85R11092 LED-D
 
  By: Muñoz, Jr. H.B. No. 2626
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to administrative and other expenditures by Medicaid
  managed care organizations.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.021 to read as follows:
         Sec. 533.021.  ADMINISTRATIVE AND OTHER EXPENDITURES. (a)  
  The legislature, after consulting with the commission, may set in
  the General Appropriations Act an upper limit on the percentage or
  amount of Medicaid capitated or other premium payments that a
  managed care organization offering a Medicaid managed care plan may
  spend on administrative, overhead, and marketing costs in each year
  of the state fiscal biennium.
         (b)  Not later than December 1 of each year, a managed care
  organization offering a Medicaid managed care plan shall report to
  the legislature and the commission the percentage of the managed
  care organization's budget that the managed care organization spent
  during the preceding state fiscal year on:
               (1)  administrative, overhead, and marketing costs;
  and
               (2)  reimbursement for clinical services provided to
  enrollees, activities that improve health care quality for those
  enrollees, and all other activities related to those enrollees.
         SECTION 2.  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 3.  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, 2017.