BILL ANALYSIS

Senate Research Center	S.B. 2450
89R16086 KKR-F	By: Hughes
	Health & Human Services
	4/28/2025
	As Filed

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

Since the implementation of Medicaid managed care in Texas in 1993, over 95 percent of Medicaid beneficiaries receive their healthcare through managed care organizations (MCOs). Optometrists play a critical role in providing essential eye care services by contracting directly with MCOs. However, in recent years, MCOs have increasingly subcontracted their vision benefits administration to third-party vision benefit managers (VBMs). This shift has resulted in significant changes to the reimbursement and contracting structures for optometrists providing care to Medicaid patients.

As MCOs subcontract with VBMs, optometrists are often required to contract with these third-party entities rather than directly with the MCOs. These VBMs frequently impose reimbursement rates that are significantly lower than the state-determined Medicaid rates, in some cases by as much as 50 percent. Given that Texas Medicaid rates are already low, further reductions in reimbursement jeopardize the financial viability of providing optometric care to Medicaid beneficiaries. This has created a system where optometrists face undue financial strain, administrative burdens, and, in some cases, an inability to continue serving Medicaid patients.

S.B. 2450 seeks to address these challenges by ensuring that optometrists have the option to contract directly with an MCO, rather than being forced to contract through a VBM or other subcontractor. Additionally, S.B. 2450 ensures that MCOs and their subcontractors pass through a reimbursement rate that is no lower than the state-determined Medicaid reimbursement rate to optometrists providing care to Medicaid patients.

To further ease administrative challenges, the legislation simplifies the process for optometrists seeking to enroll or re-enroll in Medicaid. Importantly, S.B. 2450 does not prohibit MCOs from utilizing VBMs or other subcontractors to administer vision benefits.

S.B. 2450 is designed to protect Medicaid beneficiaries' access to quality eye care by ensuring that reimbursement rates remain sustainable for optometrists. This legislation does not increase Medicaid reimbursement rates set by the state, nor does it impose additional costs on the state budget. It ensures that eye care providers can continue delivering vital services to Medicaid patients across Texas.

As proposed, S.B. 2450 amends current law relating to the participation and reimbursement of and requirements affecting certain providers, including providers of eye health care and vision care services, under Medicaid.

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the Health and Human Services Commission in SECTION 5 of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Subchapter D, Chapter 532, Government Code, as effective April 1, 2025, by adding Sections 532.01511 and 532.01512, as follows:

Sec. 532.01511. PROVIDER ENROLLMENT AND CREDENTIALING PROCESSES: PROVIDER SUPPORT; COMPLAINTS. (a) Requires the Health and Human Services Commission (HHSC) to ensure that providers have access to a dedicated support team for the Internet portal established under Section 532.0151 (Streamlining Provider Enrollment and Credentialing Processes) that assists current and prospective Medicaid providers in completing the Medicaid provider enrollment and credentialing processes and reduces the administrative burdens associated with those processes.

(b) Requires HHSC to:

(1) annually evaluate the performance of the support team described by Subsection (a), including the timeliness of assistance the support team provides; and

(2) not later than September 1 of each year, post on HHSC's Internet website a report summarizing the results of the evaluation conducted under Subdivision (1).

(c) Requires HHSC, for purposes of improving HHSC's Medicaid provider enrollment and credentialing processes, to develop a procedure by which a provider is authorized to electronically submit complaints and feedback about those processes and the support provided by the support team described by Subsection (a). Requires that information about the procedure be prominently posted on the HHSC or its designee's Internet website in the same location that instructions and resources for using the Internet portal established under Section 532.0151 are posted and allow a provider to submit a complaint or provide feedback through an electronic form from that location.

Sec. 532.01512. NOTICE OF PROVIDER DISENROLLMENT. Requires HHSC, before HHSC is authorized to disenroll a Medicaid provider during the provider's enrollment revalidation period, to not later than the 30th day before the date of disenrollment provide electronically and by mail to the provider written notice of HHSC's disenrollment determination and allow the provider to address any deficiencies in the provider's application for revalidation of enrollment before the date the provider is disenrolled.

