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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of a schedule for the payment of |
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reimbursable claims under the Medicaid managed care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0067 to read as follows: |
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Sec. 533.0067. REQUIRED CONTRACT PROVISIONS; SCHEDULE FOR |
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PAYMENT OF REIMBURSABLE CLAIMS. (a) A managed care organization |
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that contracts with the commission to provide health care services |
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to recipients shall establish a schedule for the payment of |
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reimbursable claims that complies with Sections 533.005(a)(7) and |
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(7-a) and include the schedule in a contract between the managed |
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care organization and a health care provider in the managed care |
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organization's provider network. |
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(b) If a managed care organization to which this section |
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applies delegates the payment of reimbursable claims to a third |
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party through a subcontract or otherwise, the third party shall |
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also pay those claims according to the schedule described by |
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Subsection (a). |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. The change in law made by this Act applies only |
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to a contract between a managed care organization and a health care |
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provider entered into or renewed on or after the effective date of |
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this Act. A contract between a managed care organization and a |
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health care provider entered into or renewed before the effective |
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date of this Act is governed by the law applicable to the contract |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2017. |