85R8360 LED-D     By: Muñoz, Jr. H.B. No. 1524       A BILL TO BE ENTITLED   AN ACT   relating to transparency in the rate-setting processes for the   Medicaid managed care and child health plan programs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter A, Chapter 533, Government Code, is   amended by adding Section 533.01314 to read as follows:          Sec. 533.01314.  TRANSPARENCY OF PREMIUM PAYMENT   RATE-SETTING PROCESS FOR MEDICAID MANAGED CARE PROGRAM.  (a)  The   commission shall ensure the transparency of the premium payment   rate-setting process for the Medicaid managed care program by   publishing actuarial reports:                (1)  in a format that allows for tracing data and   formulas across attachments, exhibits, and examples; and                (2)  that clearly identify and describe:                      (A)  the methodology by which the executive   commissioner set the payment rates;                      (B)  the data sources used;                      (C)  the components of the process that are   assumptions and how the assumptions are developed;                      (D)  multipliers and factors used throughout the   reports, including the source and purpose of the multipliers and   factors; and                      (E)  the methodology by which the executive   commissioner determined that the rates are actuarially sound for   the populations covered and the services provided.          (b)  Notwithstanding Subsection (a), the commission is not   required to publish particular information in an actuarial report   if the commission determines the information is proprietary.          SECTION 2.  Subchapter B, Chapter 62, Health and Safety   Code, is amended by adding Section 62.061 to read as follows:          Sec. 62.061.  TRANSPARENCY OF PREMIUM PAYMENT RATE-SETTING   PROCESS.  (a)  The commission shall ensure the transparency of the   premium payment rate-setting process for the child health plan   program by publishing actuarial reports:                (1)  in a format that allows for tracing data and   formulas across attachments, exhibits, and examples; and                (2)  that clearly identify and describe:                      (A)  the methodology by which the executive   commissioner set the payment rates;                      (B)  the data sources used;                      (C)  the components of the process that are   assumptions and how the assumptions are developed;                      (D)  multipliers and factors used throughout the   reports, including the source and purpose of the multipliers and   factors; and                      (E)  the methodology by which the executive   commissioner determined that the rates are actuarially sound for   the populations covered and the services provided.          (b)  Notwithstanding Subsection (a), the commission is not   required to publish particular information in an actuarial report   if the commission determines the information is proprietary.          SECTION 3.  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 4.  This Act takes effect September 1, 2017.