By: Zerwas	H.B. No. 3158

	A BILL TO BE ENTITLED
	AN ACT
	relating to certain contracts for Medicaid managed care.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.01.  Subchapter B, Chapter 32, Human Resources
	Code is amended by adding Sec. 32.0491, and 32.492, to read as
	follows:
	Sec. 32.491.  PILOT PROJECTS TO ENCOURAGE MANAGED CARE
	CONTRACTING WITH HEALTH CARE COLLABORATIVES. (a) In this section,
	"health care collaboratives" has the meaning assigned by Section
	848.001, Insurance Code.
	(b)  In this section, a "delegation agreement" means a
	contract that complies with Chapter 1272, Insurance Code.
	(c)  The department shall develop and implement a managed
	care contracting pilot program that is consistent with federal law
	to:
	(1)  promote efficient utilization of Medicaid
	services by recipients; and
	(2)  demonstrate the ability of provider-owned managed
	care organizations to improve patient outcomes and contain costs
	for providing medical assistance to recipients within their service
	delivery area.
	(d)  The department may develop and implement pilot programs
	in accordance with this subchapter to test one or more service
	delivery models that provide medical assistance for acute care
	through a health maintenance organization that executes a
	delegation agreement with a health care collaborative under Chapter
	848, Insurance Code. The Commissioner may contract with such a
	health maintenance organization to implement the pilot Medicaid
	managed care program under this chapter, provided, however, that:
	(1)  the delegation agreement between the health care
	collaborative and the health maintenance organization complies
	with state and federal law; and
	(2)  at least one of the pilot programs established
	under this subchapter is conducted with a provider-managed health
	maintenance organization that is owned by a not-for-profit
	pediatric facility.
	Sec. 32.492.  IMPLEMENTATION, LOCATION AND DURATION.
	(a)  The department shall implement the pilot programs established
	under this subchapter not later than September 1, 2015.
	(b)  A pilot program established under this subchapter shall
	be conducted in a service delivery area that has over 400,000
	combined STAR and CHIP eligibles; maintains three or less managed
	care organizations in that service delivery area; and has at least
	one existing managed care organization with over 40 percent market
	share in either STAR or CHIP programs.
	(c)  A pilot program established under this subchapter must
	operate for not less than 36 months and may be extended as the
	commissioner deems appropriate.
	(d)  If at the conclusion of the period specified by
	subsection (c) the department evaluates the strengths and
	weaknesses of each implemented pilot program and determines the
	feasibility of expanding the pilot program statewide, the
	department may adopt improved policies and procedures with
	statewide applicability, as determined from the information
	obtained in operating the pilot program, to ensure effective
	provision of medical assistance to recipients statewide.
	SECTION 2.  Chapter 316, Health and Safety Code, is amended
	as follows:
	SECTION 2.01.  Section 316.001, Health and Safety Code, is
	amended to read as follows:
	316.001. AUTHORITY TO ESTABLISH HEALTH CARE COLLABORATIVE.
	A public hospital created under Subtitle C or D, a facility that is
	owned or operated by a public or not-for-profit hospital and that
	includes academic health center, or a hospital district created
	under general or special law may form and sponsor a nonprofit health
	care collaborative that is certified under Chapter 848, Insurance
	Code, or otherwise exempt from certification under Section 848.002,
	Insurance Code.
	SECTION 3.  This Act takes effect September 1, 2013.