Bill > HB5185

This bill modifies Texas state law regarding managed care organizations (MCOs) in Medicaid and the child health plan program by establishing new performance measurement, contract management, and regional operation standards. The legislation introduces comprehensive performance evaluation measures for MCOs, including tracking cost efficiency, care quality, provider network size, and patient satisfaction using standardized metrics like CAHPS and HEDIS. The bill empowers the commission to monthly evaluate MCO performance by region and publicly post results, with explicit enforcement mechanisms if an MCO underperforms, such as requiring corrective action plans, seeking damages, suspending new enrollments, or ultimately terminating the contract. The bill also limits the number of MCOs operating in each Medicaid program and region, removes mandatory contract term lengths, and specifies that contract termination can only occur through a defined process or at the MCO's request. When awarding new contracts, the commission must prioritize organizations with significant local provider participation, commitment to continuity of care, ability to serve diverse populations, and electronic claims processing capabilities. These changes aim to improve accountability, transparency, and quality of health care services for Medicaid and child health plan participants in Texas, with the new provisions set to take effect on September 1, 2025.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB5185