Bill Text: TX HB2353 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to administrative and other expenditures by Medicaid managed care organizations.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-06 - Referred to Human Services [HB2353 Detail]
Download: Texas-2019-HB2353-Introduced.html
86R13482 LED-D | ||
By: Muñoz, Jr. | H.B. No. 2353 |
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relating to administrative and other expenditures by Medicaid | ||
managed care organizations. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Section 533.036 to read as follows: | ||
Sec. 533.036. ADMINISTRATIVE AND OTHER EXPENDITURES. (a) | ||
The legislature, after consulting with the commission, may set in | ||
the General Appropriations Act an upper limit on the percentage or | ||
amount of Medicaid capitated or other premium payments that a | ||
managed care organization offering a Medicaid managed care plan may | ||
spend on administrative, overhead, and marketing costs in each year | ||
of the state fiscal biennium. | ||
(b) Not later than December 1 of each year, a managed care | ||
organization offering a Medicaid managed care plan shall report to | ||
the legislature and the commission for the preceding state fiscal | ||
year: | ||
(1) the total amount of premium payments and other | ||
state money received by the managed care organization, including a | ||
list of the amount and date of each premium payment and the amount, | ||
date, and source of each receipt of state money; and | ||
(2) the amount and percentage of premium payments and | ||
other state money that the managed care organization: | ||
(A) spent on administrative, overhead, and | ||
marketing costs; | ||
(B) spent on clinical or pharmaceutical | ||
reimbursement for medical and pharmaceutical services provided to | ||
enrollees; | ||
(C) paid to subcontractors, including a list of | ||
the identity of and the amount paid to each subcontractor; and | ||
(D) retained as profit. | ||
(c) If a managed care organization contracts with a | ||
subcontractor, the report must include a list of the amount of each | ||
payment the subcontractor paid directly to a health care provider, | ||
categorized by provider type. | ||
(d) A managed care organization shall report the | ||
information required by this section in an aggregate form that may | ||
be organized by premium payments and other state money, service | ||
delivery area, and provider type. | ||
(e) A managed care organization may include in the report | ||
the amount and percentage of premium payments and other state money | ||
that the managed care organization spent on activities that improve | ||
health care quality for enrollees and all other activities for | ||
those enrollees but may not include that amount and percentage in | ||
the amount and percentage reported under Subsection (b)(2)(B). | ||
SECTION 2. 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 3. 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, 2019. |