‘Consumer Choice’ Bill Cancels Pending Bids And Extends Current Contracts

The text as introduced · 1,303 words

By: Frank
H.B. No. 5184

A BILL TO BE ENTITLED

AN ACT

relating to the Managed Care Consumer Choice Program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter A, Chapter 533, Government Code, is

amended by adding Section 533.0021 and 533.0022 to read as follows:

Sec. 533.0021. MANAGED CARE CONSUMER CHOICE PROGRAM. (a)

The commission may periodically issue a request for applications to

enter into a contract with the commission to provide health care

services to recipients.

(b) The commission shall not enter into a contract under

this section with a managed care organization until the commission

has:

(1) Certified the managed care organization under

Section 533.0035 for any service delivery area for which the

managed care organization will provide services to recipients under

the contract;

(2) Determined in writing the managed care

organization has provided satisfactory assurances regarding its

financial solvency; and

(3) Determined in writing the managed care

organization complies with the performance measures outlined in

Section 533.0036.

(c) Any contract entered under this section shall contain

the required contract provisions in Section 533.005 and all other

provisions required to be included in a contract between a managed

care organization and the commission under this chapter.

(d) The managed care organization shall not provide any

services to recipients, and the commission shall not make any

payments, under any contract entered into under this section until

the managed care organization completes readiness review as

required by federal law.

(e) The commission shall offer to contract with any managed

care organization that submits an application in response to a

request for applications under Section 533.011 and meets the

requirements of Subsection (a) of this section for the programs and

service delivery areas for which the managed care organization will

provide services under the contract.

(f) The programs to which this section applies include STAR,

CHIP, STAR Kids, and STAR + PLUS. This section does not apply to the

STAR Health program.

(g) The commission shall ensure that a recipient may select

any managed care plan offered by a managed care organization in good

standing that has entered into a contract with the commission under

this section to provide services in the recipient's service

delivery area for the program under which the recipient is eligible

for services.

(h) If a managed care organization that has contracted with

the commission under this section fails to comply with a material

requirement of this section or its contract with the commission, or

does not comply with the performance measures defined in Section

533.0036, the commission may pursue any or all of the following

remedies in addition to any remedies available to the commission

under the contract:

(1) require submission of and compliance with a

corrective action plan;

(2) seek recovery of actual damages or liquidated

damages specified in the contract;

(3) suspend automatic enrollment process of

recipients to the managed care organization in one or more service

delivery areas; or

(4) terminate the contract for cause.

Sec. 533.0022. MINIMUM SELECTION CRITERIA. (a) The

commission shall publish criteria by which managed care

organizations will be measured prior to participation in the

managed care program consistent with the performance measures in

Section 533.0036.

(b) An applicant managed care organization is responsible

for providing the necessary data for analysis to determine

performance on the minimum selection criteria published by the

commission under subsection (a). The commission shall allow the

applicant managed care organization an adequate opportunity to cure

any deficiency identified by the commission related to the minimum

selection criteria.

SECTION 2. Subchapter A, Chapter 533, Government Code, is

amended by adding Section 533.0036 fto read as follows:

Sec. 533.0036. PERFORMANCE MEASURES. (a) The commission

shall establish quality and performance measures to evaluate

managed care organizations participating in the Managed Care

Consumer Choice Program under Section 533.0021 based on experience

in the Texas Medicaid and CHIP market.

(b) In adopting the measures under Subsection (a), the

commission shall consider:

(1) cost efficiency, quality of care, experience of

care, member and provider satisfaction;

(2) the quality of a managed care organization's

provider network; and

(3) provider experience with the managed care

organization.

(c) The commission shall:

(1) annually evaluate a managed care organization's

performance and quality by service delivery area; and

(2) post on its Internet website the results of the

annual performance evaluations conducted under this section in a

format that is readily accessible to and understandable by a member

of the public.

SECTION 3. Section 62.155(a), Health and Safety Code, is

amended to read as follows:

Sec. 62.155 HEALTH PLAN PROVIDERS. (a) Beginning with

services provided on or after September 1, 2027, the commission

shall contract with [ select the ] health plan provider s under the

program through the Managed Care Consumer Choice Program in Section

533.0021 [ a competitive procurement process ]. A health plan

provider, other than a state administered primary care case

management network, must hold a certificate of authority or other

appropriate license issued by the Texas Department of Insurance

that authorizes the health plan provider to provide the type of

child health plan offered and must satisfy, except as provided by

this chapter, any applicable requirement of the Insurance Code or

another insurance law of this state.

SECTION 4. As soon as practicable after the effective date

of this act, but not later than September 1, 2026, the Health and

Human Services Commission shall begin requesting applications for

the Managed Care Consumer Choice Program, and begin entering into

contracts with managed care organizations under Section 533.0021,

Government Code.

SECTION 5. (a) The Health and Human Services Commission

shall extend contracts that were in effect as of January 1, 2025

with managed care organizations for the STAR, CHIP, STAR Kids, and

STAR + PLUS programs until new contracts are entered under

Subsections (b) or (c). The commission shall cancel all

procurements for the STAR, CHIP, or STAR Kids programs that were

pending as of January 1, 2025.

(b) The commission shall enter into contracts with managed

care organizations under the Managed Care Consumer Choice Program,

Section 533.0021, Government Code, for the STAR and CHIP programs

with services to recipients under such contracts no later than

September 1, 2027.

(c) The commission shall enter into contracts with managed

care organizations under the Managed Care Consumer Choice Program,

Section 533.0021, Government Code, for the STAR Kids and STAR + PLUS

program with services to recipients under such contracts on

September 1, 2030.

(d) The Managed Care Consumer Choice Program, Section

533.0021, Government Code, shall be the exclusive means by which

the commission may enter into new contracts with managed care

organizations for the STAR, CHIP, STAR Kids, and STAR + PLUS

programs after the effective date of this Act.

(e) A recipient enrolled in a managed care plan prior to the

date services are provided under a contract entered into under

Subsections (b) or (c) shall, until such time as the recipient

chooses to be enrolled in a different managed care plan or is no

longer eligible for services continue enrollment in the same

managed care plan if the managed care organization contracts to

provide services in the recipient's service delivery area under

Section 533.0021.

SECTION 6. 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 7. This Act takes effect immediately if it receives

a vote of two-thirds of all the members elected to each house, as

provided by Section 39, Article III, Texas Constitution. If this

Act does not receive the vote necessary for immediate effect, this

Act takes effect September 1, 2025.