SECTION 2. Amends Subchapter F, Chapter 540, Government Code, as effective April 1, 2025, by adding Sections 540.0281 and 540.0282, as follows:

Sec. 540.0281. ADMINISTRATION OF EYE HEALTH CARE AND VISION CARE SERVICES. (a) Requires that a contract to which Subchapter F (Required Contract Provisions) applies prohibit the contracting Medicaid managed care organization from using certain plans or entities the organization contracts with, offers, owns, or otherwise engages to provide or arrange for the provision of eye health care or vision care services under the managed care plan the Medicaid managed care organization offers to control certain eye health care or vision care services.

(b) Requires that certain plans or entities that a Medicaid managed care organization contracts with, offers, owns, or otherwise engages to provide or arrange for the provision of eye health care or vision care services under the organization's Medicaid managed care plan, notwithstanding Section 1451.152 (Applicability and Construction of Subchapter), Insurance Code, comply with the requirements of Subchapter D (Access to Optometrists Used Under Managed Care Plan), Chapter 1451 (Access to Certain Practitioners and Facilities), Insurance Code.

Sec. 540.0282. REIMBURSEMENT OF EYE HEALTH CARE SERVICES PROVIDERS. Requires that a contract to which this subchapter applies require that the contracting Medicaid managed care organization require certain plans and entities to reimburse an eye health care services provider who provides services to a recipient under the organization's managed care plan at a rate that is at least equal to the Medicaid fee-for-service rate for the provision of the same or similar services.

SECTION 3. Amends Section 540.0651(a), Government Code, as effective April 1, 2025, as follows:

(a) Requires HHSC to require that each managed care organization that contracts with HHSC under any managed care model or arrangement to provide health care services to recipients in a region:

(1) makes no changes to this subdivision;

(2) makes a nonsubstantive change to this subdivision;

(3) subject to Section 32.047, Human Resources Code, and notwithstanding any other law, include in the organization's provider network each optometrist, therapeutic optometrist, and ophthalmologist described by certain provisions of Government Code who, and an institution of higher education described by Section 532.0153(a)(4) (relating to an institution of higher education that provides an accredited program for certain trainings and residencies) in the region that:

(A) seeks participation in the organization's provider network;

(B) creates this paragraph from existing text and makes no further changes;

(C) redesignates existing Paragraph (B) as Paragraph (C); agrees to accept the rate specified in the contract between the provider and the organization, rather than the organization's prevailing provider contract rate;

(D) redesignates existing Paragraph (C) as Paragraph (D) and makes no further changes; and

(E) redesignates existing Paragraph (D) as Paragraph (E) and makes a nonsubstantive change; and

(4) contract directly with each provider described by Subdivision (3) to participate in the organization's provider network.

SECTION 4. Requires HHSC, notwithstanding Section 532.01511, Government Code, as added by this Act, to conduct the initial evaluation and post the report summarizing the results of the evaluation as required by that section not later than September 1, 2026.

SECTION 5. Requires HHSC, as soon as possible after the effective date of this Act, to ensure the Internet portal support team required by Section 532.01511(a), Government Code, as added by this Act, is established and adopt rules necessary to implement the changes in law made by this Act.

SECTION 6. (a) Requires HHSC, in a contract between HHSC and a managed care organization under Chapter 540 (Medicaid Managed Care Program), Government Code, as effective April 1, 2025, that is entered into or renewed on or after the effective date of this Act, to require that the managed care organization comply with Sections 540.0281 and 540.0282, Government Code, as added by this Act, and Section 540.0651 (Inclusion of Certain Providers in Medicaid Managed Care Organization Provider Network), Government Code, as effective April 1, 2025, and amended by this Act.

(b) Requires HHSC to seek to amend contracts entered into with managed care organizations under Chapter 533 (Medicaid Managed Care Program), Government Code, or under Chapter 540, Government Code, as effective April 1, 2025, before the effective date of this Act to require those managed care organizations to comply with Sections 540.0281 and 540.0282, Government Code, as added by this Act, and Section 540.0651, Government Code, as effective April 1, 2025, and amended by this Act. Provides that, to the extent of a conflict between those provisions of law and a provision of a contract with a managed care organization entered into before the effective date of this Act, the contract provision prevails.

SECTION 7. Requires a state agency, if necessary for implementation of a provision of this Act, to request a waiver or authorization from a federal agency, and authorizes a delay of implementation until such a waiver or authorization is granted.

SECTION 8. Effective date: September 1, 2025.