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A BILL TO BE ENTITLED
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AN ACT
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relating to considerations in awarding contracts under the Medicaid |
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managed care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.001, Government Code, is amended by |
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adding Subdivision (6-a) to read as follows: |
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(6-a) "Social determinants of health" means the |
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environmental conditions in which a person is born, lives, learns, |
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works, plays, worships, and ages that affect a range of health, |
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functional, and quality of life outcomes and risks. |
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SECTION 2. Section 533.003(a), Government Code, is amended |
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to read as follows: |
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(a) In awarding contracts to managed care organizations, |
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the commission shall: |
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(1) give preference to organizations that have |
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significant participation in the organization's provider network |
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from each health care provider in the region who has traditionally |
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provided care to Medicaid and charity care patients; |
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(2) give extra consideration to organizations that |
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agree to assure continuity of care for at least three months beyond |
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the period of Medicaid eligibility for recipients; |
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(3) consider the need to use different managed care |
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plans to meet the needs of different populations; |
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(4) consider the ability of organizations to process |
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Medicaid claims electronically; and |
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(5) give extra consideration to organizations that use |
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enriched data sets incorporating social determinants of health to |
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manage socially complex populations in a manner that achieves: |
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(A) cost savings through implementation of |
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appropriate interventions for those populations; and |
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(B) favorable health outcomes for those |
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populations by reducing preventable emergency room visits, |
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hospitalizations, and institutionalizations [in the initial
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implementation of managed care in the South Texas service region,
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give extra consideration to an organization that either:
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[(A)
is locally owned, managed, and operated, if
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one exists; or
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[(B)
is in compliance with the requirements of
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Section 533.004]. |
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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. |