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A BILL TO BE ENTITLED
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AN ACT
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relating to the operation and administration of certain health |
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insurance programs and medical assistance program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.005(a)(2), Government Code, is |
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amended to read as follows: |
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(2) capitation rates that include acuity and risk |
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adjustment methodologies that consider acute care services and |
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long-term services and supports covered by the Medicaid managed |
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care program, including costs for private duty nursing, and that |
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ensure the cost-effective provision of quality health care; |
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SECTION 2. Section 533.0063(b), Government Code is amended |
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as follows: |
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(b) A [Except as provided by Subsection (c), a] managed care |
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organization is required to send a paper form of the organization's |
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provider network directory for the program only to a recipient who |
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requests to receive the directory. |
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SECTION 3. Section 533.0063(c), Government Code, is |
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repealed. |
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SECTION 4. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0068 as follows: |
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Section 533.0068. PRIMARY CARE ASSIGNMENT. (a) The |
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commission shall honor a contract requirement to enable a managed |
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care organization to make the initial and subsequent primary care |
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provider assignments and changes in accordance with Section |
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533.005(a)(26). |
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(b) Managed care organizations may assign Medicaid members |
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based on published criteria that seeks to preserve existing |
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provider-member relationships and considers a member's proximity |
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to providers and other criteria as established by the managed care |
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organization. An "existing provider-member relationship" is one in |
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which the provider was a main source of Medicaid services for the |
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member during the previous year. |
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SECTION 5. Section 533.0076(c), Government Code, is amended |
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to read as follows: |
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(c) The commission shall allow a recipient who is enrolled |
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in a managed care plan under this chapter to disenroll from that |
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plan and enroll in another managed care plan[: (1)]at any time for |
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cause in accordance with federal laws and regulations governing |
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Medicaid[; and (2)once for any reason after the periods described |
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by Subsections (a) and (b)]. |
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SECTION 6. Unless otherwise stated, this Act applies to all |
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contracts between the Health and Human Services Commission and a |
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Medicaid Managed Care organization under Chapter 533, Government |
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Code, that are entered into, renewed, or amended on or after the |
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effective date of this Act. |
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SECTION 7. This Act takes effect September 1, 2021. |