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A BILL TO BE ENTITLED
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AN ACT
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relating to administrative and other expenditures by Medicaid |
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managed care organizations. |
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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 533.021 to read as follows: |
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Sec. 533.021. ADMINISTRATIVE AND OTHER EXPENDITURES. (a) |
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The legislature, after consulting with the commission, may set in |
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the General Appropriations Act an upper limit on the percentage or |
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amount of Medicaid capitated or other premium payments that a |
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managed care organization offering a Medicaid managed care plan may |
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spend on administrative, overhead, and marketing costs in each year |
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of the state fiscal biennium. |
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(b) Not later than December 1 of each year, a managed care |
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organization offering a Medicaid managed care plan shall report to |
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the legislature and the commission the percentage of the managed |
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care organization's budget that the managed care organization spent |
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during the preceding state fiscal year on: |
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(1) administrative, overhead, and marketing costs; |
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and |
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(2) reimbursement for clinical services provided to |
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enrollees, activities that improve health care quality for those |
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enrollees, and all other activities related to those enrollees. |
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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 immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2017. |