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Relating to an independent review organization to conduct reviews of certain medical necessity determinations under the Medicaid managed care program.
HB 3721 would require the Health and Human Services Commission (HHSC) to contract with an independent review organization (IRO) to make determinations with respect to disputes at issue in a request for appeal, submitted to HHSC challenging a medical necessity determination of a managed care organization (MCO) that contracts with HHSC under Medicaid. Additionally, HB 3721 would require the Executive Commissioner of HHSC to set rules that determine the manner in which an IRO is to settle disputes and when in the appeals process an IRO may be accessed.
Texas Action remains neutral on HB 3721 because it does not affect our liberty principles.