website in the same location that
40	40	instructions and resources for using the Internet portal
41	41	established under Section 532.0151 are posted; and
42	42	(2) allow a provider to submit a complaint or provide
43	43	feedback through an electronic form from that location.
44	44	Sec. 532.01512. NOTICE OF PROVIDER DISENROLLMENT. Before
45	45	the commission may disenroll a Medicaid provider during the
46	46	provider's enrollment revalidation period, the commission must:
47	47	(1) not later than the 30th day before the date of
48	48	disenrollment provide electronically and by mail to the provider
49	49	written notice of the commission's disenrollment determination;
50	50	and
51	51	(2) allow the provider to address any deficiencies in
52	52	the provider's application for revalidation of enrollment before
53	53	the date the provider is disenrolled.
54	54	SECTION 2. Subchapter F, Chapter 540, Government Code, as
55	55	effective April 1, 2025, is amended by adding Sections 540.0281 and
56	56	540.0282 to read as follows:
57	57	Sec. 540.0281. ADMINISTRATION OF EYE HEALTH CARE AND VISION
58	58	CARE SERVICES. (a) A contract to which this subchapter applies
59	59	must prohibit the contracting Medicaid managed care organization
60	60	from using a different insurer, health maintenance organization,
61	61	third-party administrator, managed care plan, vision plan, or other
62	62	plan or entity the organization contracts with, offers, owns, or
63	63	otherwise engages to provide or arrange for the provision of eye
64	64	health care or vision care services under the managed care plan the
65	65	Medicaid managed care organization offers to:
66	66	(1) establish an eye health care services provider's
67	67	inclusion in the organization's provider network;
68	68	(2) contract with an eye health care services provider
69	69	to provide or arrange for the provision of eye health care or vision
70	70	care services under the organization's Medicaid managed care plan;
71	71	(3) reduce, restrict, or limit eye health care or
72	72	vision care services that are required to be provided to recipients
73	73	and are within the eye health care services provider's scope of
74	74	practice; or
75	75	(4) deny participation of an eye health care services
76	76	provider in the organization's Medicaid managed care plan if the
77	77	provider:
78	78	(A) seeks to participate in that plan; and
79	79	(B) meets the organization's requirements for
80	80	participation in the plan.
81	81	(b) Notwithstanding Section 1451.152, Insurance Code, an
82	82	insurer, health maintenance organization, third-party
83	83	administrator, managed care plan, vision plan, or other plan or
84	84	entity that a Medicaid managed care organization contracts with,
85	85	offers, owns, or otherwise engages to provide or arrange for the
86	86	provision of eye health care or vision care services under the
87	87	organization's Medicaid managed care plan shall comply with the
88	88	requirements of Subchapter D, Chapter 1451, Insurance Code.
89	89	Sec. 540.0282. REIMBURSEMENT OF EYE HEALTH CARE SERVICES
90	90	PROVIDERS. A contract to which this subchapter applies must
91	91	require that the contracting Medicaid managed care organization
92	92	require any insurer, health maintenance organization, third-party
93	93	administrator, managed care plan, vision plan, or other plan or
94	94	entity the organization contracts with, offers, owns, or otherwise
95	95	engages to provide or arrange for the provision of eye health care
96	96	or vision care services under the managed care plan the Medicaid
97	97	managed care organization offers to reimburse an eye health care
98	98	services provider who provides services to a recipient under the
99	99	organization's managed care plan at a rate that is at least equal to
100	100	the Medicaid fee-for-service rate for the provision of the same or
101	101	similar services.
