86R9847 JG-D
 
  By: Raymond H.B. No. 2379
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to changes to and the setting of fees, charges, and rates
  under the Medicaid and child health plan programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02112 to read as follows:
         Sec. 531.02112.  PROCEDURE FOR IMPLEMENTING CHANGES TO
  PAYMENT RATES UNDER MEDICAID AND CHILD HEALTH PLAN PROGRAM. (a) In
  adopting rules and standards related to the determination of fees,
  charges, and rates for payments under Medicaid and the child health
  plan program, the executive commissioner, in consultation with the
  advisory committee established under Subsection (b), shall adopt
  rules to ensure that changes to the fees, charges, and rates are
  implemented in accordance with this section and in a way that
  minimizes administrative complexity and financial uncertainty.
         (b)  The executive commissioner shall establish an advisory
  committee of nine members to provide input for the adoption of rules
  and standards that comply with this section. The advisory
  committee is composed of representatives from managed care
  organizations and providers, including physicians, under Medicaid
  and the child health plan program. The advisory committee is
  abolished on the date the rules that comply with this section are
  adopted. This subsection expires September 1, 2021.
         (c)  Before implementing a change to the fees, charges, and
  rates for payments under Medicaid or the child health plan program,
  the commission shall:
               (1)  before or at the time notice of the proposed change
  is published under Subdivision (2), notify managed care
  organizations and the entity serving as the state's Medicaid claims
  administrator under the Medicaid fee-for-service delivery model of
  the proposed change;
               (2)  publish notice of the proposed change:
                     (A)  for public comment in the Texas Register for
  a period of not less than 30 days; and
                     (B)  on the commission's and state Medicaid claims
  administrator's Internet websites during the period specified
  under Paragraph (A);
               (3)  publish notice of a final determination to make
  the proposed change:
                     (A)  in the Texas Register for a period of not less
  than 30 days before the change becomes effective; and
                     (B)  on the commission's and state Medicaid claims
  administrator's Internet websites during the period specified
  under Paragraph (A); and
               (4)  provide managed care organizations and the entity
  serving as the state's Medicaid claims administrator under the
  Medicaid fee-for-service delivery model with a period of not less
  than 30 days before the effective date of the final change to make
  any necessary administrative or systems adjustments to implement
  the change.
         (d)  If changes to the fees, charges, or rates for payments
  under Medicaid or the child health plan program are mandated by the
  legislature or federal government on a date that does not fall
  within the time frame for the implementation of those changes
  described by this section, the commission shall:
               (1)  prorate the amount of the change over the fee,
  charge, or rate period; and
               (2)  publish the proration schedule described by
  Subdivision (1) in the Texas Register along with the notice
  provided under Subsection (c)(3).
         (e)  This section does not apply to changes to the fees,
  charges, or rates for payments made to a nursing facility.
         SECTION 2.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0059 to read as follows:
         Sec. 533.0059.  RESTRICTIONS ON CERTAIN REIMBURSEMENT RATE
  REDUCTIONS. (a)  In this section, "across-the-board provider
  reimbursement rate reduction" means a provider reimbursement rate
  reduction proposed by a managed care organization that the
  commission determines is likely to affect more than 50 percent of a
  particular type of provider participating in the organization's
  provider network during the 12-month period following
  implementation of the proposed reduction, regardless of whether:
               (1)  the organization limits the proposed reduction to
  specific service areas or provider types; or
               (2)  the affected providers are likely to experience
  differing percentages of rate reductions or amounts of lost revenue
  as a result of the proposed reduction.
         (b)  Except as provided by Subsection (e), a managed care
  organization that contracts with the commission to provide health
  care services to recipients may not implement a significant, as
  determined by the commission, across-the-board provider
  reimbursement rate reduction unless the organization:
               (1)  at least 90 days before the proposed rate
  reduction is to take effect:
                     (A)  provides the commission and affected
  providers with written notice of the proposed rate reduction; and
                     (B)  makes a good faith effort to negotiate the
  reduction with the affected providers; and
               (2)  receives prior approval from the commission,
  subject to Subsection (c).
         (c)  An across-the-board provider reimbursement rate
  reduction is considered to have received the commission's prior
  approval for purposes of Subsection (b)(2) unless the commission
  issues a written statement of disapproval not later than the 45th
  day after the date the commission receives notice of the proposed
  rate reduction from the managed care organization under Subsection
  (b)(1)(A).
         (d)  If a managed care organization proposes an
  across-the-board provider reimbursement rate reduction in
  accordance with this section and subsequently rejects alternative
  rate reductions suggested by an affected provider, the organization
  must provide the provider with written notice of that rejection,
  including an explanation of the grounds for the rejection, before
  implementing any rate reduction.
         (e)  This section does not apply to rate reductions that are
  implemented because of reductions to the Medicaid fee schedule or
  cost containment initiatives that are specifically directed by the
  legislature and implemented by the commission.
         SECTION 3.  Section 2, Chapter 1117 (H.B. 3523), Acts of the
  84th Legislature, Regular Session, 2015, which amended Section
  533.00251(c), Government Code, effective September 1, 2021, is
  repealed.
         SECTION 4.  Not later than December 31, 2019, the executive
  commissioner of the Health and Human Services Commission shall
  establish the advisory committee as required by Section
  531.02112(b), Government Code, as added by this Act.
         SECTION 5.  (a)  Not later than December 31, 2020, the
  executive commissioner of the Health and Human Services Commission
  shall adopt the rules required to implement Section 531.02112,
  Government Code, as added by this Act.
         (b)  The procedure for implementing changes to payment rates
  required by Section 531.02112, Government Code, as added by this
  Act, applies only to a change to a fee, charge, or rate that takes
  effect on or after January 1, 2021.
         SECTION 6.  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 7.  This Act takes effect September 1, 2019.