| 1 | 1 | | By: Perry S.B. No. 2988 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | A BILL TO BE ENTITLED |
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| 7 | 7 | | AN ACT |
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| 8 | 8 | | relating to certification by the commission prior to the award of |
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| 9 | 9 | | health plan provider contracts under Medicaid managed care. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 533.0035, Government Code, is amended by |
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| 12 | 12 | | adding Subsections (a-1), (a-2), (b-1), and (d), and amending |
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| 13 | 13 | | Subsection (c) to read as follows: |
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| 14 | 14 | | (a-1) The commission shall require a managed care |
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| 15 | 15 | | organization to demonstrate: |
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| 16 | 16 | | (1) financial solvency commensurate with the |
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| 17 | 17 | | projected enrollment and level of risk associated with the regions |
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| 18 | 18 | | the organization intends to pursue; |
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| 19 | 19 | | (2) full accreditation by a national quality assurance |
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| 20 | 20 | | organization selected by the executive commissioner; |
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| 21 | 21 | | (3) existing network capacity by region with a |
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| 22 | 22 | | strategy to meet network adequacy for regions the organization |
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| 23 | 23 | | intends to pursue; |
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| 24 | 24 | | (4) five full calendar years of experience providing |
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| 25 | 25 | | similar services to similar populations; |
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| 26 | 26 | | (5) licensure by the Department of Insurance; and |
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| 27 | 27 | | (6) the ability to meet any other criteria adopted by |
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| 28 | 28 | | commission rule. |
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| 29 | 29 | | (a-2) The commission shall conduct a separate certification |
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| 30 | 30 | | process for each medical assistance program under this chapter. |
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| 31 | 31 | | (b-1) A managed care organization may not exceed the number |
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| 32 | 32 | | of members for which the organization demonstrated financial |
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| 33 | 33 | | solvency as described by Subsection (a-1). An organization may |
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| 34 | 34 | | exceed that number only upon satisfactory demonstration of solvency |
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| 35 | 35 | | commensurate with additional enrollment levels. |
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| 36 | 36 | | (c) A managed care organization may appeal a denial of |
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| 37 | 37 | | certification by the commission under this section through a |
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| 38 | 38 | | process prescribed by the executive commissioner by rule. In |
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| 39 | 39 | | adopting rules under this subsection, the executive commissioner |
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| 40 | 40 | | shall provide organizations with an opportunity to address the |
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| 41 | 41 | | specific requirements in Subsection (a-1). |
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| 42 | 42 | | (d) In implementing this section, the commission shall: |
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| 43 | 43 | | (1) establish a timeline for certification prior to a |
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| 44 | 44 | | solicitation to enter into a contract; |
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| 45 | 45 | | (2) develop and publish certification criteria; |
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| 46 | 46 | | (3) provide a managed care organization that meets the |
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| 47 | 47 | | requirements of this section with a written certification; and |
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| 48 | 48 | | (4) maintain a publicly accessible record of |
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| 49 | 49 | | certifications issued. |
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| 50 | 50 | | SECTION 2. This Act takes effect immediately if it receives |
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| 51 | 51 | | a vote of two-thirds of all the members elected to each house, as |
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| 52 | 52 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 53 | 53 | | Act does not receive the vote necessary for immediate effect, this |
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| 54 | 54 | | Act takes effect September 1, 2025. |
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