102	102	SECTION 3. Section 540.0651(a), Government Code, as
103	103	effective April 1, 2025, is amended to read as follows:
104	104	(a) The commission shall require that each managed care
105	105	organization that contracts with the commission under any managed
106	106	care model or arrangement to provide health care services to
107	107	recipients in a region:
108	108	(1) seek participation in the organization's provider
109	109	network from:
110	110	(A) each health care provider in the region who
111	111	has traditionally provided care to recipients;
112	112	(B) each hospital in the region that has been
113	113	designated as a disproportionate share hospital under Medicaid; and
114	114	(C) each specialized pediatric laboratory in the
115	115	region, including a laboratory located in a children's hospital;
116	116	(2) include in the organization's provider network for
117	117	at least three years:
118	118	(A) each health care provider in the region who:
119	119	(i) previously provided care to Medicaid
120	120	and charity care recipients at a significant level as the
121	121	commission prescribes;
122	122	(ii) agrees to accept the organization's
123	123	prevailing provider contract rate; and
124	124	(iii) has the credentials the organization
125	125	requires, provided that lack of board certification or
126	126	accreditation by The Joint Commission may not be the sole ground for
127	127	exclusion from the provider network;
128	128	(B) each accredited primary care residency
129	129	program in the region; and
130	130	(C) each disproportionate share hospital the
131	131	commission designates as a statewide significant traditional
132	132	provider; [and]
133	133	(3) subject to Section 32.047, Human Resources Code,
134	134	and notwithstanding any other law, include in the organization's
135	135	provider network each optometrist, therapeutic optometrist, and
136	136	ophthalmologist described by Section 532.0153(b)(1)(A) or (B) who,
137	137	and an institution of higher education described by Section
138	138	532.0153(a)(4) in the region that:
139	139	(A) seeks participation in the organization's
140	140	provider network;
141	141	(B) agrees to comply with the organization's
142	142	terms;
143	143	(C) [(B)] agrees to accept the [organization's
144	144	prevailing provider contract] rate specified in the contract
145	145	between the provider and the organization;
146	146	(D) [(C)] agrees to abide by the organization's
147	147	required standards of care; and
148	148	(E) [(D)] is an enrolled Medicaid provider; and
149	149	(4) contract directly with each provider described by
150	150	Subdivision (3) to participate in the organization's provider
151	151	network.
152	152	SECTION 4. Notwithstanding Section 532.01511, Government
153	153	Code, as added by this Act, the Health and Human Services Commission
154	154	shall conduct the initial evaluation and post the report
155	155	summarizing the results of the evaluation as required by that
156	156	section not later than September 1, 2026.
157	157	SECTION 5. As soon as possible after the effective date of
158	158	this Act, the Health and Human Services Commission shall:
159	159	(1) ensure the Internet portal support team required
160	160	by Section 532.01511(a), Government Code, as added by this Act, is
161	161	established; and
162	162	(2) adopt rules necessary to implement the changes in
163	163	law made by this Act.
164	164	SECTION 6. (a) The Health and Human Services Commission
165	165	shall, in a contract between the commission and a managed care
166	166	organization under Chapter 540, Government Code, as effective April
167	167	1, 2025, that is entered into or renewed on or after the effective
168	168	date of this Act, require that the managed care organization comply
169	169	with Sections 540.0281 and 540.0282, Government Code, as added by
170	170	this Act, and Section 540.0651, Government Code, as effective April
171	171	1, 2025, and amended by this Act.
172	172	(b) The Health and Human Services Commission shall seek to
173	173	amend contracts entered into with managed care organizations under
174	174	Chapter 533, Government Code, or under Chapter 540, Government
175	175	Code, as effective April 1, 2025, before the effective date of this
176	176	Act to require those managed care organizations to comply with
177	177	Sections 540.0281 and 540.0282, Government Code, as added by this
178	178	Act, and Section 540.0651, Government Code, as effective April 1,
179	179	2025, and amended by this Act. To the extent of a conflict between
180	180	those provisions of law and a provision of a contract with a managed
181	181	care organization entered into before the effective date of this
182	182	Act, the contract provision prevails.
183	183	SECTION 7. If before implementing any provision of this Act
184	184	a state agency determines that a waiver or authorization from a
185	185	federal agency is necessary for implementation of that provision,
186	186	the agency affected by the provision shall request the waiver or
187	187	authorization and may delay implementing that provision until the
188	188	waiver or authorization is granted.
189	189	SECTION 8. This Act takes effect September 1, 2025.