Hinojosa Medicaid Bill Gives South Texas Local Bidders Extra Credit

The text as introduced · 904 words

89R4055 SCF-D

By: Hinojosa of Hidalgo
S.B. No. 2548

A BILL TO BE ENTITLED

AN ACT

relating to awarding contracts to managed care organizations under

Medicaid and the child health plan program.

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

SECTION 1. Section 540.0204, Government Code, as effective

April 1, 2025, is amended to read as follows:

Sec. 540.0204. CONTRACT CONSIDERATIONS RELATING TO MANAGED

CARE ORGANIZATIONS. (a) In awarding contracts to managed care

organizations, the commission shall:

(1) subject to Subsection (b), give preference to an

organization that has significant participation in the

organization's provider network from each health care provider in

the region who has traditionally provided care to Medicaid and

charity care patients;

(2) give extra consideration to an organization that

agrees to assure continuity of care for at least three months beyond

a recipient's Medicaid eligibility period;

(3) consider the need to use different managed care

plans to meet the needs of different populations , including a plan

with a children's hospital that serves a special patient population

in the plan's provider network ; [ and ]

(4) consider the ability of an organization to process

Medicaid claims electronically ;

(5) in accordance with Section 540.0051(2), consider

the impact not renewing an organization's contract may have on

access to care and the quality of care that is available in

recipients' local communities; and

(6) in the South Texas service region, give extra

consideration to an organization that is either:

(A) locally owned, managed, and operated, if one

exists; or

(B) in compliance with the requirements of

Section 540.0206.

(b) In determining whether a managed care organization must

be given preference under Subsection (a)(1), the commission shall:

(1) inquire about and evaluate the organization's

current provider network in the region where the organization seeks

to operate; and

(2) review and consider publicly available

information about the organization.

(c) The commission shall ensure bid evaluators are aware of

the requirements of this section, including the commission's duty

under Subsection (a)(1) to give preference to a managed care

organization that has significant participation in the

organization's provider network from health care providers who

traditionally provide care to Medicaid and charity care patients .

SECTION 2. Section 543A.0052(d), Government Code, as

effective April 1, 2025, is amended to read as follows:

(d) In awarding contracts to managed care organizations

under the child health plan program and Medicaid, the commission

shall, in addition to considerations under Section 540.0204 of this

code and Section 62.155, Health and Safety Code, give preference to

an organization that offers a managed care plan that:

(1) successfully implements quality initiatives under

Subsection (a) as the commission determines based on data or other

evidence the organization provides; and [ or ]

(2) meets quality-of-care and cost-efficiency

benchmarks under Subsection (b).

SECTION 3. Section 2155.144, Government Code, as effective

April 1, 2025, is amended by adding Subsection (e) to read as

follows:

(e) In addition to all relevant factors under Subsection

(d), when determining best value in awarding a contract to a managed

care organization to provide health care services to enrollees or

recipients under the child health plan program or Medicaid, the

Health and Human Services Commission shall consider the

organization's past performance under similar contracts and, if

applicable, review and score the organization's past performance

under any contract entered into with the commission.

SECTION 4. (a) Subject to Subsection (b) of this section,

the changes in law made by this Act apply only to a contract awarded

on or after the effective date of this Act. A contract awarded

before the effective date of this Act is governed by the law as it

existed immediately before the effective date of this Act, and that

law is continued in effect for that purpose.

(b) For purposes of Subsection (a) of this section, a

contract is not considered awarded if on the effective date of this

Act:

(1) the Health and Human Services Commission has not

progressed beyond issuing an intent to award a contract under the

procurement process; or

(2) the award is subject to pending litigation.

(c) In awarding a contract to a managed care organization

under a procurement described by Subsection (b)(1) or (2) of this

section, the Health and Human Services Commission shall conduct a

reevaluation of bids for each service delivery area in accordance

with the changes in law made by this Act, and if, based on the

reevaluation, the commission determines that an organization

submitted a higher scoring bid for the area than the bid submitted

by the organization the commission intended to award, or awarded, a

contract to under the law as it existed immediately before the

effective date of this Act, the commission shall instead award the

contract to the organization that submitted the highest scoring

bid.

SECTION 5. 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 6. 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.