Bill Text: TX HB3778 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to reimbursement rates for eye health care services providers participating in the Medicaid managed care program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2023-03-20 - Referred to Human Services [HB3778 Detail]

Download: Texas-2023-HB3778-Introduced.html
  88R7303 BDP-F
 
  By: Hernandez H.B. No. 3778
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to reimbursement rates for eye health care services
  providers participating in the Medicaid managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.005, Government Code, is amended by
  adding Subsection (i) to read as follows:
         (i)  In addition to the requirements specified by Subsection
  (a), a contract described by that subsection must contain a
  requirement that a managed care organization, including any
  subcontracted administrator, contractor, vision plan, or other
  entity the organization contracts with, owns, or otherwise engages
  to provide or arrange for the provision of eye health care services
  under a managed care plan, 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 2.  Section 533.0067, Government Code, is amended to
  read as follows:
         Sec. 533.0067.  EYE HEALTH CARE SERVICE PROVIDERS. Subject
  to Section 32.047, Human Resources Code, but notwithstanding any
  other law, the commission shall require that each managed care
  organization that contracts with the commission under any Medicaid
  managed care model or arrangement to provide health care services
  to recipients in a region include in the organization's provider
  network each optometrist, therapeutic optometrist, and
  ophthalmologist described by Section 531.021191(b)(1)(A) or (B)
  and an institution of higher education described by Section
  531.021191(a)(4) in the region who:
               (1)  agrees to comply with the terms and conditions of
  the organization;
               (2)  [agrees to accept the prevailing provider contract
  rate of the organization;
               [(3)]  agrees to abide by the standards of care
  required by the organization; and
               (3) [(4)]  is an enrolled provider under Medicaid.
         SECTION 3.  (a) The Health and Human Services Commission
  shall, in a contract between the commission and a managed care
  organization under Chapter 533, Government Code, that is entered
  into or renewed on or after the effective date of this Act, require
  that the managed care organization comply with Section 533.005(i),
  Government Code, as added by this Act.
         (b)  The Health and Human Services Commission shall seek to
  amend contracts entered into with managed care organizations under
  Chapter 533, Government Code, before the effective date of this Act
  to require those managed care organizations to comply with Section
  533.005(i), Government Code, as added by this Act. To the extent of
  a conflict between Section 533.005(i), Government Code, as added by
  this Act, 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 4.  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 5.  This Act takes effect September 1, 2023.
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