87R10867 BDP-F
 
  By: Oliverson H.B. No. 4252
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the award of health plan provider contracts under
  Medicaid managed care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0035 to read as follows:
         Sec. 533.0035.  CERTIFICATION BY COMMISSION. (a)  Before
  the commission may award a contract under this chapter to a managed
  care organization, the commission shall evaluate and certify that
  the organization is reasonably able to fulfill the terms of the
  contract, including all requirements of applicable federal and
  state law.
         (b)  Notwithstanding any other law, the commission may not
  award a contract under this chapter to a managed care organization
  that does not receive the certification required under this
  section.
         (c)  A managed care organization may appeal a denial of
  certification by the commission under this section.
         SECTION 2.  Section 533.004(a), Government Code, is amended
  to read as follows:
         (a)  Subject to the considerations required under Section
  533.003 and the certification required under Section 533.0035, in 
  [In] providing health care services through Medicaid managed care
  to recipients in a health care service region, the commission shall
  contract with a managed care organization in that region that is
  licensed under Chapter 843, Insurance Code, to provide health care
  in that region and that is:
               (1)  wholly owned and operated by a hospital district
  in that region;
               (2)  created by a nonprofit corporation that:
                     (A)  has a contract, agreement, or other
  arrangement with a hospital district in that region or with a
  municipality in that region that owns a hospital licensed under
  Chapter 241, Health and Safety Code, and has an obligation to
  provide health care to indigent patients; and
                     (B)  under the contract, agreement, or other
  arrangement, assumes the obligation to provide health care to
  indigent patients and leases, manages, or operates a hospital
  facility owned by the hospital district or municipality; or
               (3)  created by a nonprofit corporation that has a
  contract, agreement, or other arrangement with a hospital district
  in that region under which the nonprofit corporation acts as an
  agent of the district and assumes the district's obligation to
  arrange for services under the Medicaid expansion for children as
  authorized by Chapter 444, Acts of the 74th Legislature, Regular
  Session, 1995.
         SECTION 3.  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 4.  This Act takes effect September 1, 2021.