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A BILL TO BE ENTITLED
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AN ACT
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relating to the inclusion of certain health care providers in the |
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provider network of a Medicaid managed care organization. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.006, Government Code, is amended by |
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amending Subsection (a) and adding Subsection (c) to read as |
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follows: |
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(a) The commission shall require that each managed care |
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organization that contracts with the commission to provide health |
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care services to recipients in a region: |
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(1) seek participation in the organization's provider |
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network from: |
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(A) each health care provider in the region who |
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has traditionally provided care to recipients; |
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(B) each hospital in the region that has been |
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designated as a disproportionate share hospital under Medicaid; and |
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(C) each specialized pediatric laboratory in the |
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region, including those laboratories located in children's |
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hospitals; [and] |
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(2) include in its provider network for not less than |
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three years[: |
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[(A)] each health care provider in the region |
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who: |
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(A) [(i)] previously provided care to Medicaid |
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and charity care recipients at a significant level as prescribed by |
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the commission; |
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(B) [(ii)] agrees to accept the prevailing |
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provider contract rate of the managed care organization; and |
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(C) [(iii)] has the credentials required by the |
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managed care organization, provided that lack of board |
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certification or accreditation by The Joint Commission may not be |
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the sole ground for exclusion from the provider network; and |
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(3) include in its provider network each of the |
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following that desires to be included: |
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(A) [(B)] each accredited primary care residency |
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program in the region; [and] |
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(B) [(C)] each disproportionate share hospital |
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in the region; and |
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(C) each community center established in the |
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region under Chapter 534, Health and Safety Code [designated by the |
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commission as a statewide significant traditional provider]. |
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(c) To the extent allowed by federal law and notwithstanding |
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any state law, the commission shall require that the terms included |
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in a provider contract between a managed care organization |
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described by Subsection (a) and a provider described by Subsection |
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(a)(3) be at least as favorable as the terms the contract would |
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include if the provider were a significant traditional provider in |
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the region in which the organization provides health care services |
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to recipients. |
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SECTION 2. 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 3. This Act takes effect September 1, 2021. |