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A BILL TO BE ENTITLED
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AN ACT
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relating to requiring Medicaid managed care organizations to |
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provide an annual bonus payment to certain Medicaid providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.01317 to read as follows: |
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Sec. 533.01317. ANNUAL BONUS PAYMENT FOR CERTAIN PROVIDERS. |
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(a) Notwithstanding any other law, the executive commissioner by |
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rule shall, in accordance with this section, require each Medicaid |
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managed care organization to provide an annual bonus payment to |
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certain providers in the organization's provider network. The rule |
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must require that a Medicaid managed care organization provide a |
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bonus payment to a provider in the organization's provider network |
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if: |
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(1) during the immediately preceding fiscal year, the |
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provider: |
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(A) was an enrolled Medicaid provider who |
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provided health care services to recipients throughout the entire |
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fiscal year; and |
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(B) provided health care services to recipients |
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not later than an average of: |
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(i) 48 hours from the time a request for |
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services was made for recipients with an acute health care |
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condition; and |
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(ii) three weeks from the date a request for |
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services was made for recipients with a chronic health care |
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condition; and |
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(2) the provider is in good standing with the |
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provider's applicable licensing or regulatory authority. |
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(b) The bonus payment provided to a health care provider by |
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a Medicaid managed care organization under this section must be in |
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an amount equal to 25 percent of the profits the organization made |
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during the immediately preceding fiscal year on health care |
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services provided by the provider to recipients enrolled in the |
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organization's managed care plan. |
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(c) The executive commissioner shall ensure rules adopted |
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under this section prescribe a deadline by which a Medicaid managed |
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care organization must provide a bonus payment under this section. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2023. |