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