86R11130 KLA-D
 
  By: Moody H.B. No. 4105
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the inclusion of certain health care providers in the
  provider network of a Medicaid managed care organization.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.006, Government Code, is amended by
  amending Subsection (a) and adding Subsection (c) to read as
  follows:
         (a)  The commission shall require that each managed care
  organization that contracts with the commission to provide health
  care services to recipients in a region:
               (1)  seek participation in the organization's provider
  network from:
                     (A)  each health care provider in the region who
  has traditionally provided care to recipients;
                     (B)  each hospital in the region that has been
  designated as a disproportionate share hospital under Medicaid; and
                     (C)  each specialized pediatric laboratory in the
  region, including those laboratories located in children's
  hospitals; [and]
               (2)  include in its provider network for not less than
  three years[:
                     [(A)]  each health care provider in the region
  who:
                     (A) [(i)]  previously provided care to Medicaid
  and charity care recipients at a significant level as prescribed by
  the commission;
                     (B) [(ii)]  agrees to accept the prevailing
  provider contract rate of the managed care organization; and
                     (C) [(iii)]  has the credentials required by the
  managed care organization, provided that lack of board
  certification or accreditation by The Joint Commission may not be
  the sole ground for exclusion from the provider network; and
               (3)  include in its provider network each of the
  following that desires to be included:
                     (A) [(B)]  each accredited primary care residency
  program in the region; [and]
                     (B) [(C)]  each disproportionate share hospital
  in the region; and
                     (C)  each community center established in the
  region under Chapter 534, Health and Safety Code [designated by the
  commission as a statewide significant traditional provider].
         (c)  To the extent allowed by federal law and notwithstanding
  any state law, the commission shall require that the terms included
  in a provider contract between a managed care organization
  described by Subsection (a) and a provider described by Subsection
  (a)(3) be at least as favorable as the terms the contract would
  include if the provider were a significant traditional provider in
  the region in which the organization provides health care services
  to recipients.
         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 September 1, 2019.