Subscribe to receive our Floor Reports covering all the action on the Texas House and Senate floor!
No significant fiscal implication to the State is anticipated.
No fiscal implication to units of local government is anticipated.
The legislation would amend Chapter 533 of the Government Code by requiring HHSC to establish minimum provider access standards for the provider network of a managed care organization (MCO) that has a contract with the Health and Human Services Commission (HHSC) in order to provide health care services to recipients. The HHSC would have to submit a biennial report to the legislature that contains access to providers through MCO networks and MCO compliance with provider access standards. As a matter of contract retention and renewal, if a MCO fails to comply with one or more provider access standards and fails to resolve their noncompliance, the bill would require a MCO to pay liquidated damages for each failure.
Medicaid MCOs would be required to establish and implement an expedited credentialing process allowing certain providers to provide services on a provisional basis. The bill would allow MCOs to recover the difference between in-network and out-network payment from providers that do not meet the full expedited credentialing requirements. It would also allow MCOs to recover the entire payment from providers whose credentialing application is fraudulent.
MCOs would be required to make their provider network directories available in electronic and paper format. HHSC would be required to establish and implement a process for direct monitoring of Medicaid MCO provider networks and network providers.
This bill is substantively the same as when we reported on it in its original chamber. We continue to support SB 760. The second chamber sponsor is Representative Four Price.
First chamber recommendation:
The state has a vested interest in safeguarding the use of public dollars and ensuring they are not utilized for wasteful, fraudulent, and abusive purposes. By establishing minimum provider access standards, this legislation will likely diminish fraud in Medicaid MCOs.
We support SB 760 because it fits within our view of a legitimate role of government (protecting taxpayer dollars from fraud, waste, and abuse).