Bill > HB3538

This bill establishes the Managed Care Consumer Choice Program, which fundamentally changes how Texas contracts with managed care organizations (MCOs) for Medicaid and CHIP programs. The bill requires the Health and Human Services Commission to periodically issue requests for applications from MCOs and establish specific criteria for their selection and performance evaluation. MCOs must be certified, demonstrate financial solvency, and meet performance measures before entering contracts, which will cover programs like STAR, CHIP, STAR Kids, and STAR + PLUS (excluding STAR Health). The commission will create performance measures considering cost efficiency, quality of care, member and provider satisfaction, and provider network quality. MCOs will be evaluated annually, with results posted publicly. The bill mandates that the commission extend existing MCO contracts until new contracts are implemented, with STAR and CHIP programs transitioning by September 1, 2027, and STAR Kids and STAR + PLUS by September 1, 2030. If an MCO fails to comply with contract requirements, the commission can impose remedies such as requiring corrective action plans, seeking damages, suspending automatic enrollment, or terminating the contract. Recipients will be allowed to select any managed care plan offered by an MCO in good standing within their service delivery area.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB3538