Bill > HB5183

This bill establishes new regulations for managed care organizations (MCOs) participating in Texas Medicaid and child health plan programs, introducing comprehensive performance measures and oversight mechanisms. The bill requires the Health and Human Services Commission to adopt clear performance evaluation criteria for MCOs, including measures like cost efficiency, quality of care, provider network size, and member satisfaction. These evaluations will use standardized metrics such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and Healthcare Effectiveness Data and Information Set (HEDIS) results. The commission will monthly evaluate MCO performance by region and publicly post these results. If an MCO fails to meet performance standards or contract requirements, the commission can implement escalating remedies including requiring corrective action plans, seeking damages, suspending new enrollments, and ultimately terminating the contract. The bill also allows the commission to limit the number of MCOs operating in each region and the number of regions in which an MCO can operate. Contracts with MCOs will no longer have set term lengths, and termination will follow a specific process. The legislation is set to take effect on September 1, 2025, with provisions for transitioning existing contracts and pending procurements for programs like STAR, CHIP, STAR Kids, and STAR + Plus.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB5183