By: Frank H.B. No. 5184       A BILL TO BE ENTITLED   AN ACT   relating to the Managed Care Consumer Choice Program.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter A, Chapter 533, Government Code, is   amended by adding Section 533.0021 and 533.0022 to read as follows:          Sec. 533.0021.  MANAGED CARE CONSUMER CHOICE PROGRAM. (a)     The commission may periodically issue a request for applications to   enter into a contract with the commission to provide health care   services to recipients.          (b)  The commission shall not enter into a contract under   this section with a managed care organization until the commission   has:                (1)  Certified the managed care organization under   Section 533.0035 for any service delivery area for which the   managed care organization will provide services to recipients under   the contract;                (2)  Determined in writing the managed care   organization has provided satisfactory assurances regarding its   financial solvency; and                (3)  Determined in writing the managed care   organization complies with the performance measures outlined in   Section 533.0036.          (c)  Any contract entered under this section shall contain   the required contract provisions in Section 533.005 and all other   provisions required to be included in a contract between a managed   care organization and the commission under this chapter.          (d)  The managed care organization shall not provide any   services to recipients, and the commission shall not make any   payments, under any contract entered into under this section until   the managed care organization completes readiness review as   required by federal law.          (e)  The commission shall offer to contract with any managed   care organization that submits an application in response to a   request for applications under Section 533.011 and meets the   requirements of Subsection (a) of this section for the programs and   service delivery areas for which the managed care organization will   provide services under the contract.          (f)  The programs to which this section applies include STAR,   CHIP, STAR Kids, and STAR + PLUS.  This section does not apply to the   STAR Health program.          (g)  The commission shall ensure that a recipient may select   any managed care plan offered by a managed care organization in good   standing that has entered into a contract with the commission under   this section to provide services in the recipient's service   delivery area for the program under which the recipient is eligible   for services.          (h)  If a managed care organization that has contracted with   the commission under this section fails to comply with a material   requirement of this section or its contract with the commission, or   does not comply with the performance measures defined in Section   533.0036, the commission may pursue any or all of the following   remedies in addition to any remedies available to the commission   under the contract:                (1)  require submission of and compliance with a   corrective action plan;                (2)  seek recovery of actual damages or liquidated   damages specified in the contract;                (3)  suspend automatic enrollment process of   recipients to the managed care organization in one or more service   delivery areas; or                (4)  terminate the contract for cause.          Sec. 533.0022.  MINIMUM SELECTION CRITERIA. (a) The   commission shall publish criteria by which managed care   organizations will be measured prior to participation in the   managed care program consistent with the performance measures in   Section 533.0036.          (b)  An applicant managed care organization is responsible   for providing the necessary data for analysis to determine   performance on the minimum selection criteria published by the   commission under subsection (a). The commission shall allow the   applicant managed care organization an adequate opportunity to cure   any deficiency identified by the commission related to the minimum   selection criteria.          SECTION 2.  Subchapter A, Chapter 533, Government Code, is   amended by adding Section 533.0036 fto read as follows:          Sec. 533.0036.  PERFORMANCE MEASURES. (a) The commission   shall establish quality and performance measures to evaluate   managed care organizations participating in the Managed Care   Consumer Choice Program under Section 533.0021 based on experience   in the Texas Medicaid and CHIP market.          (b)  In adopting the measures under Subsection (a), the   commission shall consider:                (1)  cost efficiency, quality of care, experience of   care, member and provider satisfaction;                (2)  the quality of a managed care organization's   provider network; and                (3)  provider experience with the managed care   organization.          (c)  The commission shall:                (1)  annually evaluate a managed care organization's   performance and quality by service delivery area; and                (2)  post on its Internet website the results of the   annual performance evaluations conducted under this section in a   format that is readily accessible to and understandable by a member   of the public.          SECTION 3.  Section 62.155(a), Health and Safety Code, is   amended to read as follows:          Sec. 62.155  HEALTH PLAN PROVIDERS. (a) Beginning with   services provided on or after September 1, 2027, the commission   shall contract with [select the] health plan providers under the   program through the Managed Care Consumer Choice Program in Section   533.0021[a competitive procurement process]. A health plan   provider, other than a state administered primary care case   management network, must hold a certificate of authority or other   appropriate license issued by the Texas Department of Insurance   that authorizes the health plan provider to provide the type of   child health plan offered and must satisfy, except as provided by   this chapter, any applicable requirement of the Insurance Code or   another insurance law of this state.          SECTION 4.  As soon as practicable after the effective date   of this act, but not later than September 1, 2026, the Health and   Human Services Commission shall begin requesting applications for   the Managed Care Consumer Choice Program, and begin entering into   contracts with managed care organizations under Section 533.0021,   Government Code.          SECTION 5.  (a) The Health and Human Services Commission   shall extend contracts that were in effect as of January 1, 2025   with managed care organizations for the STAR, CHIP, STAR Kids, and   STAR + PLUS programs until new contracts are entered under   Subsections (b) or (c). The commission shall cancel all   procurements for the STAR, CHIP, or STAR Kids programs that were   pending as of January 1, 2025.          (b)  The commission shall enter into contracts with managed   care organizations under the Managed Care Consumer Choice Program,   Section 533.0021, Government Code, for the STAR and CHIP programs   with services to recipients under such contracts no later than   September 1, 2027.          (c)  The commission shall enter into contracts with managed   care organizations under the Managed Care Consumer Choice Program,   Section 533.0021, Government Code, for the STAR Kids and STAR + PLUS   program with services to recipients under such contracts on   September 1, 2030.          (d)  The Managed Care Consumer Choice Program, Section   533.0021, Government Code, shall be the exclusive means by which   the commission may enter into new contracts with managed care   organizations for the STAR, CHIP, STAR Kids, and STAR + PLUS   programs after the effective date of this Act.          (e)  A recipient enrolled in a managed care plan prior to the   date services are provided under a contract entered into under   Subsections (b) or (c) shall, until such time as the recipient   chooses to be enrolled in a different managed care plan or is no   longer eligible for services continue enrollment in the same   managed care plan if the managed care organization contracts to   provide services in the recipient's service delivery area under   Section 533.0021.          SECTION 6.  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 7.  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.