89R16086 KKR-F
By: Hughes S.B. No. 2450
A BILL TO BE ENTITLED
AN ACT
relating to the participation and reimbursement of and requirements
affecting certain providers, including providers of eye health care
and vision care services, under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 532, Government Code, as
effective April 1, 2025, is amended by adding Sections 532.01511
and 532.01512 to read as follows:
Sec. 532.01511. PROVIDER ENROLLMENT AND CREDENTIALING
PROCESSES: PROVIDER SUPPORT; COMPLAINTS. (a) The commission shall
ensure that providers have access to a dedicated support team for
the Internet portal established under Section 532.0151 that:
(1) assists current and prospective Medicaid
providers in completing the Medicaid provider enrollment and
credentialing processes; and
(2) reduces the administrative burdens associated
with those processes.
(b) The commission shall:
(1) annually evaluate the performance of the support
team described by Subsection (a), including the timeliness of
assistance the support team provides; and
(2) not later than September 1 of each year, post on
the commission's Internet website a report summarizing the results
of the evaluation conducted under Subdivision (1).
(c) For purposes of improving the commission's Medicaid
provider enrollment and credentialing processes, the commission
shall develop a procedure by which a provider may electronically
submit complaints and feedback about those processes and the
support provided by the support team described by Subsection (a).
Information about the procedure must:
(1) be prominently posted on the commission's or the
commission's designee's Internet website in the same location that
instructions and resources for using the Internet portal
established under Section 532.0151 are posted; and
(2) allow a provider to submit a complaint or provide
feedback through an electronic form from that location.
Sec. 532.01512. NOTICE OF PROVIDER DISENROLLMENT. Before
the commission may disenroll a Medicaid provider during the
provider's enrollment revalidation period, the commission must:
(1) not later than the 30th day before the date of
disenrollment provide electronically and by mail to the provider
written notice of the commission's disenrollment determination;
and
(2) allow the provider to address any deficiencies in
the provider's application for revalidation of enrollment before
the date the provider is disenrolled.
SECTION 2. Subchapter F, Chapter 540, Government Code, as
effective April 1, 2025, is amended by adding Sections 540.0281 and
540.0282 to read as follows:
Sec. 540.0281. ADMINISTRATION OF EYE HEALTH CARE AND VISION
CARE SERVICES. (a) A contract to which this subchapter applies
must prohibit the contracting Medicaid managed care organization
from using a different insurer, health maintenance organization,
third-party administrator, managed care plan, vision plan, or other
plan or entity the organization contracts with, offers, owns, or
otherwise engages to provide or arrange for the provision of eye
health care or vision care services under the managed care plan the
Medicaid managed care organization offers to:
(1) establish an eye health care services provider's
inclusion in the organization's provider network;
(2) contract with an eye health care services provider
to provide or arrange for the provision of eye health care or vision
care services under the organization's Medicaid managed care plan;
(3) reduce, restrict, or limit eye health care or
vision care services that are required to be provided to recipients
and are within the eye health care services provider's scope of
practice; or
(4) deny participation of an eye health care services
provider in the organization's Medicaid managed care plan if the
provider:
(A) seeks to participate in that plan; and
(B) meets the organization's requirements for
participation in the plan.
(b) Notwithstanding Section 1451.152, Insurance Code, an
insurer, health maintenance organization, third-party
administrator, managed care plan, vision plan, or other plan or
entity that a Medicaid managed care organization contracts with,
offers, owns, or otherwise engages to provide or arrange for the
provision of eye health care or vision care services under the
organization's Medicaid managed care plan shall comply with the
requirements of Subchapter D, Chapter 1451, Insurance Code.
Sec. 540.0282. REIMBURSEMENT OF EYE HEALTH CARE SERVICES
PROVIDERS. A contract to which this subchapter applies must
require that the contracting Medicaid managed care organization
require any insurer, health maintenance organization, third-party
administrator, managed care plan, vision plan, or other plan or
entity the organization contracts with, offers, owns, or otherwise
engages to provide or arrange for the provision of eye health care
or vision care services under the managed care plan the Medicaid
managed care organization offers to 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 3. Section 540.0651(a), Government Code, as
effective April 1, 2025, is amended to read as follows:
(a) The commission shall require that each managed care
organization that contracts with the commission under any managed
care model or arrangement to provide health care services to
recipients in a region:
(1) seek participation in the organization's provider
network from:
(A) each health care provider in the region who
has traditionally provided care to recipients;
(B) each hospital in the region that has been
designated as a disproportionate share hospital under Medicaid; and
(C) each specialized pediatric laboratory in the
region, including a laboratory located in a children's hospital;
(2) include in the organization's provider network for
at least three years:
(A) each health care provider in the region who:
(i) previously provided care to Medicaid
and charity care recipients at a significant level as the
commission prescribes;
(ii) agrees to accept the organization's
prevailing provider contract rate; and
(iii) has the credentials the organization
requires, provided that lack of board certification or
accreditation by The Joint Commission may not be the sole ground for
exclusion from the provider network;
(B) each accredited primary care residency
program in the region; and
(C) each disproportionate share hospital the
commission designates as a statewide significant traditional
provider; [and]
(3) subject to Section 32.047, Human Resources Code,
and notwithstanding any other law, include in the organization's
provider network each optometrist, therapeutic optometrist, and
ophthalmologist described by Section 532.0153(b)(1)(A) or (B) who,
and an institution of higher education described by Section
532.0153(a)(4) in the region that:
(A) seeks participation in the organization's
provider network;
(B) agrees to comply with the organization's
terms;
(C) [(B)] agrees to accept the [organization's
prevailing provider contract] rate specified in the contract
between the provider and the organization;
(D) [(C)] agrees to abide by the organization's
required standards of care; and
(E) [(D)] is an enrolled Medicaid provider; and
(4) contract directly with each provider described by
Subdivision (3) to participate in the organization's provider
network.
SECTION 4. Notwithstanding Section 532.01511, Government
Code, as added by this Act, the Health and Human Services Commission
shall conduct the initial evaluation and post the report
summarizing the results of the evaluation as required by that
section not later than September 1, 2026.
SECTION 5. As soon as possible after the effective date of
this Act, the Health and Human Services Commission shall:
(1) ensure the Internet portal support team required
by Section 532.01511(a), Government Code, as added by this Act, is
established; and
(2) adopt rules necessary to implement the changes in
law made by this Act.
SECTION 6. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 540, Government Code, as effective April
1, 2025, that is entered into or renewed on or after the effective
date of this Act, require that the managed care organization comply
with Sections 540.0281 and 540.0282, Government Code, as added by
this Act, and Section 540.0651, Government Code, as effective April
1, 2025, and amended 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, or under Chapter 540, Government
Code, as effective April 1, 2025, before the effective date of this
Act to require those managed care organizations to comply with
Sections 540.0281 and 540.0282, Government Code, as added by this
Act, and Section 540.0651, Government Code, as effective April 1,
2025, and amended by this Act. To the extent of a conflict between
those provisions of law 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 7. 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 8. This Act takes effect September 1, 2025.