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A BILL TO BE ENTITLED
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AN ACT
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relating to transparency in the rate-setting processes for the |
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Medicaid managed care and child health plan programs. |
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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 533.01314 to read as follows: |
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Sec. 533.01314. TRANSPARENCY OF PREMIUM PAYMENT |
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RATE-SETTING PROCESS FOR MEDICAID MANAGED CARE PROGRAM. (a) The |
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commission shall ensure the transparency of the premium payment |
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rate-setting process for the Medicaid managed care program by |
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publishing actuarial reports: |
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(1) in a format that allows for tracing data and |
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formulas across attachments, exhibits, and examples; and |
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(2) that clearly identify and describe: |
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(A) the methodology by which the executive |
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commissioner set the payment rates; |
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(B) the data sources used; |
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(C) the components of the process that are |
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assumptions and how the assumptions are developed; |
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(D) multipliers and factors used throughout the |
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reports, including the source and purpose of the multipliers and |
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factors; and |
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(E) the methodology by which the executive |
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commissioner determined that the rates are actuarially sound for |
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the populations covered and the services provided. |
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(b) Notwithstanding Subsection (a), the commission is not |
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required to publish particular information in an actuarial report |
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if the commission determines the information is proprietary. |
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SECTION 2. Subchapter B, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.061 to read as follows: |
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Sec. 62.061. TRANSPARENCY OF PREMIUM PAYMENT RATE-SETTING |
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PROCESS. (a) The commission shall ensure the transparency of the |
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premium payment rate-setting process for the child health plan |
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program by publishing actuarial reports: |
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(1) in a format that allows for tracing data and |
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formulas across attachments, exhibits, and examples; and |
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(2) that clearly identify and describe: |
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(A) the methodology by which the executive |
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commissioner set the payment rates; |
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(B) the data sources used; |
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(C) the components of the process that are |
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assumptions and how the assumptions are developed; |
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(D) multipliers and factors used throughout the |
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reports, including the source and purpose of the multipliers and |
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factors; and |
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(E) the methodology by which the executive |
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commissioner determined that the rates are actuarially sound for |
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the populations covered and the services provided. |
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(b) Notwithstanding Subsection (a), the commission is not |
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required to publish particular information in an actuarial report |
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if the commission determines the information is proprietary. |
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SECTION 3. 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 4. This Act takes effect September 1, 2019. |