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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 533.036 to read as follows: |
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Sec. 533.036. 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 for the preceding state fiscal |
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year: |
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(1) the total amount of premium payments and other |
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state money received by the managed care organization, including a |
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list of the amount and date of each premium payment and the amount, |
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date, and source of each receipt of state money; and |
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(2) the amount and percentage of premium payments and |
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other state money that the managed care organization: |
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(A) spent on administrative, overhead, and |
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marketing costs; |
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(B) spent on clinical or pharmaceutical |
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reimbursement for medical and pharmaceutical services provided to |
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enrollees; |
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(C) paid to subcontractors, including a list of |
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the identity of and the amount paid to each subcontractor; and |
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(D) retained as profit. |
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(c) If a managed care organization contracts with a |
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subcontractor, the report must include a list of the amount of each |
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payment the subcontractor paid directly to a health care provider, |
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categorized by provider type. |
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(d) A managed care organization shall report the |
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information required by this section in an aggregate form that may |
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be organized by premium payments and other state money, service |
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delivery area, and provider type. |
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(e) A managed care organization may include in the report |
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the amount and percentage of premium payments and other state money |
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that the managed care organization spent on activities that improve |
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health care quality for enrollees and all other activities for |
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those enrollees but may not include that amount and percentage in |
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the amount and percentage reported under Subsection (b)(2)(B). |
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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, 2019. |