SB2548 - Relating to awarding contracts to managed care organizations under Medicaid and the child health plan program.

  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.