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A BILL TO BE ENTITLED
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AN ACT
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relating to the award of health plan provider contracts under |
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Medicaid managed care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0035 to read as follows: |
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Sec. 533.0035. CERTIFICATION BY COMMISSION. (a) Before |
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the commission may award a contract under this chapter to a managed |
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care organization, the commission shall evaluate and certify that |
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the organization is reasonably able to fulfill the terms of the |
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contract, including all requirements of applicable federal and |
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state law. |
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(b) Notwithstanding any other law, the commission may not |
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award a contract under this chapter to a managed care organization |
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that does not receive the certification required under this |
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section. |
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(c) A managed care organization may appeal a denial of |
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certification by the commission under this section. |
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SECTION 2. Section 533.004(a), Government Code, is amended |
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to read as follows: |
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(a) Subject to the considerations required under Section |
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533.003 and the certification required under Section 533.0035, in |
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[In] providing health care services through Medicaid managed care |
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to recipients in a health care service region, the commission shall |
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contract with a managed care organization in that region that is |
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licensed under Chapter 843, Insurance Code, to provide health care |
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in that region and that is: |
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(1) wholly owned and operated by a hospital district |
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in that region; |
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(2) created by a nonprofit corporation that: |
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(A) has a contract, agreement, or other |
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arrangement with a hospital district in that region or with a |
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municipality in that region that owns a hospital licensed under |
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Chapter 241, Health and Safety Code, and has an obligation to |
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provide health care to indigent patients; and |
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(B) under the contract, agreement, or other |
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arrangement, assumes the obligation to provide health care to |
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indigent patients and leases, manages, or operates a hospital |
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facility owned by the hospital district or municipality; or |
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(3) created by a nonprofit corporation that has a |
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contract, agreement, or other arrangement with a hospital district |
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in that region under which the nonprofit corporation acts as an |
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agent of the district and assumes the district's obligation to |
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arrange for services under the Medicaid expansion for children as |
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authorized by Chapter 444, Acts of the 74th Legislature, Regular |
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Session, 1995. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect September 1, 2021. |